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Background Socio-demographic factors have been suggested to contribute to differences in healthcare utilization for several elective orthopedic procedures. Reports on disparities in utilization of orthopedic trauma procedures remain limited. The purpose of our study is to assess the roles of clinical and socio-demographic variables in utilization of operative fixation of calcaneus fractures in the USA. Methods The National Inpatient Sample (NIS) dataset was used to analyze all patients from 2005 to 2014 with closed calcaneal fractures. Multivariate logistic regression analyses were performed to evaluate the impact of clinical and socio-demographic variables on the utilization of surgical versus non-surgical treatment. Results A total of 17,156 patients with closed calcaneus fractures were identified. Operative treatment was rendered in 7039 patients (41.03%). A multivariate logistic regression demonstrated multiple clinical and socio-demographic factors to significantly influence the utilization of surgical treatment including age, gender, insurance status, race/ethnicity, income, diabetes, peripheral vascular disease, psychosis, drug abuse, and alcohol abuse ( p  <  0.05). In addition, hospital size and hospital type (teaching versus non-teaching) showed a statistically significant difference ( p  <  0.05). Conclusions Besides different clinical variables, we identified several socio-demographic factors influencing the utilization of surgical treatment of calcaneus fractures in the US patient population. Further studies need to identify the specific patient-related, provider-related, and system-related factors leading to these disparities.

Shallow landslides have posed significant threats to humans around the world. In order to reduce landslide disaster risk, the effectiveness of early warning systems and hazard zonation work needs to be improved. This research attempted to couple a landslide simulation model (LS-RAPID model) and a hydrological model (Rainfall-Runoff-Inundation (RRI) model) to exploit the advantages of each model for simulating and predicting landslide hazard (location and timing). The pilot area is a small catchment where a shallow landslide happened in July 2015 after 2 days of heavy rain. The landslide buried 3 houses and killed 8 people in Cao Thang Ward, Halong City, Vietnam. A soil sample was collected from the sliding surface and tested using an undrained ring-shear apparatus ICL-2 in the undrained condition. A thickness map of the potential sliding material was interpolated from the relationship between the depth of sandy soil layer and slope (based on 12 soil drill locations) and updated through field surveys in the study area. Different pore water pressure ratio scenarios were applied in the LS-RAPID model to simulate in 3D the initiation and motion of the rapid shallow landslide to create different hazard maps. The subsurface water level was monitored at two locations on the top of the shallow landslide. Based on the observed subsurface water and rainfall data, the RRI model was calibrated and then integrated with the LS-RAPID scenarios to generate Risk Index maps. The simulation results from the newly proposed coupled hydrological-geotechnical framework were compared with those from the observed landslide hazard and showed the reliability to predict the spatial and temporal occurrence of landslide hazard. This could be very useful for supporting decision-makers in rainfall-induced landslide hazard early warning and land use planning.

A rapid and long-traveling landslide was triggered at Aranayaka, Kegalle district, Sri Lanka on 17 May 2016 by exceptionally heavy rainfall associated with a slow-moving tropical cyclone. The precipitation that accumulated within the last 3 days from May 14 to 17 reached 446.5 mm. The landslide mass traveled over an approximately 2-km distance killing 127 people and destroying 75 houses. To deduce the failure mechanism of the Aranayaka landslide, shear behavior of two samples taken from the initial landslide area were examined through ring-shear tests. The first sample (S1) was taken from the weathered soil layer on the left scarp of the landslide. The second sample (S2) was taken from the weathered granitic gneiss at the bottom of the depression in the middle part of the landslide area. The layer was affected by intense tectonic crushing and subsequent deep weathering. A high value of shear resistance at steady state was measured on the sample S1 while the sample S2 obtained a much smaller steady state shear resistance. This indicated that the sliding surface of the landslide was located in the weathered granitic gneiss associated with the sample S2. A series of computer simulations of this landslide was then carried out given the soil parameters from the ring-shear tests and pore-water pressure ratio estimated from the rainfall records using the “SLIDE” model. In the simulation, the landslide initiated from the middle part of the source area, close to the location from where sample S2 was taken. Moreover, the time of occurrence from the simulation was similar to that observed in the real event. This is a very important information to assess further rapid landslides in areas with similar conditions. This study also indicates the importance of selecting soil samples and suggests that the ring-shear apparatus and computer simulations are effective tools to reproduce the process of landslides.

A rapid and long-traveling landslide was triggered by a monsoon rainfall of a total of 446.5 mm for 3 days in the Aranayake area, Sri Lanka. The landslide destroyed 75 houses and killed 127 persons along the course of this landslide. The mechanism of this landslide was investigated by a joint team of the International Consortium on Landslides (ICL) and the National Building Research Organization (NBRO) of the Government of Sri Lanka in 2017 and 2018; the investigation was part of the WCoE and IPL projects. Physical properties of soil samples taken from the source area of the Aranayake landslide were examined through a series of undrained ring-shear tests, and the measured properties were used in a numerical method, LS-RAPID, to simulate initiations and motions of landslides in this area. The authors then tried to first reproduce a landslide, which was considered, from available pieces of evidence, to have most likely happened in the past, then, to assess the risk of a potential future landslide that is expected to occur close to the 2016 Aranayake landslide. Two possible sliding surfaces were assumed to develop through the soil mass, one along the boundary between the weathered surface soil and the jointed bedrock and another along a potential aquiclude inside the soil. This attempt to estimate movements of both past and future landslides based on the numerical reproduction of the 2016 Aranayake landslide hazard will help develop landslide hazard assessment technologies.

Safety-critical sounds at job sites play an essential role in construction safety, but hearing capability is often declined due to the use of hearing protection and the complicated nature of construction noise. Thus, preserving or augmenting the auditory situational awareness of construction workers has become a critical need. To enable further advances in this area, it is necessary to synthesize the state-of-the-art auditory signal processing techniques and their implications for auditory situational awareness (ASA) and to identify future research needs. This paper presents a critical review of recent publications on acoustic signal processing techniques and suggests research gaps that merit further research for fully embracing construction workers’ ASA of hazardous situations in construction. The results from the content analysis show that research on ASA in the context of construction safety is still in its early stage, with inadequate AI-based sound sensing methods available. Little research has been undertaken to augment individual construction workers in recognizing important signals that may be blocked or mixed with complex ambient noise. Further research on auditory situational awareness technology is needed to support detecting and separating important acoustic safety cues from complex ambient sounds. More work is also needed to incorporate context information into sound-based hazard detection and to investigate human factors affecting the collaboration between workers and AI assistants in sensing the safety cues of hazards.

High-energy tibial pilon fractures continue to represent a significant challenge to the treating orthopaedic surgeon. Pre-operative evaluation includes a careful clinical assessment of the associated soft tissue injury, which frequently dictates surgical management. Staged surgical reconstruction remains the standard treatment protocol at most trauma centres. This includes application of a temporary spanning external fixator for approximately one to four weeks, followed by open reduction and internal fixation once the surrounding soft tissues are amendable. Despite careful soft tissue management protocols, the risk of wound complications continues to be relatively high compared to other orthopaedic trauma procedures. The functional long-term outcomes of these injuries remain limited, and recent data has emphasised that the majority of patients do not regain their pre-operative work status. In addition, the health-related quality of life scores fare poorly when compared to other orthopaedic and non-orthopaedic patient populations, and many patients develop post-traumatic arthritis within the tibiotalar joint. It has been shown that the quality of fracture reduction may significantly correlate with the long-term functional outcomes. While the orthopaedic community has come a long way with regard to safe management of high-energy tibial pilon fractures, the clinical outcomes continue to remain limited. In particular, the persistently high rates of wound complications and the limited functional long-term outcomes leave significant room for improvement. Future investigators may focus on further innovations to minimise the risk of wound complications. The surgical team may emphasise the quality of fracture reduction as an important treatment goal.

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Introduction Recent advances have led to the design of a new cephalomedullary nail, which aims to decrease the risk of failures in patients with intertrochanteric hip fractures by allowing for insertion of two interdigitating screws into the head segment. The goal of this study is to evaluate the safety and efficacy of this two-screw cephalomedullary nailing system. Patients/participants Patients 18 years of age and older who underwent intramedullary nailing of their intertrochanteric femoral fracture using the InterTAN nailing system (Smith and Nephew, Memphis, TN) from 2012 to 2016 were included in this retrospective study which was performed at two urban certified level-1 trauma centers and one urban certified level-3 trauma center. The study data was collected through a retrospective chart review and review of the existing radiographic studies. Primary outcome measure was mechanical hardware failure and screw cutout. Secondary outcome measures included nonunion, malunion, medical and surgical complications. Results A total of 264 patients were included in this analysis. Two patients (0.75%) were found to have a screw cut out requiring revision surgery. Two other revision surgeries were performed for malrotation ( n  = 1) and malunion ( n  = 1). Other implant-related complications occurred in 19 cases (7.9%), which included broken distal screws ( n  = 9), distal screw loosening ( n  = 8), and loose lag screws ( n  = 2). There was a total of 10 (3.8%) surgical wound complications, including four deep and six superficial infections. Discussion This modified cephalomedullary nail is a reliable, safe, and effective implant for management of intertrochanteric hip fractures. Surgical treatment of patients with intertrochanteric hip fractures can be performed in a safe fashion using this implant.