The aims . of this research were twofold, firstly to find out if interferential currents could reduce the healing time for fractures of the tibia and thereby prevent nonunion and secondly to develop a model which could predict nonunion, given the subject characteristics such as race, mechanism of injury, severity of fracture etc. Subjects, males only between the ages of 12 and 86, who had sustained fractures of the tibiae were entered into this double blind clinical trial on admission to the orthopaedic wards at Groote Schuur Hospital (between January 1989 and October 1991). According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomisation into three groups; an experimental group (n=41), placebo group (n=35) and control group (n= 151). lnterferential currents were applied to the experimental group via suction electrodes for, 30 minutes per day for 10 days, using a beat frequency of 10 - 25 Hz and a swing mode of 6 ϟ 6. The placebo group had the suction electrodes applied which produce a rhythmical massage effect. Subjects commented on pain relief which resulted in the addition of the control group as a check on the possible effect of suction, the control group received no intervention. The data were analysed firstly, by using the ANOV A with continuous covariates which resulted in a finding of no significant difference in the time taken to union for the three groups. The second statistical analysis using the same data set, were logistic regression models demonstrating risk factors for nonunion within 24, 32 and 40 weeks. These models were then validated, showing sensitivity and specificity for a variety of possible cutoffs. The conclusions reached about the validity of these models were that they could not be used to predict, accurately enough, those cases where surgical intervention would be necessary; however, for low cost non-invasive intervention they may have value.

The relationship between milk intake and risk of osteoporotic fractures is uncertain. Associations between milk intake and milk avoidance in relation to osteoporotic hip fracture were examined in the Utah Study of Nutrition and Bone Health (USNBH), a statewide case-control study. Cases were ascertained at Utah hospitals treating 98 percent of hip fractures during 1997-2001 and included 1188 men and women aged 50-89 years. Age- and gender-matched controls were randomly selected from Utah driver's license and Medicare databases (N= 1324). In-person interviews were conducted and participants reported frequency of milk intake per week at age 18 and during pregnancy among women who reported being pregnant. Milk avoidance for a period of more than one year and duration of milk avoidance were also reported. Diet and supplement intake in the one-year period before fracture (cases) or the interview (controls) was assessed using a picture-sort food frequency questionnaire. Milk consumption frequency was categorized into four levels of intake at each life stage. Total calcium intake was categorized into quintiles of distribution of intake. Logistic regression models were used to examine associations between milk intake and milk avoidance and risk of hip fracture while controlling for the potential confounding effects of gender, age, body mass index, alcohol use, smoking, physical activity, estrogen use, and total calorie, protein, calcium, and vitamin D intake. Recent milk intake, milk intake during pregnancy, and milk avoidance duration were not associated with risk of hip fracture. A borderline association was found at age 18 showing a decreased risk of hip fracture among those in the highest quartile (2: 15 cups of milk per week) of milk intake (odds ratio (OR): 0.86, 95 percent confidence interval (Cl): 0.75, 1.00; P = 0.046). Milk avoidance for a year or more was associated with an increased risk of hip fracture compared to those who did not avoid milk (OR: 1.38, 95 percent CI: 1.07, 1.78). A significant interaction was found between milk avoidance and quintile of total calcium intake (P = 0.02). Milk avoidance was associated with a significantly higher risk of hip fracture at the lowest two quintiles of calcium intake (OR: 1.72, 95 percent CI: 1.26, 2.17; P = 0.02 and OR: 1.58, 95 percent CI: 1.01, 2.15; P = 0.01, respectively) but was not associated with elevated risk among those with higher calcium intakes. In conclusion, milk intake during pregnancy for women, and in the year before hip fracture (for cases) or before interview (for controls), was not associated with hip fracture risk. The highest level of milk intake at age 18 was associated with decreased risk of hip fracture. Avoidance of milk for one year or more was associated with hip fracture risk, but only among those with low calcium intake (Q1 and Q2).

Les calcaires sont des roches sensibles aux phénomènes physiques et chimiques qui peuvent les dissoudre, les cimenter ou les fracturer. Dans ce cas, les propriétés des calcaires vont évoluer en fonction de ces différents processus qui varient dans le temps et dans l’espace. Or les réservoirs carbonatés peuvent s’étendre sur plusieurs centaines de kilomètres. Afin d’exploiter ces réservoirs géologiques (ressources en eau, gaz ou pétrole), il est donc nécessaire de caractériser en 3 dimensions leurs propriétés (porosité, perméabilité) ainsi que les hétérogénéités géologiques ou tectoniques, qui peuvent modifier la géométrie du réservoir ou ses propriétés. L’acquisition de données locales (affleurements, forages), réparties sur la totalité du réservoir, pose la question de leurs représentativités projetées sur l’ensemble du volume de roche mais aussi de leurs distributions entre les points d’acquisitions qui sont espacés de plusieurs kilomètres. Cette thèse propose d’étudier les propriétés des calcaires Urgoniens (d’âge Barrémien supérieur – Aptien inférieur) situés en Provence, analogues aux calcaires des réservoirs d’hydrocarbures présents au Moyen-Orient. Trois sites comportant différentes échelles sont étudiés afin de caractériser cette série carbonatée. L’étude propose ensuite des règles géologiques dans le but d’extrapoler les mesures réalisées sur des échantillons d’unités centimétriques à l’échelle hectométrique / Carbonates are sensitive to physical and chemical processes which can dissolve, cement or fracturing them. In this case, the carbonate properties evolve according to these different changes that vary in time and space. Carbonated reservoirs can extend for hundreds of kilometres. To prospect these geological reservoirs (water, gas or oil resources), it’s therefore necessary to characterize in 3 dimensions their properties (porosity, permeability), as well as geological and structural heterogeneities which can modify the basin geometry or the reservoir properties. The acquisition of local data (outcrops, boreholes) compared to the properties distributed at field scale ponder their representativeness at multi-kilometres scale but also their distribution between the acquisition area. This thesis proposes to study the properties of Urgonian limestones (Upper Barremian - Lower Aptian) located in Provence, analogue of Middle East hydrocarbon reservoirs. Three sites with different scales are studied to characterize this carbonate series. Additionally, this study proposes geological rules to upscale the measurements made on centimetric samples to hectometric scale

Bakgrund: Höftfrakturer är en vanlig och allvarlig händelse som främst drabbar äldremänniskor. Risken för komplikationer är stor, dödligheten efter frakturen är hög och vägentillbaka till sitt vanliga liv kan för patienterna vara lång. Då livskvalitet ofta är kopplat till denegna hälsan är det viktigt att identifiera vad som påverkar livskvaliteten hos just dessa patienter. Syfte: Syftet med detta examensarbete var att studera vilka faktorer som påverkat livskvalitetenhos patienter över 60 år efter en höftfraktur.Metod: Designen i detta examensarbete var en deskriptiv, induktiv design med kvantitativ ansatssom gjordes i form av en litteraturstudie. Resultatet baserades på tretton kvantitativa studier ochstudiernas kvalitet granskades med hjälp av en kvalitetsgranskningsmall. Resultatet analyserades,likheter och skillnader identifierades. Resultat: Sex kategorier återfanns gällande vad som påverkat livskvaliteten efter höftfraktur hospatienter över 60 år: patientkaraktäristika, mental hälsa, fysisk hälsa, vården, förmåga att utföraADL samt social situation. Slutsats: Hög ålder, depression, kognitiv nedsättning, smärta, nedsatt förmåga till rörelse ochADL samt att drabbas av vårdrelaterade komplikationer var alla faktorer som visade sig påverkapatienternas självskattade livskvalitet negativt. Faktorer som visade sig positivt influeralivskvaliteten var att ha ett gott socialt stöd, erhålla god rehabiliterande träning, samt informationoch utbildning om sitt sjukdomstillstånd. Sjuksköterskan har en viktig roll i arbetet med attförbättra patienters livskvalitet då många av de påverkande faktorer som identifierats i dettaexamensarbete faller under sjuksköterskans ansvarsområde. / Background: Hip fractures are both common and serious injuries that primarily affect theelderly. There is a high risk of complications, mortality is high and the road of rehabilitation is along one. Quality of life is often intertwined with health, wherefore it is important to identify thatwhich affects quality of life for these patients. Aim: The aim of this bachelor thesis was to study which factors affect the quality of life ofpatients aged 60 and older after having suffered a hip fracture.Method: The design of this bachelor thesis was a descriptive, inductive design with aquantitative approach in the form of a literature study. The results are based on thirteenquantitative studies, which quality was assessed with the aid of a quality review template. Theresults were analyzed, similarities and differences were noted. Results: The elements that have been found to influence quality of life after a hip fracture wereorganized in six categories: patient characteristics, mental health, physical health, the health caresystem, ability to perform ADL and social situation. Conclusion: Old age, depression, cognitive impairment, pain, reduced ability to move andperform ADL independently, as well as suffering from care-related complications were elementsthat were shown to affect patients' self-rated quality of life negatively. Elements that positivelyinfluenced the quality of life were having good social support, receiving good rehabilitativetraining, as well as getting information and education about their illness. The nurse has animportant role when it comes to improving patients' quality of life, since many of the influencingelements identified in this degree project fall within the nurse's area of responsibility.

No description available.

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.

No description available.

No description available.

The exposed Tertiary carbonates of the Dammam Dome present an opportunity to study fractures in outcrops within the oil-producing region of Eastern Saudi Arabia. The study focuses on: 1) the characterization of fractures, 2) interpretation of their fracturing mechanism, and 3) the implications for the deep carbonate reservoirs of the Dammam Dome. The characterization of the outcrop fractures is integrated with structural analysis of the near-surface horizons mapped from reflection seismic and well data. Fractures are observed within all exposed carbonate units, but predominantly within the widely exposed Middle Rus unit. The fractures are opening-mode, bed-bound joints that form orthogonal sets (NW-SE and NE-SW trending joints). The trends of through-going, primary NW-SE trending joints do not correlate with the trends of remote regional stress associated with compression of Zagros uplift, suggesting they did not develop due to that orogenic event. The primary joints also seem to have developed independently of the observed karst features and interpreted near-surface faults. The analysis of joint pattern and their spacings generally seem to reflect the fold growth of the strata, position on fold and mechanical stratigraphy. The study results provide a first-order conceptual fracture model for the subsurface reservoirs to guide future development.

No description available.