THE RESULTS OF EXAMINATION OF MEDICAL CARE QUALITY FOR ASSOCIATED VERTEBRO-SPINAL-CORD INJURY

Medical care quality assessment for patients with vertebro-spinal-cord injury at different stages in St.-Petersburg during year was performed. The first aid in the most cases (74,8%) was rendered by emergency service. A vertebro-spinal-cord injuries were not diagnosed by a staff of line and special medical aid brigades in 31,6-51,9%. The causes of incorrect diagnostics at hospital stage: insufficient and delayed patient examination, underestimation of injury severity in consequence of delayed use of neuro-imaging methods. Surgical operations for vertebro-spinal-cord injuries were performed in 59 (8%) cases. 43 (73%) patients needed in vertebral fixation

Kirschner Wire Migration into SpinaL Canal after Acromioclavicular Joint Fixation (Literature Review and Clinical Case)

Fracture and migration of metal implants is a well-known issue which is especially relevant for actively loaded zones with a high amplitude of physiological movements. The authors analyzed 17 publications dedicated to Kirschner wire migration into the spinal canal after fixation of acromioclavicular joint (ACJ) injury. The present paper contains literature review and own clinical case of the authors. The authors generalize the conceptions of migration causes, surgical tactics and prevention recommendations. The key reason of fracture and migration of Kirschner wires during fixation of ACJ injury is the instability of implants, trans-articular wire insertion during fixation of reduced dislocation of acromial end of the clavicle, insufficient immobilization and untimely implants removal after removal of immobilization. Implants migration into the spinal canal is the indication for their surgical removal irrespective of clinical signs. In the majority of studied publications authors described posterior approach or lateral approach aligned with the migration direction. No grafting techniques for dura mater defects were present in the studied literature. The authors of the current paper justify a surgical procedure for removal of migrated implant using a combined posterior and lateral approach on the own clinical case. The choice of procedure algorithm results from the need for prophylaxis of secondary spinal cord lesion and liquorrhea during removal of migrated implants from spinal canal

Influence of the local mass density variation on the fracture behavior of fiber network materials

International audienceThe fracture process in two fiber network materials, a low- and a high-density paper, is analyzed experimentally and numerically. The high-density paper is able to localize continued fracture to very small defects while a rather large defect is required in the low-density paper. Whereas the high-density paper has a homogeneous and limited variation in local mass density, the low-density paper is substantially more heterogeneous and has a higher local mass density variation. It is hypothesized that these fairly large regions of lower mass density govern the fracture process in paper and similar fiber network materials. A nonlocal fracture model is applied to describe and capture this length scale phenomenon and intents to simulate forces bridged over distant regions in the material via connected fibers. The suggested fracture hypothesis is consistent with experiments and hence offers an explanation to why network materials with different mass density variation may fracture differently