Objective: The purpose of this study is to determine the relationship between cone beam CT (CBCT) voxel size and tooth root fracture detection. Materials and Methods: Vertical and horizontal root fractures were induced in a total of 30 teeth, and 15 teeth were left intact. Teeth were imaged with projection digital radiography and the Kodak 9000 3D CBCT system with a native voxel size of 76 μm. The CBCT voxels were then downsampled to 100 μm, 200 μm and 300 μm. Five blinded observers evaluated both sets of images with a 1 week washout interval between each set of observations. Results: CBCT outperformed the projection images for fracture detection for all voxel sizes except 300 μm (p<0.05). No significant differences were found between the different voxel sizes (p>0.05). Conclusion: Although voxel size does not impact the interpretation of root fractures, in vitro, CBCT outperformed projection imaging for voxel sizes less than 300 μm.

Transmissivity (T) and Hydraulic apertures are often calculated from hydraulic test data obtained in fractured rock using analytical solutions such as the Thiem and cubic law equations developed for flow through unconsolidated porous media. These analytical solutions use a variety of simplifying assumptions, which are often violated due to the complex nature of flow through fractured rock systems which introduces error into the calculated hydraulic apertures. A 3-D discrete fracture network numerical model (SMOKER) for flow in dual-permeability media was used to simulate constant-head straddle packer tests to assess the errors in fracture characterization that result from deviations from the Thiem and cubic law assumptions caused by permeable rock matrix, variable aperture fractures, and complex flow patterns. The simulations indicate that SMOKER offers potential as a useful tool for representing non-ideal scenarios of rock and fracture network characteristics to assist in estimates and error analysis in T values and resultant errors in hydraulic aperture. / NSERC: Natural Sciences and Engineering Research Council of Canada

Prediction of contaminant transport and fate relies on robust delineation of hydrogeologic units (HGUs), which serve as the framework for all conceptual and numerical models. In layered sedimentary rock systems, contrasts in bulk vertical hydraulic conductivity (Kv) are expected to refract groundwater flow lines and be indicative of distinct HGUs. However, HGU delineation typically relies on data indirectly related to hydraulic properties or hydraulic data insensitive to contrasts in Kv. Flow system theory shows that the distribution of hydraulic head reflects contrasts in Kv. Therefore, depth-discrete and detailed (i.e. high resolution) hydraulic head profiles should identify contrasts in Kv in layered systems. This research develops, applies, and tests a high resolution head/vertical gradient profile approach to HGU delineation for sedimentary rock groundwater systems. First, the repeatability and characteristics of head profiles in sedimentary rocks were evaluated by collecting data from three contaminated field sites with contrasting geologic and flow system conditions. The shapes of the head profiles were reproducible in time and geometric in nature. The head profiles displayed thick zones with no or minimal vertical gradient separated by thinner zones with large vertical gradient indicating contrasts in Kv that did not coincide with lithostratigraphic units. Next, the method was applied at the plume scale to a site in Wisconsin with seven vertical gradient profiles collected along two cross-sections. The vertical gradient cross-sections revealed nine laterally extensive zones with contrasting Kv. The contrasts in Kv were closely associated with key sequence stratigraphic units and integration of the two data sets resulted in delineation of eight HGUs for the site. Last, comparison of these HGUs to the site contaminant mass and phase distributions, including detailed rock core contaminant profiles, provided additional verification for the HGU delineation and added insight regarding important flow and contaminant migration pathways. Application of the high resolution head/vertical gradient profile method at the Wisconsin site resulted in hydraulic measurement based, geologically integrated, and more accurately delineated HGUs. The revised hydrogeologic unit conceptual model will improve predictions of contaminant transport and fate and evaluation of remediation system designs.

No description available.

No description available.

Objective: The purpose of this study is to determine the relationship between cone beam CT (CBCT) voxel size and tooth root fracture detection. Materials and Methods: Vertical and horizontal root fractures were induced in a total of 30 teeth, and 15 teeth were left intact. Teeth were imaged with projection digital radiography and the Kodak 9000 3D CBCT system with a native voxel size of 76 μm. The CBCT voxels were then downsampled to 100 μm, 200 μm and 300 μm. Five blinded observers evaluated both sets of images with a 1 week washout interval between each set of observations. Results: CBCT outperformed the projection images for fracture detection for all voxel sizes except 300 μm (p<0.05). No significant differences were found between the different voxel sizes (p>0.05). Conclusion: Although voxel size does not impact the interpretation of root fractures, in vitro, CBCT outperformed projection imaging for voxel sizes less than 300 μm.

No description available.

An intramedullary nail is a trauma treatment device used for fracture fixation of long bones. These devices are subject to failure, including lag screw cut-out and failure at the lag screw insertion hole from high stress concentrations in that region. Clinical developments for such devices are frequently based on a trial and error method, which often results in failure before improvement. However, the finite element method can be used for the development of trauma treatment devices, and their interaction with bone, by providing a large data set at a relatively low cost. Also, parameters can be changed to assess the relative benefits of one device to another. A novel finite element model has been developed that can be used for the analysis of intramedullary nails inserted into long bones. A commercially available finite element package, ANSYS, has been used to implement the modelling strategy. The finite element modelling technique has been applied to fractures of the proximal femur, but the model is generic, and can be developed to deal with any form of intramedullary device where contact between the bone and implant is important. The finite element strategy can be used in pre-clinical trials to test a new device, or for the design optimisation of existing devices. The finite element model consists of the device surrounded by a thin layer of bone, which forms a 'base' model component that is re-usable. This 'base' component can be mathematically connected to any long bone model, forming an integrated implant and bone construct. The construct can be used to assess which device is best suited to a particular fracture, for example. Contact elements have been used to allow stresses to develop as contact is achieved within the implant and bone construct. Pre-assignment of contact points is not required. Verification of the finite element model is achieved by comparison to available data from experiments carried out on constructs of bone and device that use intramedullary femoral nails. In this thesis the finite element model has been applied to two areas of proximal femoral nailing. The finite element model is used to analyse the distal end of a Gamma nail, and shows that analyses that do not consider contact may not lead to accurate predictions of stresses. The model has been developed for using configurations with one and two distal locking screws. The most distal locking screw is more critical under axial loading, and the more proximal screw is more important for bending loads. The use of 'softer' screws distributes the load more evenly between them. The finite element model has been used to investigate the mechanical environment of a fracture callus for a femoral neck fracture, and a subtrochanteric fracture. The use of one and two lag screws, fracture gap size and material properties of the nail have been investigated for a stiffening callus. Results show that the use of two lag screws for a neck fracture provides a more rigid support at the early stages of fracture healing, and minimises stress-shielding once the callus has healed. For subtrochanteric fractures there is a critical point at which the fracture callus is able to carry any load. A Titanium nail significantly reduces the peak stress at the lag screw insertion hole, and titanium lag screws share the load more evenly between them. Each two-lag-screw configuration used transfers a similar load into the fracture callus. A configuration using a larger lag screw above a smaller has a significantly higher stress at the upper lag screw insertion hole. Critically, the load shared between two lag screws changes as the fracture callus stiffens and an assessment should be made at different stages of fracture healing to optimise the use of a device.

Im Rahmen der vorliegenden Arbeit wurden die in der Fachliteratur am häufigsten beschriebenen Formen der aviären Frakturtherapie anhand von 147 Wildvogelpatienten mit 237 gebrochenen Knochen im Hinblick auf ihre Einsatzmöglichkeiten, den Stellenwert, sowie auf Vorteile und Risiken der jeweiligen Methoden überprüft und die in der Literatur getroffenen Aussagen den Ergebnissen der eigenen Untersuchungen gegenübergestellt. Weiterhin wurden die publizierten Informationen bezüglich therapiebegleitender Maßnahmen einer kritischen Prüfung unterzogen und um die eigenen Erkenntnisse ergänzt. Rund 55 % der therapierten Wildvögel konnten nach Abschluß der klinischen Versorgung ausgewildert werden, wobei die therapeutische Erfolgsquote von Patienten mit frischen Frakturen und denjenigen, deren Frakturereignis wenige Tage zurücklag nur unwesentlich differierte. Demgegenüber wiesen Tiere mit älteren oder bereits in Heilung befindlichen Knochenbrüchen eine schlechte Prognose auf. Fast 27 % der Vögel verstarben während der Behandlung an den Folgen ihres Traumas oder einer Begleiterkrankung, etwas mehr als 13 % wurden aufgrund eines unbefriedigenden Heilungsverlaufs oder Therapieversagens euthanasiert und in etwa 5 % der Fälle reichte das erzielte Ergebnis zur Wiedereingliederung in die freie Wildbahn nicht aus. Von den untersuchten Therapiemethoden erwies sich lediglich die intramedulläre Versorgung mittels kurzer Polyacrylstäbe nach der „Shuttle-Pin“-Methode sowie die Kombination dieser Implantate mit Knochenzement bei Patienten unter 300 g Körpergewicht als problematisch. Bei einem der auf diese Weise behandelten Patienten wurde zudem eine therapieresistente Osteomyelitis als Folge einer Fremdkörperreaktion auf das eingebrachte Material dokumentiert. Positive Erfahrung konnte in zwei Fällen mit der Verwendung eines die Markhöhle weitestgehend ausfüllenden Polyacrylstabes bei ausgedehnten Splitterfrakturen gesammelt werden – eine bislang nicht beschriebene Variante bei der Versorgung mit Markraumimplantaten. Sowohl die Therapie der geschädigten Knochen mit einem modifizierten Fixateur externe bei geeigneter Frakturcharakteristik, als auch die Markraumnagelung mit Kirschner-Drähten erbrachten zumeist die angestrebten Ergebnisse. Der in der Literatur häufig betonte Vorteil kurzer intramedullärer Implantate, wie auch des Fixateur externe gegenüber einer Markraumnagelung mit Stahlstiften aufgrund einer früheren Beübungsfähigkeit der verletzten Gliedmaße konnte anhand der eigenen Ergebnisse nicht bestätigt werden. Klinische Vorteile infolge einer ungehinderten endostalen Kallusbildung bei Verwendung des Fixateur externe im Vergleich zu intramedullären Implantaten waren nicht zu ermitteln. Die Zeitdauer bis zur Auswilderung der Patienten war in der überwiegenden Zahl der Fälle weniger von der Therapieform, als vielmehr von Frakturausmaß und -lokalisation bestimmt. Die Ergebnisse der konservativen Behandlung waren – eine entsprechende Eignung der Fraktur für das Verfahren vorausgesetzt – bei vergleichsweise geringem Risiko den operativen Methoden zumindest ebenbürtig. Für eine chirurgische Versorgung von Schultergürtelfrakturen ergab sich keine zwingende Indikation; selbst hochgradig dislozierte Coracoidfrakturen konnten mittels konservativer Behandlung funktionell wieder hergestellt werden. Die röntgenologische Kontrolluntersuchung in siebentägigen Intervallen während der ersten 3 Behandlungswochen bewährte sich dabei im Hinblick auf das zeitnahe Befunden von Therapiezwischenfällen, ausbleibenden Therapieerfolgen und insbesondere zur frühzeitigen Diagnose entzündlicher Knochenveränderungen. / This study examined the methods of avian fracture therapy most commonly described in scientific literature in regard to their usability, their significance/value as well as their advantages and risks. For this purpose 147 wild birds with 237 fractured bones were treated with different methods, depending on the type of fracture. The results were compared to relevant statements found in specialist literature. In addition, published information about supportive treatment was analysed and supplemented with specific additional findings. It was possible to release about 55% of the treated wild birds back into the wild after therapy. The rate of success in therapy showed little difference between patients with fresh fractures and those with fractures that had occurred a few days previously. In contrast to this, animals with older fractures or fractures that were already in an advanced stage of untreated healing process showed a poor prognosis. Almost 27% of the birds died during therapy as a consequence of the initial trauma or accompanying diseases, a little more than 13% had to be euthanized because of an unsatisfactory healing process or failure of fracture repair and in about 5% of the cases the results were not sufficient for rehabilitation into the wild. Among the examined methods of therapy only intramedullary application of short polyacryl rods with the shuttle pin technique and the combination of these implants with bone cement in patients with a body-weight below 300g showed unsatisfactory results. One patient treated by this method developed a therapy-resistant osteomyelitis as a consequence of a foreign-body reaction. Positive results were achieved in two cases with the use of a polyacryl rod filling most of the bone cavity in extended comminuted fractures – a variation of internal fixation not previously described. Treatment with a modified external fixator as well as intramedullary fixation with Kirschner wires resulted in the required outcome in most cases whereas unimpaired endosteal callus formation, often associated with the use of an external fixator, did not result in clinical advantages. Trials did not confirm an earlier return to function by the use of short intramedullary implants or of the external fixator compared to internal fixation with intramedullary pins, which is often emphasised in scientific literature. In most cases duration of hospitlisation and of captivity depended on the extent and site of bone injury rather than on method of therapy. Results of conservative treatment and surgery were similar in terms of low risk – as long as the method of therapy matched the type of fracture. There was no requirement for surgical therapy of fractures of the shoulder girdle. Even severely dislocated fractures of the coracoid returned to normal function through conservative treatment. Weekly radiological examination at intervals of seven days during the first three weeks of therapy proved essential to identify early complications in the healing of the fracture, failure in the healing process, or, in particular, early diagnosis of osteomyelitis.

The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children&rsquo / s Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention.<br /> <br /> One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery.