Sweden and Norway have the worldwide highest incidence of osteoporotic fractures. As these fractures constitute a tremendous and growing problem, primary prevention is of great importance. The principal causes of an osteoporotic fracture are a fall and a fragile skeleton. The aim of the studies reported in these papers was therefore to determine the genetic and environmental influences on fractures and the genetic influence on the two main reasons to the emergence of osteoporotic fractures; bone mineral density and propensity to fall. In the present thesis, we display that the heritability of fractures is dependent on fracture site and age. With increasing age, lifestyle becomes the dominant explanatory factor. These results indicate that focus should be on lifestyle interventions for the prevention of fractures in the elderly. Although the genetic liability to impaired balance is modest, twins with self-reported impaired balance have a substantially increased risk of osteoporotic fractures compared to their co-twin without impaired balance. Asking a patient about his or her balance might be a simple tool for future risk assessment. The genetic influence on bone phenotypes is under strong genetic influence in Swedish adult twins. These findings are in agreement with the results from previous studies in other countries, with a lower incidence of osteoporotic fractures compared to Sweden. The high heritability of bone phenotypes together with the low heritability of fractures at old age, indicates that bone mineral density has a modest influence on fracture risk at old age. In summary, based on the results in this thesis, more emphasis should be targeted to the prevention of falls, by strength and balance training in order to prevent the occurrence of  low energy fractures in the elderly.

<p>&nbsp / Characterisation of fractured rock aquifers is important when dealing with groundwater protection and management. Fractures are often good conduits for water and contaminants, leading to high flow velocities and the fast spread of contaminants in these aquifers. A cost effective methodology is required for the characterisation of the role of individual fractures contributing to flow to boreholes in fractured rock aquifers. Literature shows that some of the conventional methods used to characterise hydraulic properties in fractured rock aquifers are expensive, complicated, time consuming and are associated with some disadvantages such as over-or under- estimations of flow rates. iii This thesis evaluates the use of Fluid Electrical Conductivity (FEC) logging in fractured rock aquifers. This FEC data are compared to various traditional methods used to determine aquifer hydraulic properties applied at the Franschhoek and Rawsonville research sites. Both these sites were drilled into the fractured rock Table Mountain Group (TMG) Aquifer, forming one of the major aquifers in South Africa.</p>

In spite of the abundance of opening-mode fractures in the earth's upper crust, knowledge about their spatial arrangement remains limited. The spatial arrangement of fractures refers to the patterns of fracture positions in space. On one-dimensional analyses, fracture position can be obtained by combining fracture apertures, spacings, and their sequence along a one-dimensional scanline. Previous approaches failed to account for fracture position and fracture size, thus a new technique, normalized correlation count (NCC), was used to overcome these limitations. This technique was designed to distinguish random from non-random (fractal, inherited/imposed, periodically arranged fractures, or periodically arranged clusters) spatial arrangements of fractures. In addition, another method to quantify the attributes of microfractures in rock samples larger than a thin section was developed and used to quantify their spatial arrangements. NCC indicated that where statistically significant (non-random) clusters exist, large fractures are more clustered than small ones. Differential clustering according to fracture size was detected in data sets from different lithologies at outcrop and rock-sample scale, suggesting that this phenomenon is related to development of fracture systems as opposed to host rock lithology and scale. Fracture clusters with power-law variation of spatial correlation with length scale are not strictly natural fractals because clusters occur in cascades at discrete values of length scale and not in a continuous fashion. Some statistically significant clusters with a power-law of spatial correlation are formed by smaller clusters with a power-law of spatial correlation that are also periodically arranged. Fractures from the Cupido Fm. in the Monterrey salient were grouped in three categories based on their trace morphology, cement composition, and timing of fracture cements with respect to fracture opening. Fractures at outcrop scale in two of the categories exhibit low percentages of synkinematic cement and random arrangements, whereas fractures in the remaining category exhibit large amounts of synkinematic cement and periodically arranged clusters. An evolutionary model of fracture development based on subcritical propagation is proposed. This model suggests that mechanical layering increases during cluster development, explaining the non-random clustering within interclustering domains at outcrop scale and implies that cluster spacing increases with mechanical layering but decreases during evolution towards cluster saturation. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The thesis considers three-dimensional analyses of fractures and wellbores in low-permeability petroleum/geothermal reservoirs, with a special emphasis on the role of coupled thermo-hydro-mechanical processes. Thermoporoelastic displacement discontinuity and stress discontinuity methods are elaborated for infinite media. Furthermore, injection/production-induced mass and heat transport inside fractures are studied by coupling the displacement discontinuity method with the finite element method. The resulting method is then used to simulate problems of interest in wellbores and fractures for related to drilling and stimulation. In the examination of fracture deformation, the nonlinear behavior of discontinuities and the change in status from joint (hydraulically open, mechanically closed) to hydraulic fracture (hydraulically open, mechanically open) are taken into account. Examples are presented to highlight the versatility of the method and the role of thermal and hydraulic effects, three-dimensionality, hydraulic/natural fracture deformation, and induced micro earthquakes. Specifically, injection/extraction operations in enhanced geothermal reservoirs and hydraulic/thermal stimulation of fractured reservoirs are studied and analyzed with reference to induced seismicity. In addition, the fictitious stress method is used to study three-dimensional wellbore stresses in the presence of a weakness plane. It is shown that the coupling of hydro-thermo-mechanical processes plays a very important role in low-permeability reservoirs and should be considered when predicting the behavior of fractures and wellbores.

Osteoporosis is a common condition characterized by bone fragility and fractures. Hip fracture, leads to disability, morbidity, excess mortality and growing costs to health care systems. / Antiresorptive agents are used to treat osteoporosis and fractures; it is unknown if these agents are effective in preventing recurrent fractures in individuals who have sustained a hip fracture. / Using health services administrative databases, we ascertained the incidence of hip fractures and associated-mortality rates in the elderly population in Quebec, from 1996 to 2002 and, evaluated the effectiveness of antiresorptive agents for the prevention of recurrent hip fractures. / We identified 33,243 hip fractures. Age-adjusted annual rates of hip fractures decreased in women by 11% from 1996 to 2002 while they did not change in men. Overall one-year mortality rates were higher in men than in women (37% versus 24%), and remained stable over time. Patients exposed to antiresorptives had a 26% reduction in the rate of recurrent fractures (95% CI, 0.64--0.86) compared to patients who were not exposed to these agents. / Hip fractures remain a prevalent disease with serious complications. Further research is essential to confirm our results and, to clarify the association between increasing use of antiresorptive agents and the trend reversal in the incidence of hip fractures.

<p>&nbsp / Characterisation of fractured rock aquifers is important when dealing with groundwater protection and management. Fractures are often good conduits for water and contaminants, leading to high flow velocities and the fast spread of contaminants in these aquifers. A cost effective methodology is required for the characterisation of the role of individual fractures contributing to flow to boreholes in fractured rock aquifers. Literature shows that some of the conventional methods used to characterise hydraulic properties in fractured rock aquifers are expensive, complicated, time consuming and are associated with some disadvantages such as over-or under- estimations of flow rates. iii This thesis evaluates the use of Fluid Electrical Conductivity (FEC) logging in fractured rock aquifers. This FEC data are compared to various traditional methods used to determine aquifer hydraulic properties applied at the Franschhoek and Rawsonville research sites. Both these sites were drilled into the fractured rock Table Mountain Group (TMG) Aquifer, forming one of the major aquifers in South Africa.</p>

[Truncated abstract] Renewed interest in the fixation of fractures using plates has been stimulated by an improved understanding of the biology of fracture healing and a drive towards minimally invasive surgery. This has led to a change in the way we use plates nowadays and the way in which we build the bone-plate construct, as well as the development of new implants better suited to these techniques. As a result of this, we have now the potential to safely expand the indications for plate fixation especially in the management of fractures in osteopenic bone. This thesis provides scientific evidence allowing for better formulation of the optimum way to use the modern plating systems in the clinical setting. Biological fracture repair with conventional plates, in terms of a less rigid construct to enhance fracture healing, is becoming increasingly popular. By omitting screws the construct becomes more flexible with a risk of fixation failure. It was the aim of the first paper to investigate in an experimental model the construct strength of different conventional plate lengths and number / position of the screws, and if an oblique screw at the plate end could increase the fixation strength. Our data suggest that the plate length is the most important factor in withstanding forces in cantilever bending. Longer plates with an equal number of screws require greater peak loads to failure than short plates with more screws. Furthermore, an oblique screw at the plate end produces an increased strength of fixation in all different test setups. However, the difference is more significant in shorter plates and in constructs with no screw omission adjacent to the fracture site. ... Following cyclic loading, however, locking plates can better retain fracture reduction compared to compression plates. On the other hand, under torsional load the compression plate appears to be biomechanical superior to the locking system. In supracondylar comminuted femur fractures, combining the two principles results in less plastic deformation, and a higher load to failure compared to their single application. The last two papers examine the behaviour of locking plates in osteopenic bone. In cadaveric intra-articular calcaneal fractures, the locking plate showed a significantly lower irreversible deformation during cyclic loading and a significantly higher load to failure. In dorsal and volar fixed angle distal radius constructs in a cadaveric model, all constructs showed adequate stability with minimal deformation on fatigue testing under physiological conditions in good bone quality. In osteoporotic bone, however, dorsal fixed angle constructs are stiffer and stronger than volar constructs. The addition of a styloid plate to a volar plate does not significantly improve stability.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [102]-108).