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Search Results (1,052)

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19 pages, 9727 KiB  
Article
Characterization of Spatial Variability in Rock Mass Mechanical Parameters for Slope Stability Assessment: A Comprehensive Case Study
by Xin Dong, Tianhong Yang, Yuan Gao, Feiyue Liu, Zirui Zhang, Peng Niu, Yang Liu and Yong Zhao
Appl. Sci. 2025, 15(15), 8609; https://doi.org/10.3390/app15158609 (registering DOI) - 3 Aug 2025
Viewed by 54
Abstract
The spatial variability in rock mass mechanical parameters critically affects slope stability assessments. This study investigated the southern slope of the Bayan Obo open-pit mine. A representative elementary volume (REV) with a side length of 14 m was determined through discrete fracture network [...] Read more.
The spatial variability in rock mass mechanical parameters critically affects slope stability assessments. This study investigated the southern slope of the Bayan Obo open-pit mine. A representative elementary volume (REV) with a side length of 14 m was determined through discrete fracture network (DFN) simulations. Based on the rock quality designation (RQD) data from 40 boreholes, a three-dimensional spatial distribution model of the RQD was constructed using Ordinary Kriging interpolation. The RQD values were converted into geological strength index (GSI) values through an empirical correlation, and the generalized Hoek–Brown criterion was applied to develop a spatially heterogeneous equivalent mechanical parameter field. Numerical simulations were performed using FLAC3D, with the slope stability evaluated using the point safety factor (PSF) method. For comparison, three homogeneous benchmark models based on the 5th, 25th, and 50th percentiles produced profile-scale safety factors of 0.96–1.92 and failed to replicate the observed failure geometry. By contrast, the heterogeneous model yielded safety factors of approximately 1.03–1.08 and accurately reproduced the mapped sliding surface. These findings demonstrate that incorporating spatial heterogeneity significantly improves the accuracy of slope stability assessments, providing a robust theoretical basis for targeted monitoring and reinforcement design. Full article
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17 pages, 5464 KiB  
Article
Association Between Stiffness of the Deep Fibres of the Tibialis Anterior Muscle and Seiza Posture Performance After Ankle Fracture Surgery
by Hayato Miyasaka, Bungo Ebihara, Takashi Fukaya, Koichi Iwai, Shigeki Kubota and Hirotaka Mutsuzaki
J. Funct. Morphol. Kinesiol. 2025, 10(3), 300; https://doi.org/10.3390/jfmk10030300 - 1 Aug 2025
Viewed by 72
Abstract
Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit [...] Read more.
Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit plantarflexion and affect functional recovery. This study aimed to investigate the relationship between TA muscle stiffness, assessed using shear wave elastography (SWE), and the ability to assume the seiza posture after ankle fracture surgery. We also sought to determine whether the stiffness in the deep or superficial TA fibres was more strongly correlated with seiza ability. Methods: In this cross-sectional study, 38 patients who underwent open reduction and internal fixation for ankle fractures were evaluated 3 months postoperatively. Seiza ability was assessed using the ankle plantarflexion angle and heel–buttock distance. The shear moduli of the superficial and deep TA fibres were measured using SWE. Ankle range of motion, muscle strength, and self-reported seiza pain were also measured. Multiple linear regression was used to identify the predictors of seiza performance. Results: The shear moduli of both deep (β = −0.454, p < 0.001) and superficial (β = −0.339, p = 0.017) TA fibres independently predicted ankle plantarflexion angle during seiza (adjusted R2, 0.624). Pain during seiza was significantly associated with reduced plantarflexion, whereas muscle strength was not a significant predictor. Conclusions: TA muscle stiffness, especially in the deep fibres, was significantly associated with limited postoperative seiza performance. Targeted interventions that reduce deep TA stiffness may enhance functional outcomes. Full article
(This article belongs to the Section Functional Anatomy and Musculoskeletal System)
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14 pages, 2047 KiB  
Article
Fracture Behavior of Steel-Fiber-Reinforced High-Strength Self-Compacting Concrete: A Digital Image Correlation Analysis
by Maoliang Zhang, Junpeng Chen, Junxia Liu, Huiling Yin, Yan Ma and Fei Yang
Materials 2025, 18(15), 3631; https://doi.org/10.3390/ma18153631 - 1 Aug 2025
Viewed by 156
Abstract
In this study, steel fibers were used to improve the mechanical properties of high-strength self-compacting concrete (HSSCC), and its effect on the fracture mechanical properties was investigated by a three-point bending test with notched beams. Coupled with the digital image correlation (DIC) technique, [...] Read more.
In this study, steel fibers were used to improve the mechanical properties of high-strength self-compacting concrete (HSSCC), and its effect on the fracture mechanical properties was investigated by a three-point bending test with notched beams. Coupled with the digital image correlation (DIC) technique, the fracture process of steel-fiber-reinforced HSSCC was analyzed to elucidate the reinforcing and fracture-resisting mechanisms of steel fibers. The results indicate that the compressive strength and flexural strength of HSSCC cured for 28 days exhibited an initial decrease and then an enhancement as the volume fraction (Vf) of steel fibers increased, whereas the flexural-to-compressive ratio linearly increased. All of them reached their maximum of 110.5 MPa, 11.8 MPa, and 1/9 at 1.2 vol% steel fibers, respectively. Steel fibers significantly improved the peak load (FP), peak opening displacement (CMODP), fracture toughness (KIC), and fracture energy (GF) of HSSCC. Compared with HSSCC without steel fibers (HSSCC-0), the FP, KIC, CMODP, and GF of HSSCC with 1.2 vol% (HSSCC-1.2) increased by 23.5%, 45.4%, 11.1 times, and 20.1 times, respectively. The horizontal displacement and horizontal strain of steel-fiber-reinforced HSSCC both increased significantly with an increasing Vf. HSSCC-0 experienced unstable fracture without the occurrence of a fracture process zone during the whole fracture damage, whereas the fracture process zone formed at the notched beam tip of HSSCC-1.2 at its initial loading stage and further extended upward in the beams of high-strength self-compacting concrete with a 0.6% volume fraction of steel fibers and HSSCC-1.2 as the load approaches and reaches the peak. Full article
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11 pages, 577 KiB  
Systematic Review
Hallux Sesamoid Nonunion: A Comprehensive Systematic Review of Current Evidence
by Elena Artioli, Antonio Mazzotti, Gianmarco Di Paola, Federico Sgubbi, Gianmarco Gemini, Simone Ottavio Zielli and Cesare Faldini
J. Pers. Med. 2025, 15(8), 342; https://doi.org/10.3390/jpm15080342 - 1 Aug 2025
Viewed by 103
Abstract
Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature [...] Read more.
Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article
(This article belongs to the Special Issue Orthopedic Trauma: New Perspectives and Innovative Techniques)
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13 pages, 3512 KiB  
Article
Cumulative Risk for Periprosthetic Fracture and Operative Treatment Options After Revision Total Hip Arthroplasty with a Modular and Tapered Revision Device—A Consecutive Series of 117 Cases in a Mid-Term Duration
by Oliver E. Bischel, Matthias K. Jung, Max Pilgrim, Arnold J. Höppchen, Paul M. Böhm and Jörn B. Seeger
J. Clin. Med. 2025, 14(15), 5321; https://doi.org/10.3390/jcm14155321 - 28 Jul 2025
Viewed by 260
Abstract
Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure [...] Read more.
Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure of reconstruction during follow-up. Methods: A cohort of 117 cases receiving femoral RTHA by a modular stem was investigated retrospectively with a mean follow-up of 5.7 (0.5–13.7) years. Cumulative risk and potential factors affecting the occurrence of PPFs were calculated with the Kaplan–Meier method. In addition, cases were presented to discuss operative treatment options. Results: A cumulative risk of PPF of 12.1% (95% CI: 0–24.6%) was calculated at 13.7 years. Female patients had significantly higher risk compared to male patients (0% after 13.5 years for male patients vs. 20.8% (95% CI: 0.5–41.2%) after 13.7 years for female patients; log-rank p = 0.0438) as all five patients sustaining a PPF during follow-up were women. Four fractures were treated by open reduction and internal fixation. Non-union and collapse of the fracture occurred in one patient after closed reduction and internal fixation. Conclusions: Postoperative PPF after femoral revision with a modular stem has shown to be a frequent complication within this mid-term follow-up. Female patients were at a significantly higher risk in this aged cohort, indicating osteoporosis as a risk factor. The surgical treatment of PPF with an integrated long-stemmed prosthesis is challenging and thorough considerations of adequate operative treatment of PPFs are strongly advised in order to limit complication rates. Full article
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18 pages, 3199 KiB  
Article
Geomechanical Basis for Assessing Open-Pit Slope Stability in High-Altitude Gold Mining
by Farit Nizametdinov, Rinat Nizametdinov, Denis Akhmatnurov, Nail Zamaliyev, Ravil Mussin, Nikita Ganyukov, Krzysztof Skrzypkowski, Waldemar Korzeniowski, Jerzy Stasica and Zbigniew Rak
Appl. Sci. 2025, 15(15), 8372; https://doi.org/10.3390/app15158372 - 28 Jul 2025
Viewed by 266
Abstract
The development of mining operations in high-altitude regions is associated with a number of geomechanical challenges caused by increased rock fracturing, adverse climatic conditions, and high seismic activity. These issues are particularly relevant for the exploitation of gold ore deposits, where the stability [...] Read more.
The development of mining operations in high-altitude regions is associated with a number of geomechanical challenges caused by increased rock fracturing, adverse climatic conditions, and high seismic activity. These issues are particularly relevant for the exploitation of gold ore deposits, where the stability of open-pit slopes directly affects both safety and extraction efficiency. The aim of this study is to develop and practically substantiate a comprehensive approach to assessing and ensuring slope stability, using the Bozymchak gold ore deposit—located in a high-altitude and seismically active zone—as a case study. The research involves the laboratory testing of rock samples obtained from engineering–geological boreholes, field shear tests on rock prisms, laser scanning of pit slopes, and digital geomechanical modeling. The developed calculation schemes take into account the structural features of the rock mass, geological conditions, and the design contours of the pit. In addition, special bench excavation technologies with pre-shear slotting and automated GeoMoS monitoring are implemented for real-time slope condition tracking. The results of the study make it possible to reliably determine the strength characteristics of the rocks under natural conditions, identify critical zones of potential collapse, and develop recommendations for optimizing slope parameters and mining technologies. The implemented approach ensures the required level of safety. Full article
(This article belongs to the Special Issue Latest Advances in Rock Mechanics and Geotechnical Engineering)
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14 pages, 2206 KiB  
Article
Numerical Simulation Study on the Fracture Process of CFRP-Reinforced Concrete
by Xiangqian Fan, Jueding Liu, Li Zou and Juan Wang
Buildings 2025, 15(15), 2636; https://doi.org/10.3390/buildings15152636 - 25 Jul 2025
Viewed by 188
Abstract
To investigate the crack extension mechanism in CFRP-reinforced concrete, this paper derives analytical expressions for the external load and crack opening displacement in the fracture process of CFRP concrete beams based on the crack emergence toughness criterion and the Paris displacement formula as [...] Read more.
To investigate the crack extension mechanism in CFRP-reinforced concrete, this paper derives analytical expressions for the external load and crack opening displacement in the fracture process of CFRP concrete beams based on the crack emergence toughness criterion and the Paris displacement formula as the theoretical basis. A numerical iterative method was used to computationally simulate the fracture process of CFRP-reinforced concrete beams and to analyze the effect of different initial crack lengths on the fracture process. The research results indicate that the numerical simulation results of the crack initiation load are in good agreement with the test results, and the crack propagation curves and the test results are basically consistent before the CFRP-concrete interface peels off. The numerical results of ultimate load are lower than the test results, but it is safe for fracture prediction in actual engineering. With the increase in the initial crack length, the effect of the initial crack length on the critical effective crack propagation length is more obvious. Full article
(This article belongs to the Section Building Materials, and Repair & Renovation)
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31 pages, 14609 KiB  
Article
Reservoir Properties and Gas Potential of the Carboniferous Deep Coal Seam in the Yulin Area of Ordos Basin, North China
by Xianglong Fang, Feng Qiu, Longyong Shu, Zhonggang Huo, Zhentao Li and Yidong Cai
Energies 2025, 18(15), 3987; https://doi.org/10.3390/en18153987 - 25 Jul 2025
Viewed by 231
Abstract
In comparison to shallow coal seams, deep coal seams exhibit characteristics of high temperature, pressure, and in-situ stress, leading to significant differences in reservoir properties that constrain the effective development of deep coalbed methane (CBM). This study takes the Carboniferous deep 8# coal [...] Read more.
In comparison to shallow coal seams, deep coal seams exhibit characteristics of high temperature, pressure, and in-situ stress, leading to significant differences in reservoir properties that constrain the effective development of deep coalbed methane (CBM). This study takes the Carboniferous deep 8# coal seam in the Yulin area of Ordos basin as the research subject. Based on the test results from core drilling wells, a comprehensive analysis of the characteristics and variation patterns of coal reservoir properties and a comparative analysis of the exploration and development potential of deep CBM are conducted, aiming to provide guidance for the development of deep CBM in the Ordos basin. The research results indicate that the coal seams are primarily composed of primary structure coal, with semi-bright to bright being the dominant macroscopic coal types. The maximum vitrinite reflectance (Ro,max) ranges between 1.99% and 2.24%, the organic is type III, and the high Vitrinite content provides a substantial material basis for the generation of CBM. Longitudinally, influenced by sedimentary environment and plant types, the lower part of the coal seam exhibits higher Vitrinite content and fixed carbon (FCad). The pore morphology is mainly characterized by wedge-shaped/parallel plate-shaped pores and open ventilation pores, with good connectivity, which is favorable for the storage and output of CBM. Micropores (<2 nm) have the highest volume proportion, showing an increasing trend with burial depth, and due to interlayer sliding and capillary condensation, the pore size (<2 nm) distribution follows an N shape. The full-scale pore heterogeneity (fractal dimension) gradually increases with increasing buried depth. Macroscopic fractures are mostly found in bright coal bands, while microscopic fractures are more developed in Vitrinite, showing a positive correlation between fracture density and Vitrinite content. The porosity and permeability conditions of reservoirs are comparable to the Daning–Jixian block, mostly constituting oversaturated gas reservoirs with a critical depth of 2400–2600 m and a high proportion of free gas, exhibiting promising development prospects, and the middle and upper coal seams are favorable intervals. In terms of resource conditions, preservation conditions, and reservoir alterability, the development potential of CBM from the Carboniferous deep 8# coal seam is comparable to the Linxing block but inferior to the Daning–Jixian block and Baijiahai uplift. Full article
(This article belongs to the Section H: Geo-Energy)
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22 pages, 7542 KiB  
Article
Flow-Induced Vibration Stability in Pilot-Operated Control Valves with Nonlinear Fluid–Structure Interaction Analysis
by Lingxia Yang, Shuxun Li and Jianjun Hou
Actuators 2025, 14(8), 372; https://doi.org/10.3390/act14080372 - 25 Jul 2025
Viewed by 146
Abstract
Control valves in nuclear systems operate under high-pressure differentials generating intense transient fluid forces that induce destructive structural vibrations, risking resonance and the valve stem fracture. In this study, computational fluid dynamics (CFD) was employed to characterize the internal flow dynamics of the [...] Read more.
Control valves in nuclear systems operate under high-pressure differentials generating intense transient fluid forces that induce destructive structural vibrations, risking resonance and the valve stem fracture. In this study, computational fluid dynamics (CFD) was employed to characterize the internal flow dynamics of the valve, supported by experiment validation of the fluid model. To account for nonlinear structural effects such as contact and damping, a coupled fluid–structure interaction approach incorporating nonlinear perturbation analysis was applied to evaluate the dynamic response of the valve core assembly under fluid excitation. The results indicate that flow separation, re-circulation, and vortex shedding within the throttling region are primary contributors to structural vibrations. A comparative analysis of stability coefficients, modal damping ratios, and logarithmic decrements under different valve openings revealed that the valve core assembly remains relatively stable overall. However, critical stability risks were identified in the lower-order modal frequency range at 50% and 70% openings. Notably, at a 70% opening, the first-order modal frequency of the valve core assembly closely aligns with the frequency of fluid excitation, indicating a potential for critical resonance. This research provides important insights for evaluating and enhancing the vibration stability and operational safety of control valves under complex flow conditions. Full article
(This article belongs to the Section Control Systems)
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15 pages, 7392 KiB  
Article
The Influence of Temperature on the Fracture Toughness and Fracture Mechanism of Ferritic Nodular Cast Iron
by Guobin Duan, Yu Jiang, Yongxin Zhang, Jibin Zhang and Xuechong Ren
Metals 2025, 15(8), 828; https://doi.org/10.3390/met15080828 - 23 Jul 2025
Viewed by 288
Abstract
Nodular Cast Iron (NCI, also known as ductile iron) is widely used in important components such as crankshafts for automotive engines and internal combustion engines, as well as storage and transportation containers for spent fuel in nuclear power plants, due to its good [...] Read more.
Nodular Cast Iron (NCI, also known as ductile iron) is widely used in important components such as crankshafts for automotive engines and internal combustion engines, as well as storage and transportation containers for spent fuel in nuclear power plants, due to its good comprehensive mechanical properties such as strength, toughness, and wear resistance. The effect of temperature on the fracture behavior of NCI was investigated using compact tensile (CT) specimens at different temperatures. The results showed that the conditional fracture toughness parameter (KQ) of the NCI specimens firstly increased and then decreased with decreasing temperature. The crack tip opening displacement δm shows a significant ductile–brittle transition behavior with the decreasing of temperature. δm remains constant in the upper plateau region but sharply decreases in the ductile–brittle region (−60 °C to −100 °C) and stabilizes at a smaller value in the lower plateau region. Multiscale fractographic analysis indicated that the fracture mechanism changed from ductile fracture (above −60 °C) to ductile–brittle mixed (−60 °C to −100 °C) and then to completely brittle fracture (below −100 °C). As the temperature decreased, the fracture characteristics changed from ductile dimples to dimple and cleavage mixed and then to brittle cleavage. Full article
(This article belongs to the Special Issue Fracture and Fatigue of Advanced Metallic Materials)
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25 pages, 4994 KiB  
Article
Dynamic Slope Stability Assessment Under Blast-Induced Ground Vibrations in Open-Pit Mines: A Pseudo-Static Limit Equilibrium Approach
by Sami Ullah, Gaofeng Ren, Yongxiang Ge, Muhammad Burhan Memon, Eric Munene Kinyua and Theoneste Ndayiragije
Sustainability 2025, 17(14), 6642; https://doi.org/10.3390/su17146642 - 21 Jul 2025
Viewed by 492
Abstract
Blasting is one of the most widely used and cost-effective techniques for rock excavation and fragmentation in open-pit mining, particularly for large-scale operations. However, repeated or poorly controlled blasting can generate excessive ground vibrations that threaten slope stability by causing structural damage, fracturing [...] Read more.
Blasting is one of the most widely used and cost-effective techniques for rock excavation and fragmentation in open-pit mining, particularly for large-scale operations. However, repeated or poorly controlled blasting can generate excessive ground vibrations that threaten slope stability by causing structural damage, fracturing of the rock mass, and potential failure. Evaluating the effects of blast-induced vibrations is essential to ensure safe and sustainable mining operations. This study investigates the impact of blasting-induced vibrations on slope stability at the Saindak Copper-Gold Open-Pit Mine in Pakistan. A comprehensive dataset was compiled, including field-monitored ground vibration measurements—specifically peak particle velocity (PPV) and key blast design parameters such as spacing (S), burden (B), stemming length (SL), maximum charge per delay (MCPD), and distance from the blast point (D). Geomechanical properties of slope-forming rock units were validated through laboratory testing. Slope stability was analyzed using pseudo-static limit equilibrium methods (LEMs) based on the Mohr–Coulomb failure criterion, employing four approaches: Fellenius, Janbu, Bishop, and Spencer. Pearson and Spearman correlation analyses quantified the influence of blasting parameters on slope behavior, and sensitivity analysis determined the cumulative distribution of slope failure and dynamic response under increasing seismic loads. FoS values were calculated for both east and west pit slopes under static and dynamic conditions. Among all methods, Spencer consistently yielded the highest FoS values. Under static conditions, FoS was 1.502 for the east slope and 1.254 for the west. Under dynamic loading, FoS declined to 1.308 and 1.102, reductions of 12.9% and 11.3%, respectively, as calculated using the Spencer method. The east slope exhibited greater stability due to its gentler angle. Correlation analysis revealed that burden had a significant negative impact (r = −0.81) on stability. Sensitivity analysis showed that stability deteriorates notably when PPV exceeds 10.9 mm/s. Although daily blasting did not critically compromise stability, the west slope showed greater vulnerability, underscoring the need for stricter control of blasting energy to mitigate vibration-induced instability and promote long-term operational sustainability. Full article
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14 pages, 561 KiB  
Review
Current Evidence and Surgical Strategies in the Management of Greater Tuberosity Fracture–Dislocations: A Narrative Review
by Gabriele Colò, Federico Fusini, Luca Faoro, Giacomo Popolizio, Sergio Ferraro, Giorgio Ippolito, Massimiliano Leigheb and Michele Francesco Surace
J. Clin. Med. 2025, 14(14), 5159; https://doi.org/10.3390/jcm14145159 - 21 Jul 2025
Viewed by 404
Abstract
Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, [...] Read more.
Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article
(This article belongs to the Special Issue Orthopedic Trauma Surgery: Current Challenges and Future Perspectives)
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23 pages, 4725 KiB  
Tutorial
Fragility Fractures of the Pelvis—Current Understanding and Open Questions
by Amber Gordon, Michela Saracco, Peter V. Giannoudis and Nikolaos K. Kanakaris
J. Clin. Med. 2025, 14(14), 5122; https://doi.org/10.3390/jcm14145122 - 18 Jul 2025
Viewed by 839
Abstract
Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is [...] Read more.
Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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19 pages, 3064 KiB  
Article
HR-pQCT and 3D Printing for Forensic and Orthopaedic Analysis of Gunshot-Induced Bone Damage
by Richard Andreas Lindtner, Lukas Kampik, Werner Schmölz, Mateus Enzenberg, David Putzer, Rohit Arora, Bettina Zelger, Claudia Wöss, Gerald Degenhart, Christian Kremser, Michaela Lackner, Anton Kasper Pallua, Michael Schirmer and Johannes Dominikus Pallua
Biomedicines 2025, 13(7), 1742; https://doi.org/10.3390/biomedicines13071742 - 16 Jul 2025
Viewed by 270
Abstract
Background/Objectives: Recent breakthroughs in three-dimensional (3D) printing and high-resolution imaging have opened up new possibilities in personalized medicine, surgical planning, and forensic reconstruction. This study breaks new ground by evaluating the integration of high-resolution peripheral quantitative computed tomography (HR-pQCT) with multimodal imaging and [...] Read more.
Background/Objectives: Recent breakthroughs in three-dimensional (3D) printing and high-resolution imaging have opened up new possibilities in personalized medicine, surgical planning, and forensic reconstruction. This study breaks new ground by evaluating the integration of high-resolution peripheral quantitative computed tomography (HR-pQCT) with multimodal imaging and additive manufacturing to assess a chronic, infected gunshot injury in the knee joint of a red deer. This unique approach serves as a translational model for complex skeletal trauma. Methods: Multimodal imaging—including clinical CT, MRI, and HR-pQCT—was used to characterise the extent of osseous and soft tissue damage. Histopathological and molecular analyses were performed to confirm the infectious agent. HR-pQCT datasets were segmented and processed for 3D printing using PolyJet, stereolithography (SLA), and fused deposition modelling (FDM). Printed models were quantitatively benchmarked through 3D surface deviation analysis. Results: Imaging revealed comminuted fractures, cortical and trabecular degradation, and soft tissue involvement, consistent with chronic osteomyelitis. Sphingomonas sp., a bacterium that forms biofilms, was identified as the pathogen. Among the printing methods, PolyJet and SLA demonstrated the highest anatomical accuracy, whereas FDM exhibited greater geometric deviation. Conclusions: HR-pQCT-guided 3D printing provides a powerful tool for the anatomical visualisation and quantitative assessment of complex bone pathology. This approach not only enhances diagnostic precision but also supports applications in surgical rehearsal and forensic analysis. It illustrates the potential of digital imaging and additive manufacturing to advance orthopaedic and trauma care, inspiring future research and applications in the field. Full article
(This article belongs to the Section Biomedical Engineering and Materials)
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30 pages, 2419 KiB  
Systematic Review
Rehabilitation Protocols for Surgically Treated Acetabular Fractures in Older Adults: Current Practices and Outcomes
by Silviya Ivanova, Ondrej Prochazka, Peter V. Giannoudis, Theodoros Tosounidis, Moritz Tannast and Johannes D. Bastian
J. Clin. Med. 2025, 14(14), 4912; https://doi.org/10.3390/jcm14144912 - 10 Jul 2025
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Abstract
Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have [...] Read more.
Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have advanced considerably. Nevertheless, optimal postoperative rehabilitation and particularly weight-bearing (WB) recommendations remain controversial and inconsistent. This review aims to assess rehabilitation protocols, focusing on WB strategies following the surgical treatment of acetabular fractures in older adults. It also examines differences in WB restrictions by surgical technique (ORIF vs. CHP) and their impact on recovery, complications, reoperations, and mortality. Methods: A systematic review of PubMed, Embase, and the Cochrane Library (2006–2024) included studies involving patients aged ≥65 years treated surgically for displaced acetabular fractures. Data included WB protocols (full, partial, toe-touch), length of stay (LOS), healing, functional outcomes (mobility, Harris and Oxford Hip Scores), complications, reoperations, delayed THA, compliance, readmission, and mortality. Due to heterogeneity, findings were narratively synthesized. Risk of bias was assessed using ROBINS-I and RoB2. Results: Twenty studies involving 929 patients (530 isolated ORIF, 399 CHP) were analyzed. The overall mean follow-up was 3.5 years (range: 1–5.25 years). Postoperative WB protocols were reported in 19 studies (95%). Immediate full WB was permitted in 0% of isolated ORIF studies (0/13), with partial WB recommended by 62% (8/13) for durations typically between 6 and 12 weeks. On the other hand, immediate full WB was allowed in 53% (9/17) of CHP studies. Functional outcomes were moderate following isolated ORIF (mean HHS: 63–82 points), with delayed THA conversion rates ranging from 16.5% to 45%. CHP demonstrated superior functional outcomes (mean HHS: 70–92 points), earlier independent ambulation, and higher patient satisfaction (74–90%), yet increased orthopedic complications, including dislocations (8–11%) and implant loosening (up to 18%). LOS varied from 12 to 21 days (mean 16 days) for isolated ORIF and from 8 to 25 days (mean 17 days) for CHP. Readmission within 30 days was not explicitly reported in any study. Mortality at 1 year varied significantly (ORIF: 0–25%; CHP: 0–14%), increasing markedly at long-term follow-up (up to 42% ORIF, up to 70% CHP at five years). Compliance with WB restrictions was monitored in only two studies (11%). Conclusions: Postoperative rehabilitation after acetabular fracture surgery in older adults remains inconsistent and lacks standardization. Combining ORIF with acute THA may enable earlier weight-bearing and improved short-term function but carries risks such as dislocation and implant loosening. In contrast, isolated ORIF avoids these implant-related complications but often requires prolonged weight-bearing restrictions. Robust evidence is still missing. Future trials are essential to establish standardized protocols that balance mechanical protection and functional recovery. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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