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William M Ricci - One of the best experts on this subject based on the ideXlab platform.

  • In-vivo stiffness assessment of distal femur fracture locked plating constructs.
    Clinical biomechanics (Bristol Avon), 2018
    Co-Authors: Christopher Parks, William M Ricci, Christopher M. Mcandrew, Amanda Spraggs-hughes, Matthew J. Silva, Michael J. Gardner
    Abstract:

    Abstract Background The purpose of this study was to design and validate a novel stiffness-measuring device using locked plating of distal femur fractures as a model. Methods All patients underwent a laterally-based approach, with a bridging locked construct after Indirect Reduction. A custom and calibrated intraoperative stiffness device was applied and the stiffness of the construct was blindly recorded. Fourteen of twenty-seven patients enrolled with distal femur fractures (AO/OTA 33A and 33C) completed the study. Correlations between stiffness and callus formation, working length, working length/plate length ratio, number of distal locking screws, and fracture pattern were explored. Findings Callus and modified radiographic union scale in tibias scores as a linear function of stiffness did not correlate (R2 = 0.06 and 0.07, respectively). Construct working length and working length to plate length ratio did not correlate to stiffness (R2 = 0.18 and 0.16 respectively). A combined delayed and nonunion rate was 14%. Lower extremity measure scores were not statistically different when comparing delayed and nonunion with healed fractures. Interpretation The lack of correlation may have been due to the mechanical properties of the plate itself and its large contribution to the overall stiffness of the construct. To our knowledge, clinically relevant stiffness has not been described and this study may provide some estimates. This methodology and these preliminary findings may lay the groundwork for further investigations into this prevalent clinical problem. Other parameters not investigated may play a key role such as body mass index and bone mineral density. Level of evidence Diagnostic/Prognostic Level II.

  • Intramedullary nailing of femoral shaft fractures: current concepts.
    The Journal of the American Academy of Orthopaedic Surgeons, 2009
    Co-Authors: William M Ricci, Bethany Gallagher, George J. Haidukewych
    Abstract:

    Intramedullary nailing is the preferred method for treating fractures of the femoral shaft. The piriformis fossa and greater trochanter are viable starting points for antegrade nailing. Alternatively, retrograde nailing may be performed. Each option has relative advantages, disadvantages, and indications. Patient positioning can affect the relative ease of intramedullary nailing and the incidence of malalignment. The timing of femoral intramedullary nailing as well as the use of reaming must be tailored to each patient to avoid systemic complications. Associated comorbidities, the body habitus, and associated injuries should be considered when determining the starting point, optimal patient positioning for nailing, whether to use Reduction aids as well as which to use, and any modifications of standard technique. Intramedullary nailing of diaphyseal femur fractures provides a stable fixation construct that can be applied using Indirect Reduction techniques. This method yields high union rates and low complication rates when vigilance is maintained during preoperative planning, the surgical procedure, and the postoperative period.

  • Indirect Reduction and plate fixation without grafting for periprosthetic femoral shaft fractures about a stable intramedullary implant
    Journal of Bone and Joint Surgery American Volume, 2005
    Co-Authors: William M Ricci, Brett R Bolhofner, Timothy Loftus, Scott Mitchell, Joseph Borrelli
    Abstract:

    BACKGROUND: The application of Indirect Reduction techniques has improved fracture-healing and reduced the need for bone-grafting compared with the outcomes of older, direct Reduction techniques. We investigated the results of such Indirect Reduction techniques for the treatment of periprosthetic femoral shaft fractures. METHODS: Fifty consecutive patients with a femoral shaft fracture about a stable intramedullary implant (a Vancouver Type-B1 fracture) were treated with a protocol that included open Reduction with use of Indirect Reduction techniques and internal fixation with a single lateral plate without structural allografting or other bone-grafting. Four patients died in the early postoperative period, and five had inadequate follow-up. The remaining forty-one patients (average age, seventy-two years) were evaluated clinically and radiographically at an average of twenty-four months. RESULTS: All fractures healed in satisfactory alignment at an average of twelve weeks (range, seven to twenty-three weeks) after the index procedure. One patient had one fractured cable and two others had one fractured screw, but all of the fractures healed without evidence of implant loosening or malalignment. There was one deep infection in the perioperative period. Thirty of the forty-one patients returned to their baseline ambulatory status. CONCLUSIONS: The results of this study support the use of Indirect open Reduction and internal fixation with a single extraperiosteal lateral plate, without the use of allograft struts, for the treatment of a femoral shaft fracture about a stable intramedullary implant.

Thomas Dipasquale - One of the best experts on this subject based on the ideXlab platform.

  • intraarticular pilon fracture of the tibia
    Clinical Orthopaedics and Related Research, 1994
    Co-Authors: David L Helfet, Kenneth J Koval, James Pappas, Roy Sanders, Thomas Dipasquale
    Abstract:

    Classification and treatment options for the management of tibial pilon fractures are reviewed. For comminuted and/or displaced fractures that require open Reduction and internal fixation, a detailed description of the surgical technique, including Indirect Reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. All were high-energy injuries (15 patients with multiple trauma) with Ruedi-Allgower Type II in 26 and Type III in eight. Eighteen (56%) were open fractures. Six fractures were treated with external fixation and the remaining 28 with open Reduction and internal fixation. The patient follow-up examination period averaged 16.2 months (range, six to 38 months)

  • intraarticular pilon fracture of the tibia
    Clinical Orthopaedics and Related Research, 1994
    Co-Authors: David L Helfet, Kenneth J Koval, James Pappas, Roy Sanders, Thomas Dipasquale
    Abstract:

    Classification and treatment options for the management of tibial pilon fractures are reviewed. For comminuted and/or displaced fractures that require open Reduction and internal fixation, a detailed description of the surgical technique, including Indirect Reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. All were high-energy injuries (15 patients with multiple trauma) with Ruedi-Allgower Type II in 26 and Type III in eight. Eighteen (56%) were open fractures. Six fractures were treated with external fixation and the remaining 28 with open Reduction and internal fixation. The patient follow-up examination period averaged 16.2 months (range, six to 38 months). Thirty (88%) fractures had united by 16 weeks (two delayed unions, one below knee amputation, and one plate breakage). In the 26 Type II fractures, functional grading found 17 excellent (65%) and six (23%) poor results. In the eight Type III fractures, there were four (50%) excellent and three (37%) poor results. Complications included one superficial pin-tract infection and two deep wound infections, both in Grade II open fractures.

David L Helfet - One of the best experts on this subject based on the ideXlab platform.

  • intraarticular pilon fracture of the tibia
    Clinical Orthopaedics and Related Research, 1994
    Co-Authors: David L Helfet, Kenneth J Koval, James Pappas, Roy Sanders, Thomas Dipasquale
    Abstract:

    Classification and treatment options for the management of tibial pilon fractures are reviewed. For comminuted and/or displaced fractures that require open Reduction and internal fixation, a detailed description of the surgical technique, including Indirect Reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. All were high-energy injuries (15 patients with multiple trauma) with Ruedi-Allgower Type II in 26 and Type III in eight. Eighteen (56%) were open fractures. Six fractures were treated with external fixation and the remaining 28 with open Reduction and internal fixation. The patient follow-up examination period averaged 16.2 months (range, six to 38 months)

  • intraarticular pilon fracture of the tibia
    Clinical Orthopaedics and Related Research, 1994
    Co-Authors: David L Helfet, Kenneth J Koval, James Pappas, Roy Sanders, Thomas Dipasquale
    Abstract:

    Classification and treatment options for the management of tibial pilon fractures are reviewed. For comminuted and/or displaced fractures that require open Reduction and internal fixation, a detailed description of the surgical technique, including Indirect Reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. All were high-energy injuries (15 patients with multiple trauma) with Ruedi-Allgower Type II in 26 and Type III in eight. Eighteen (56%) were open fractures. Six fractures were treated with external fixation and the remaining 28 with open Reduction and internal fixation. The patient follow-up examination period averaged 16.2 months (range, six to 38 months). Thirty (88%) fractures had united by 16 weeks (two delayed unions, one below knee amputation, and one plate breakage). In the 26 Type II fractures, functional grading found 17 excellent (65%) and six (23%) poor results. In the eight Type III fractures, there were four (50%) excellent and three (37%) poor results. Complications included one superficial pin-tract infection and two deep wound infections, both in Grade II open fractures.

Junichiro Yagi - One of the best experts on this subject based on the ideXlab platform.

  • mathematical simulation and life cycle assessment of blast furnace operation with hydrogen injection under constant pulverized coal injection
    Journal of Cleaner Production, 2021
    Co-Authors: Jue Tang, Mansheng Chu, Zedong Zhang, Yating Tang, Zhenggen Liu, Junichiro Yagi
    Abstract:

    Abstract Considering the serious coal restriction in some areas of China and enhancing the utilization of H2 in blast furnace, the mathematical simulation and life cycle assessment of blast furnace (BF) operation with H2 injection under a constant pulverized coal injection were studied in this work. It was shown that the thermal compensation by increasing oxygen enrichment was to keep a stable adiabatic flame temperature after H2 injection. When the H2 injection rate was 120 m3 per ton hot metal (m3/tHM), the oxygen enrichment rate was 10.38%, and the H2 concentration in raceway was enhanced to 15.23%. With the increasing H2 injection, the Reduction of burden was promoted and the cohesive zone became thinner and its position moved down, contributing to the good permeability. Meanwhile, the amount and temperature of top gas decreased, the utilization rate of CO increased while that of H2 decreased resulting from several gaseous reactions, and the Indirect Reduction was intensified but the direct Reduction was weakened in the stack of BF. When the H2 injection rate was 120 m3/tHM, the productivity increased by 28.8%, the coke rate decreased by 12.87%, and the pressure drop decreased by 19.38%. Through life cycle assessment, it was obvious that the total environmental impacts and CO2 emission during the whole ironmaking were both cut down, with the evident decreases from the 9.13E-11 to 8.11E-11 and from 1956.9 kg/tHM to 1854.64 kg/tHM respectively corresponding to the injection rate from 0 to 120 m3/tHM. Moreover, the environmental improvements for H2 injection were mainly achieved through the two processes of BF and coking, and the impact type of acidification had the most significant effect on the total environmental impact. With the increasing H2 injection rate, the contribution on the total environmental impact by impact type was descended by acidification, eutrophication, and followed by climate change.

  • numerical analysis on blast furnace performance under operation with top gas recycling and carbon composite agglomerates charging
    Isij International, 2004
    Co-Authors: Mansheng Chu, Hiroshi Nogami, Junichiro Yagi
    Abstract:

    The blast furnace operations with top gas recycling, carbon composite agglomerates (CCB) charging, cold oxygen blast and waste plastics injection are numerically evaluated by means of multi-fluid blast furnace model on the premise of constant raceway conditions and hot metal temperature. These evaluations are in comparison with conventional operation. Simulation results reveal that CCB charging and/or cold oxygen blast lead to low temperature level in the shaft region, which retards the Reduction of CCB. On the other hand, injection of waste plastics enriches hydrogen gas in the furnace. And top gas (after CO 2 removal) recycling tremendously enhances the concentrations of H 2 and CO in the whole furnace, which greatly promote the Indirect Reduction of sinter in shaft despite lower temperature. Under the innovative operations, the efficiency of blast furnace shows evident improvement, especially in the case with simultaneous injections of treated top gas through shaft and tuyere. The model computations predicted that total heat input decreases while the productivity increases under the operation with top gas recycling. Additionally, top gas recycling and waste plastics injection also contribute to considerably reduce carbon dioxide emission. It is expectable to develop high efficiency blast furnace with improved productivity and lowered environment load through exploiting the processes presented in this study. If scrubbing and fixing of CO 2 and manufacturing of process oxygen are commercially available, these innovative processes will possess broad applying potential.

Djg Stephen - One of the best experts on this subject based on the ideXlab platform.

  • Indirect Reduction and percutaneous fixation versus open Reduction and internal fixation for displaced intra articular fractures of the distal radius
    Journal of Bone and Joint Surgery-british Volume, 2005
    Co-Authors: Hans J Kreder, Emil H Schemitsch, Douglas P Hanel, J Agel, Michael D Mckee, T E Trumble, Djg Stephen
    Abstract:

    A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive Indirect percutaneous Reduction and external fixation (n = 88) or open Reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups. During the period of two years, patients who underwent Indirect Reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open Reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised.