The Euler angles to rotate the object coordinates of an hcp crystal in such a way that the plane of interest coincide with the (0001) of the reference hcp crystal, whose [0001] and \n
\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
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The main focus is placed on the following three subjects:
Evolution of crystal structure during nucleation
Crystal orientation relationship with the matrix
Effect of crystallography of precipitates on mechanical properties
These subjects are closely related to the following three basic theories, each of which has a long history greater than a half century:
The theory of crystal nucleation (since 1876) [4]
From an engineering viewpoint, the knowledge provided here is primarily useful for developing stronger materials. Dispersing fine precipitate particles over the matrix at high density is a common engineering technique for improving the strength of metals and alloys. By introducing a minor amount of second-phase precipitate particles, such as 2% in volume fraction, the material strength is increased by several times greater. In the traditional theory of precipitation hardening (a.k.a. dispersion strengthening) established in the 1950s–1960s, the primary factor controlling the magnitude of strengthening effect is assumed to be the shear modulus [10, 11], whether or not precipitates are harder than the matrix. This concept has been partly revised in the past few years. Recent experimental studies using state-of-the-art material characterization techniques demonstrated that crystallography of precipitate particles is another factor dominating their obstacle strength [1, 2]. When the slip plane of dislocations in precipitates is not parallel to that in the matrix, dislocations are unable to cut through the precipitates, resulting in large hardening, regardless of the shear modulus. This subject is extensively discussed in the next chapter.
\nThis chapter may also be of interest for the audience outside of the research community of materials science and solid-state physics. Nucleation is one of the areas of basic science related to a wide variety of research subjects including chemical reactions in liquid and gas. In fact, the first theory was originally developed for the nucleation of droplets from gas. Nucleation of crystals in solid is more complicated than the situation assumed in liquid and gas, in a sense that the formation of a new crystal is highly constrained by the surrounding matrix, in terms of the strain energy associated with the precipitate/matrix interface and the diffusivity of atoms for their agglomeration. A long-standing open question is the critical condition for nucleation regarding size and composition of nucleus. Precipitates are in many cases compounds consisting of multiple elements such as carbides and oxides. Unlike in gas and in liquid, the diffusivity of each element is not the same in solids [12]. For instance, the diffusivity of light elements like carbon and oxygen is several orders of magnitude greater than that of metallic elements. Although the classical nucleation theory assumes that the crystal structure and composition of precipitates are the same as those of the final product from the beginning of embryo growth (Figure 1), the diffusivity difference indicates a possibility that the composition of precipitates fluctuates during the nucleation process. The classical nucleation theory also assumes that nucleation occurs when the embryos have grown up to a critical size. In many cases the critical size of precipitates for nucleation is 2–3 nm [3]. Assessing the composition of such small precipitates has been technically impossible until recently. The highlights of recent studies are discoveries that, in the early stage of precipitation, the crystal structure and composition of precipitates are different from those of the final product and that the precipitates structurally transform into the final product at a critical size with a critical composition (Figure 1). Precipitates are clusters of solute elements when they start spontaneous growth, which is defined as the state of “nucleation” in the classical nucleation theory. An implication of this finding is that the obstacle strength of precipitates in precipitation hardening may change during precipitation. They are weak obstacles in the early stage of precipitation regardless of the crystal structure of the final product. They can become strong obstacles due to a change in the shear modulus or the crystal structure. In some cases, precipitates become brittle by the structural change, while they are ductile in the state of solute clusters. Brittle precipitates are considered to serve as the nucleation site of cracks via particle cracking. Hence, from the viewpoint of fracture mechanics, the ductile-brittle transition of precipitates during precipitation considered a factor controlling the engineering lifetime of materials.
\nNucleation of precipitates in metals and alloys: classical nucleation and two-step nucleation [
As a result of the constraints from the surrounding matrix, precipitation of the second phase often occurs with a specific crystal orientation relationship with the matrix. Precipitates and matrix share a specific atomic plane in such a way to minimize the mismatch between them. The orientation relationship is dependent on their crystal structure. For instance, in the Burgers orientation relationship, bcc precipitates in hcp matrix share atomic planes as follows (Figure 2) [13]: (0001)hcp//(110)bcc ˄ \n
The Burgers orientation relationship for bcc and hcp crystals [
Example of EBSD analysis of precipitates: bcc Zr precipitates containing Nb and hcp Zr matrix in a Zr–2.5Nb alloy [
EBSD analysis results of atomic planes of precipitate particles parallel to the slip plane of matrix: bcc Nb precipitates and hcp Zr matrix in a Zr–2.5Nb alloy [
Recent updates of these theories have been achieved by progress in material characterization methods for determining the crystal structure and composition of nano-sized precipitates. Before going into the details of these theories, we briefly review the technological breakthrough in experimental methods. This chapter is addressed to not only the specialists of precipitates but also nonspecialists including students. For better understanding, traditional methods of material characterization are also briefly reviewed at the beginning.
\nCrystal structure is determined based on the concept of diffraction, discovered in 1912. It appears that X-ray diffraction (XRD) became common in the 1920s; a great many structures of alloys were determined. Early works determined simple structures having a high symmetry with which peaks in the XRD spectrum are clearly resolved free from overlapping. Precipitates are, however, in many cases compounds having a low symmetry. XRD became applicable to such complicated structures by the invention of the Rietveld method in 1966 [16]. Precipitates involved in bulk metallic samples are detectable only when their volume fraction is higher than ∼1% [17], though that is highly dependent on their crystal orientation relationship with the matrix. In bulk samples the crystal orientation of precipitates is not necessarily random, and the matrix grains also not. Metallic bulk samples cannot be crushed into powders due to their high ductility. They can be mechanically grinded into powders by using a hand grinder; however, the XRD peaks of such grinded metallic powders are broadened due to introduction of dislocations, resulting in hindering the peaks of precipitates by the background noise. These issues are avoided by the use of residue extracted from the matrix via chemical dissolution using an acid [18]. This extraction residue analysis is, however, applicable to only nonmetallic compound precipitates embedded in metallic matrix.
\nTransmission electron microscope (TEM) is a multifunctional characterization tool capable of determining not only crystal structure but also composition and size of precipitates on the image of microstructure, free from the constraint due to volume fraction. The first prototype was produced by Ruska et al. in 1932, and the first commercial model was released by Siemens in 1939. It appears that TEM became common in the 1950s; for example, the number of commercial products released in Japan was greater than 250. The resolution (point resolution) was 50 nm for Ruska’s first TEM, 1 nm for the Siemens Elmiskap I released in 1956, and 0.2 nm for the JEOL JEM100B released in 1968. Precipitates are visualized using diffraction contrasts; those satisfying the Bragg condition exhibit dark contrast in the so-called bright-field image (bright contrast in the dark-field image), whereas the others are indistinguishable from the matrix. The number density of precipitates determined by diffraction contrast images represents the true number density only in the case where precipitates are all aligned to the same crystal orientation. This condition is achievable only when precipitation occurs with a specific crystal orientation relationship with the matrix such as the cube-on-cube orientation relationship, where the unit cells of the precipitate and the matrix completely overlap each other. In the other orientation relationships, some crystallographic variants are often invisible. This is a potential error in the evaluation of the number density of precipitate particles but often out of consideration. In many cases, the magnitude of error bars is determined solely by a statistical analysis: either the standard error or standard deviation.
\nHigh-resolution (HR)-TEM is another mode capable of visualizing precipitates using phase contrasts, i.e., lattice fringes generated by interference of transmitted and diffracted electron waves. This imaging mode became common in the 1970s–1980s [19]. In those days, however, alignment of electron beam axis was technically difficult for entry-level users. This technical issue was resolved in the 1990s by an introduction of the field-emission gun, which provides a hundred times brighter illumination, a digital camera system, a real-time image processing software (fast Fourier transformation for the alignment minimizing the objective lens stigmatism), etc. However, even though the issue of beam alignment has been resolved, HR-TEM analysis of nano-precipitates is still extremely time-consuming due to alignment of crystal orientation. The HR-TEM image (crystal lattice image) is obtained only when the direction of incident electron beam is aligned with the crystal’s zone axis having a low index, e.g. [001] and [110]. The beam-crystal alignment, achieved by using Kikuchi lines or bend counters, is easy for large precipitates greater than several hundred nm but technically almost impossible for nano-precipitates. So for this reason, in practice, the operator searches particles which already exhibit the crystal lattice image without tilting the sample. Unless otherwise precipitates have a specific orientation relationship with the matrix, the operator can find only a few but not many such particles, whereas the minimum requirement of the number of precipitates for drawing a smooth histogram of the size distribution is ~500 in the author’s experience [3].
\nTEM is capable of determining the crystal orientation relationship between precipitates and matrix, though this analysis is also extremely time-consuming. In order to determine the orientation relationship, one needs to find out a sample-tilting angle, where the beam direction is aligned with a zone axis. Three such tilting angles need to be found for both precipitates and matrix in order to determine their (hkl) indices. In some cases precipitates may not have any specific orientation relationship with the matrix; however, proving such a random orientation relationship is practically impossible for one-to-one analysis using a TEM. The random orientation issue can be assessed only if the number density of precipitates is sufficiently high enough for obtaining the Debye ring patterns in selected-area electron diffraction. A more appropriate method rather than TEM to investigate this research subject is EBSD equipped on a scanning electron microscope (SEM). EBSD determines the orientation of crystals based on the Kikuchi pattern, whose theoretical accuracy is ∼0.1° [20, 21], whereas the accuracy of orientation analysis using diffraction spots is ∼3° [22, 23].
\nThe first report introducing the principle of EBSD was published in 1973, within 10 years after the release of the first commercial SEM, the Stereoscan series 1, by the Cambridge Instrument Company in 1965. EBSD became a practically useful tool in 1993, by full automation of mapping (detecting, indexing, and recording the Kikuchi bands based on the Hough transformation). The spatial resolution of EBSD is dependent on probe size, step size of scanning, accelerating voltage of electrons, sample geometry (bulk or thin foil), etc. According to the author’s experience, precipitates of ∼500 nm in diameter can be identified but ∼50 nm not. The spatial resolution is improved by using an advanced technique called transmission Kikuchi diffraction (TKD), a.k.a. transmission EBSD, proposed in 2012 [24]. This new technique works on conventional EBSD system and software. The difference is that TKD uses forward-scattered electrons, whereas EBSD uses backscatter electrons. In other words, TKD uses transmitted electrons as well as TEM; hence, the samples must be thin foils. Sample preparation is not difficult for TEM users; TEM samples can be directly subjected to this analysis. The high spatial resolution of TKD owes not only to the use of thin foil specimens, which minimize unfavorable lateral beam spreading inside the specimens, but also to a greater signal intensity of forward-scattered electrons than backscattered electrons [25]. Since the Kikuchi pattern is generated from elastic scattering (diffraction) of inelastically scattered electrons [26], there exists a lower limit in both specimen thickness and precipitate size below which the Kikuchi patterns are not obtained. When the thickness of thin foil specimens is largely greater than the size of precipitates, the signal from the precipitates is hindered by that from the matrix. In other words, there exists an upper limit of measurable foil thickness depending on the size of precipitates. Only a limited range of thickness is applicable to this method in a wedged-shaped TEM thin foil specimens. The practical spatial resolution limit of TKD is dependent on many factors such as the position of detector (florescent screen); according to the author’s experience using a conventional EBSD system, precipitates of ∼50 nm in diameter can be identified but ∼10 nm not. The resolution will be improved if the detector is placed just beneath of the sample; this is an ideal setting that minimizes the loss of forward-scattered electrons.
\nTraditionally, TEM has been a primary analysis tool for composition analysis of precipitates: energy-dispersive X-ray spectroscopy (EDS) and electron energy loss spectroscopy (EELS). In these TEM-based composition analyses, samples having a 3D geometry are projected on 2D space via electron transmission. Precipitates often overlap the matrix in the thickness direction, whereas their TEM image is constructed based on integrated information over thickness. These analyses are unable to determine the composition of overlapped portion. It is practically impossible to judge from the projected 2D image if the precipitates are free from overlapping. In terms of composition analysis of precipitates, the most innovative breakthrough in the past two decades is probably the invention of atom probe tomography (APT). Although its concept was first proposed in 1967, it has become a practically useful tool since the commercial release of local-electrode atom probe (LEAP) in 2003. APT is capable of visualizing atoms in 3D space, which is a critical advantage over the TEM-based composition analyses. APT is a quantitative mass analysis, whereas EDS and EELS are semiquantitative analyses that require a standard sample for calibration. Furthermore, EDS is inherently lack of quantitative accuracy in detection of light elements; emission of Auger electrons is dominant over characteristic X-ray and is dominant for low-Z elements like oxygen. Although APT is superior to TEM-based analyses in many aspects, determination of precipitates’ composition is a challenging subject even for APT. The quantitative precision of the APT composition analysis is often limited by artifacts partly due to the so-called trajectory aberration [27, 28, 29]. For precipitates darkly imaged in FIM (i.e., low evaporate field regions) compared to the surrounding matrix, defocused high-field iron ions coming from the surrounding matrix fall into the precipitate image on the detector [30]. Conversely, for precipitates brightly imaged in FIM, image overlapping occurs outside the precipitate image. In both cases, mixing with the matrix elements inevitably occurs at the interface. Hence, matrix elements are often detected in nano-precipitates [31, 32].
\nThe classical nucleation theory is based on the so-called capillarity approximation, which assumes that the properties of nuclei are the same as those of the final product from the beginning of embryo growth. In other words, all parameters that characterize the new crystal phase to be distinct from the matrix phase, such as density, composition, and structure, are assumed to be unchanged throughout the nucleation stage. Under this assumption, nucleation event is expected to be solely controlled by the size of embryos. Spontaneous growth (nucleation) of precipitates is expected to occur at a critical composition where the hierarchy of the bulk free energy of the precipitate phase and the surface free energy of precipitate/matrix interface is reversed. In the past two decades, a modern concept called the two-step nucleation has been established by the research community of crystal nucleation from liquid (Figure 5) [33]. This concept is nonclassical in that embryos become distinct from the matrix liquid in terms of density prior to the structural change. Here, fluctuation of composition is generally out of consideration, as in liquid diffusivity of solute elements is equally very high; composition fluctuation is expected to be negligibly small. On the other hand, in the nucleation of compound precipitates in crystalline solids, fluctuation of density is relatively small (compared to the nucleation of solid from liquid), but instead, composition may be a variable parameter. In solids, diffusion coefficients of solute elements are merely the same; stoichiometric composition of the compound may not be fulfilled in the early stage of embryo growth. In this case, although the parameter being in focus is different from the conventional two-step nucleation in liquid, this is also nonclassical in the sense that multiple parameters required for nucleation evolve in parallel during nucleation. In 2014, Peng et al. demonstrated that a solid-solid phase transition occurs in a two-step process [34]. In their experiments using a model crystal consisting of microgel colloidal spheres, the two-step represents a two-step change in structure. The first step is a transition from a two-dimensional square lattice structure to a liquid-like structure, and the second step is a transition from the liquid-like structure to a two-dimensional triangular lattice structure. Fluctuation of composition is not associated with their two-step process. Within the framework of the classical nucleation theory, in 1937 Borelius assumed that composition is a variable parameter in the nucleation of precipitates in solids [35]. Absolute value of the bulk free energy of precipitates becomes the greatest with the compound’s stoichiometric composition; nucleation is expected to occur at this critical composition. Borelius did not discuss the effect of compositional fluctuation on the critical size. In 1949, Hobstetter attempted to handle both size and composition as variable parameters [36]. He demonstrated that in this two-variable analysis there is a pathway (in terms of evolution of size and composition) energetically more favorable than the pathway fixed by the previous one-variable analyses. However, the meaning of the energetically most favorable pathway remained unclear in the context of critical size and composition.
\nTwo-step nucleation of crystals from liquid [
The final product described in the classical nucleation theory is not necessarily the most stable, equilibrium phase. In many cases, the first nucleating phase is a metastable phase, formation of which occurs with the lowest energy barrier; the equilibrium phase is produced through multiple transitions from a metastable phase to another metastable phase step-by-step. This is an empirical rule known as Ostwald’s rule of stages, proposed in the 1890s [37, 38]. One of such examples is precipitation of Al2Cu at Guinier-Preston (GP) zone in Al-Cu alloys [39, 40]. The precipitation of Al2Cu, which is the stable phase in this system, is known to occur via multiple intermediate configurations such as GP zone → coherent θ” phase → semi-coherent θ’ phase → incoherent θ phase (Al2Cu). Those intermediate phases are distinct from the Al2Cu in both crystal structure and composition. Another example is precipitation of fcc Cu in bcc Fe matrix. Precipitation of Cu is known to occur via multiple intermediate configurations such as bcc Cu → a twinned 9R Cu → fcc Cu [41]. The bcc Cu precipitates are crystallographically indistinct from the matrix; in other words, they are solute clusters in the bcc solid solution. The critical composition for their structural changes remains unclear. It is technically rather difficult to determine the composition of precipitates in the early stage of precipitation due to their small sizes.
\nTraditionally, experimental studies on the nucleation in solids have focused on determining the critical size. For example, Othen et al. [41] reported that the bcc Cu precipitates grow with the twinned 9R structure in a size range from 6 to 15 nm. Their conclusion is based on the results of HR-TEM observation. This methodology is, however, insufficient for statistical argument as mentioned in the previous section.
\nEven today, experimental studies on the critical composition for nucleation are still limited. As mentioned earlier, even in atom probe tomography, mixing with matrix elements inevitably occurs at the precipitate/matrix interface due to trajectory aberration. Hence, it is practically impossible to judge if the abovementioned Cu precipitates embedded in Fe matrix is 100% pure Cu. When the precipitate of interest is a compound consisting of multiple elements, the ratio of its constituent elements can be discussed. However, when one of those elements is the element of matrix, such as the Al–Cu precipitates in Al alloys, interpretation of their concentration ratio is not straightforward.
\nIn order to determine the critical composition for the structural change, the crystal structure of precipitates must be examined together with composition. In TEM observation of diffraction contrasts, precipitates are indistinguishable from the matrix while they are solute clusters, and they become visible after structural change. By using this unique feature in visibility, recently, Matsukawa et al. performed a systematic analysis on the precipitation of the G-phase in a duplex stainless steel subjected to thermal aging [3]. The crystal structure of the G-phase is cF116 (a variant of fcc structure), and the lattice parameter is exactly fourfold of the matrix ferrite (Figure 6). Precipitation occurs with the cube-on-cube orientation relationship [42]. The stoichiometric composition is Ni16Si7Mn6; its constituent elements are different from the matrix elements (Fe and Cr). So for these reasons, this intermetallic compound is ideal for the fundamental study of nucleation. Precipitation of G-phase in duplex stainless steels is known to occur only in a very narrow temperature range, 673–773 K [43]. In their study, thermal aging was performed at 673 K for up to 10,000 h.
\nCrystal structure and TEM electron pattern of the G-phase precipitates in the ferrite portion of a duplex stainless steel subjected to thermal annealing at 673 K [
Their analysis revealed that precipitation of Ni–Si–Mn clusters started at 500 h (Figure 7), whereas their structural change transforming into the G-phase started at 10,000 h (Figure 8). The number density of G-phase particles detected by TEM was only ∼26% of the number of Ni–Si–Mn precipitates detected by APT. In other words, three quarters of the Ni–Si–Mn precipitates were solute clusters yet without structural change. The number of particles examined by TEM was ∼750. A potential error factor that could cause a misevaluation of the precipitate number density is the method used to evaluate the thickness of the TEM foil. Their method was to use thickness fringes obtained at an exact Bragg condition, where the deviation parameter was s=0. In this case, thickness is determined by the number of thickness fringes multiplied by the extinction distance of the electron beam. Since the precipitate number density was counted in portions where the number of thickness fringes was 4, the magnitude of the error in the foil-thickness evaluation was ±25%. In other words, the number of Ni–Si–Mn clusters that exhibited the crystal structure change was at most 50% of the total.
\nAPT results on the steel [
TEM results on the steel [
Their APT analysis also revealed that the Ni–Si–Mn clusters contained not only the G-phase elements (Ni, Si, and Mn) but also the matrix elements (Fe and Cr) and that enrichment of the G-phase elements occurred during thermal aging. Unlike the size growth, the solute enrichment continued even after 5,000 h. In the composition analysis of the clusters (Figure 9), those clusters were divided into three groups by size, i.e., small (<2 nm in diameter), medium (2–3 nm), and large (>3 nm), in order to minimize the artifacts that occur at the cluster/matrix interface; a comparison of cluster composition should be made for those having the same size. The concentration ratio of the G-phase elements (Si/Ni and Mn/Ni) did not change during the isothermal aging. The Mn/Ni ratio was in good agreement with that of stoichiometric composition, whereas the Si/Ni ratio was roughly a half of the stoichiometric ratio.
\nAPT results on the steel [
Their analysis indicates that the nucleation of the G-phase occurred via a two-step process: the first step is the spontaneous growth of solute clusters (i.e., nucleation as solute clusters), and the second step is the nucleation as compounds (i.e., the G-phase) (Figure 1). There was a time lag between the end of size growth (5,000 h) and the start of structural change (10,000 h). It appears that the incubation period was controlled by solute enrichment inside the clusters. In other words, the structural change occurred via another two-step process: the first step is size fluctuation to become a critical size, and the second step is composition fluctuation to become a critical composition (Figure 1).
\nThe G-phase is currently of particular interest in nuclear materials research, as this compound precipitates also in the steel constituting the main body of reactor pressure vessels (RPVs) at the operation temperature of light water reactors (∼573 K) under neutron irradiation. It has long been well known that precipitation of impurity Cu causes embrittlement of the RPV steels. In the late 1990s, Odette et al. pointed out that, in the case of RPV steels containing a low amount of Cu such as those manufactured after 1973, precipitation of Cu occurs in the first few years of reactor operation, but near the end of the plants’ initial operational license lifetime (typically 40 years), precipitation of Ni, Mn, and occasionally Si becomes dominant over Cu [44]. The Ni–Mn(–Si), precipitates have been called the late-blooming phase [45, 46, 47] since their structural and compositional features were unclear at that time. It was very recently that the late-blooming phase is in many cases found to be characterized as the G-phase [48, 49]. The composition of the late-blooming phase detected by APT is not always the same [31, 32]. The composition range of Ni–Si–Mn clusters to become brittle G-phase is a subject to be investigated further.
\nCrystal orientation relationship between precipitates and matrix is a potential factor controlling the mechanical properties of metals and alloys. Dislocations can glide on specific atomic planes, the choice of which is specific to crystal structure and material. For instance, the slip plane is the {111} plane for fcc metals, the {0001} plane for hcp magnesium, and the {10-10} plane for hcp titanium and hcp zirconium [9]. When the slip plane of precipitates is not parallel to that of the matrix, dislocations are in theory unable to cut through the precipitates. Although the orientation relationship has been extensively studied in the past [50], only a few studies have been reported on the effect of the crystal mismatch on the plasticity [1, 2]. The absence of such studies is partly due to a technical difficulty in determination of crystal orientation of fine precipitate particles as mentioned in the Section 2. Recently, Matsukawa et al. performed a systematic analysis on the parallelism of atomic planes between precipitates and matrix in a Zr–2.5Nb alloy: the precipitates are bcc Nb containing Zr ∼10% and the matrix is hcp Zr. Based on the analysis results obtained from 100 precipitate particles (∼50 nm in diameter) by means of TKD, they demonstrated that the orientation is practically random. Only 1 out of 100 precipitates had a slip plane parallel to that of the matrix. Their experimental result is inconsistent with a preceding theoretical prediction by Zhang and Kelly [51, 52]. Judging from the mismatch of inter-planar spacings, the most favorable crystal orientation relationship for the Nb-rich bcc precipitates in the hcp Zr matrix is (\n
The Zr–Nb binary alloy phase diagram [
In the study of the Zr–2.5Nb alloy, the parallelism of slip planes between precipitates and matrix was analyzed as follows. This analysis is achieved by using the Euler angles obtained from EBSD/TKD measurements, though so far not automated. The analysis procedure is slightly different depending on the analysis software due to the different definition of the Euler angles. In the case of the TSL-OIM software based on Bunge’s description [53], the Euler angles (φ1, Φ, φ2) are given by three rotations along z1-x-z2 axes in accordance with passive rotation (intrinsic rotation), where the axes are rotated instead of the vectors of object, while the object is fixed in space (Figure 11). In this case, the rotation matrix (R) relative to the space coordinates is given as follows [54]:
\nPassive rotations of a cubic crystal with Euler angles (the Bunge Euler angles).
In the reference crystal, the z- and the x-axes of space coordinates are parallel to the [001] and to the [100] directions of cubic crystals. Here, we consider the orientation relationship between two cubic crystals, A and B, whose rotation matrices relative to the reference crystal are RA and RB. The rotation matrix between these two crystals (RC) is given as follows:
\nAn atomic plane of crystal B, \n
RA and RB are directly determined by EBSD measurements of crystals A and B. The Euler angles of the RD are determined by using a simulation equipped on the TSL-OIM data collection software. This simulation module is capable of (1) calculating how the index of a crystal (in the ND and the RD directions) changes in accordance with rotations along the three axes and (2) visualizing where the index (of the ND direction) is located on the Kikuchi map (the inverse pole figure). By using these functions, the index \n
Determination of theoretical accuracy of this analysis method is not straightforward, since errors are introduced by various factors such as (1) the conversion of the Euler angles (φ1, Φ, φ2) to direction cosines, (2) the conversion of direction cosines denoted in fractional values to the Millar indices (h k l) denoted in integer ratio, and (3) the noise of EBSD data. In order to estimate the practical accuracy of this analysis method, they first analyzed a standard sample in which the atomic-plane parallelism between grains is already known. Their standard sample was a type-316 austenitic stainless steel containing annealing twins (Figure 12). The twin boundary of fcc metals is one of the four crystallographically equivalent {111} planes. The Euler angles of these {111} planes for the RD rotation are, e.g., (φ1, Φ, φ2) = (0°, 55°, 45°), (0°, 55°, 135°), (0°, 55°, 225°), and (0°, 55°, 315°). They performed this analysis on 50 twin couples and found that the largest offset from the exact {111} was 3.3°. This is the magnitude of practical error of this analysis method.
\nEvaluation of the magnitude of error of the EBSD analysis method on the atomic plane parallelism described in this chapter, using annealing twins in a type-316 stainless steel [
To date, several orientation relationships have been reported on bcc precipitates in hcp matrix (Figure 13). The parallelism of slip planes in those orientation relationships is as follows: (1) the Burgers orientation relationship [13]: (0001)hcp//(110)bcc ˄ (\n
Examples of crystal orientation relationships between bcc and hcp crystals [
The magnitude of error of the abovementioned analysis of atomic-plane parallelism is greater than the orientation difference between the Potter and the Burgers orientation relationships, 1.5°. It follows that these two orientation relationships are practically indistinguishable from each other in this analysis. On the other hand, the orientation difference between the Pitsch-Schrader and the Burgers orientation relationships is 5.3°; in theory, they are distinguishable. In both the Burgers and the Pitsch-Schrader orientation relationships, the basal plane of the hcp crystal is parallel to a {110} plane of the bcc crystal. In other words, when any one of {110} planes of a precipitate is not parallel to the (0001) plane of the matrix, it follows that the precipitate is in neither one of these two orientation relationships. The criterion for the judgment of whether the Burgers or the Pitsch-Schrader is given by another atomic-plane parallelism, which is whether \n
In the study of the Zr–2.5Nb alloy, Matsukawa et al. fixed the plane of hcp matrix and plotted its corresponding atomic planes of bcc precipitates on an inverse pole figure (Figure 4). In the TSL-OIM software, the Euler angles of hcp crystals are given in the orthogonal coordinate system. In the reference crystal, the z- and the x-axes of space coordinates are parallel to the [0001]hcp and the \n
\n | Index | \nEuler angle (φ1, Φ, φ2) [°] | \n
---|---|---|
Basal | \n\n\n | \n0, 0, 0 | \n
Prismatic (type 1) | \n\n\n | \n0, 90, 0 | \n
\n | \n\n | \n0, 90, 60 | \n
\n | \n\n | \n0, 90, 120 | \n
Prismatic (type 2) | \n\n\n | \n0, 90, 90 | \n
\n | \n\n | \n0, 90, 150 | \n
\n | \n\n | \n0, 90, 210 | \n
The Euler angles to rotate the object coordinates of an hcp crystal in such a way that the plane of interest coincide with the (0001) of the reference hcp crystal, whose [0001] and \n
Recent progresses in our understanding of the crystallography of precipitates in metals and alloys have been briefly reviewed. The major highlights are the following three: (1) crystal structure of precipitates changes during nucleation. This concept in itself has been known since the 1930s. Recent new findings concern the critical conditions for the structural change in terms of fluctuations in size and composition, discovered by mean of combining transmission electron microscopy crystallographic analysis with atom probe tomography compositional analysis. It appears that the structural change occurs at a critical size with a critical composition. There is a long incubation period (in some cases a year long) before the structural change after the growth to be the critical size. During the incubation period, enrichment of solute elements occurs inside the precipitates without further size growth. It still remains unclear if these features are universal for any types of precipitates. This research field is expected to advance drastically in the years ahead. (2) In the past years, it has also become technically possible to examine the crystal orientation relationship of fine precipitate particles such as ∼50 nm in diameter with the matrix, on numbers of samples numerically sufficient for statistical arguments. Transmission Kikuchi diffraction, which is an advanced technique of electron backscatter diffraction equipped with a scanning electron microscope, revealed that the crystal orientation of precipitates can be random even when they are in theory favorable to have a specific orientation relationship with the matrix from the viewpoint of lattice mismatch. It appears that such a situation is realized when the matrix exhibits recrystallization after precipitation. (3) Crystal orientation relationship between precipitates and matrix was found to be a factor controlling the magnitude of precipitation hardening. This is a new concept beyond the scope of the traditional theory of precipitation hardening, which assumes that the hardening is controlled solely by the shear modulus, whether or not the precipitates are harder than the matrix. In cases where the slip plane of precipitates is not parallel to the slip plane of the matrix, dislocations gliding in the matrix are unable to cut through them, resulting in strong obstacles regardless of the shear modulus. Further information on this issue is provided in the next chapter.
\nThe author was supported by the MEXT Grant-in-Aid for Young Scientists (A) (22686058), by the Japan Society for the Promotion of Science (JSPS) KAKENHI (#16K06767), and by the Iron and Steel Institute of Japan (ISIJ) in the 23rd and the 26th Research Promotion Grants. This review article is based on the author’s previous researches partly sponsored by the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, under the Strategic Promotion Program for Basic Nuclear Researches entitled “Study on hydrogenation and radiation effects in advanced nuclear fuel cladding materials” and “Study of degradation mechanism of stainless steel weld-overlay cladding of nuclear reactor pressure vessels” and a program entitled “R&D of nuclear fuel cladding materials and their environmental degradations for the development of safety standards” entrusted to Tohoku University by the MEXT. Those researches were also supported in part by the Collaborative Research Programs of “the Oarai Center” and “the Cooperative Research & Development Center for Advanced Materials” of the Institute for Materials Research, Tohoku University, and of the Research Institute for Applied Mechanics, Kyushu University; by Advanced Characterization Nanotechnology Platform, Nanotechnology Platform Program of the MEXT, Japan, at the Research Center for Ultra-High Voltage Electron Microscopy in Osaka University and at the Ultramicroscopy Research Center in Kyushu University; and by the Joint Usage/Research Program on Zero-Emission Energy Research, Institute of Advanced Energy, Kyoto University (ZE27C-07, ZE28C-09, ZE29C-11, and ZE30C-01).
\nThe author declares no conflicts of interest directly relevant to the content of this chapter.
The musculoskeletal system consists of bones, muscles, tendons, ligaments, and intervertebral discs, as well as their associated nerves and blood vessels [1], and is powered by the complex interrelationship between these separate structures, each of which depends on the other to function properly. Musculoskeletal injuries are common and, hence, are routinely seen in the emergency department. This requires the attending physician to have a thorough understanding of human anatomy and to be familiar with the subtypes of these injuries in order to prevent life- or limb-threatening damage, anticipate possible complications, and avoid further disability, any of which might not be clear from the immediate presentation of the injury. Patients may come to the emergency department with a variety of complaints and be in pain, but on examination are found to have a strain (tendon) or sprain (ligament). Many musculoskeletal injuries are overuse injuries resulting from strenuous and/or repetitive activity.
Barring major complications and the potential for long-term deformities, most musculoskeletal injuries are relatively minor and rarely require an immediate life-threatening intervention. However, in patients who sustain blunt trauma, 85% incur musculoskeletal injuries that can be more serious. These patients need to be assessed and managed quickly and correctly. In cases of major musculoskeletal trauma when there are extraordinary forces that cause crushing injuries, the emergency physician may be confronted with more pressing challenges. When major muscle damage occurs, large amounts of myoglobin (a hemeprotein) are released into the bloodstream. When the myoglobin reaches the kidneys, it breaks down into harmful substances that can damage kidney cells, leading to precipitation in the renal tubules and acute kidney injury (AKI). Major musculoskeletal trauma can also result in internal torso injuries; in some cases, the pooling of fluids can form into an intact musculofascial layer with swelling in the space. This can cause complications such as acute compartment syndrome, which can lead to dire consequences if misdiagnosed. Continuous and careful assessment and correct recognition and management of musculoskeletal injuries in the emergency department are the key to successfully preventing further morbidity and reducing mortality.
The human musculoskeletal system (also known as the locomotor system) is a multiple organ system that gives human the ability to move using their muscles, tendons, and bones; it provides form, support, stability, and flexibility to the body as well as protecting vital organs [2]. Also, the skeletal portion of the system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system [3].
Within the system, bones are connected to muscle fibers via connective tissue like tendons and ligaments. Muscles keep bones in place and also play a role in the movement of bones allowing overall motion; different bones are connected to by joints and cartilage prevents the bone ends from rubbing directly into each other.
There are, however, specific diseases and disorders, which will not be discussed in this chapter, that may adversely affect the function and overall effectiveness of the system. Some of which can be difficult to diagnose and treat in the emergency setting and may require a specialist to handle like an orthopedic surgeon; other issues may require physical rehabilitation which is handled by a physiotherapist.
It is of worth to note that previously, the musculoskeletal system used to be called the activity system (Figure 1).
Features of the human activity system from the 1911.
This system serves many important functions; it aids in the shape and morphology of the whole body; it provides support and protection as well as allowing movement. It plays a major role in producing blood for the body and in storage of minerals [4]. The number of bones in the human skeleton is estimated to be around 270 at birth; however, many bones fuse together between birth and maturity. As a result, an average adult skeleton consists of 206 bones. The number of bones varies according to the method used to derive the count. While some consider certain structures to be a single bone with multiple parts, others may see it as a single part with multiple bones [5]. There are five general types of bones: long bones, short bones, flat bones, irregular bones, and sesamoid bones. The human skeleton is composed of both fused and individual bones. It is a complex structure with two distinct divisions; the axial skeleton, which includes the vertebral column, and the appendicular skeleton [2].
The skeletal system serves as a framework for tissues and organs to attach themselves to. This system acts as a protective structure for all vital organs. Major examples of this are the brain being protected by the skull and the heart with the lungs being protected by the rib cage.
Within the long bones are two distinctions of bone marrow (yellow and red). The yellow marrow has fatty connective tissue and is found in the marrow cavity. During starvation, the body uses the fat in yellow marrow for energy [2]. The red marrow of some bones is an important site for blood cell production; here, all erythrocytes, platelets, and most leukocytes form in adults. From the red marrow, erythrocytes, platelets, and leukocytes migrate to the peripheral blood to do their special tasks approximately 2.6 million red blood cells per second in order to replace existing cells that have been destroyed by the spleen [2].
Another function of bones is the storage of certain minerals. Calcium and phosphorus are among the main minerals being stored. The value of this storage “device” helps to regulate mineral balance in the bloodstream. When the fluctuation of minerals is high, these minerals are stored in bone; when it is low, it will be withdrawn from the bone.
There are three types of muscles (smooth, skeletal, and cardiac). Smooth muscles are nonstriated muscles used to control the flow of substances within the lumens of hollow organs like vessels and bowels and are involuntarily controlled [3]. Skeletal and cardiac muscles have striations that are visible under a microscope due to the components within their cells. Only skeletal and smooth muscles are part of the musculoskeletal system and only the skeletal muscles can move the body skeleton. Skeletal muscles are attached to bones and arranged in opposing groups around joints. Cardiac muscles are found in the heart only and used to pump blood; they are like the smooth muscles, involuntarily controlled. Muscles are innervated by nerves which conduct electrical currents from the central nervous system and cause the muscles to contract.
The body contains three types of muscle tissue seen under microscope as shown in (Figure 2): (a) skeletal muscle, (b) smooth muscle, and (c) cardiac muscle.
Muscle tissue under microscope.
Joints, also called articulations, serve two important functions in the human body: holding the skeleton together and allowing it to be mobile. Simply defined as the site where two or more bones meet [2].
There are three types of joints according to its functional classification which measures the amount of movement the joint provides: diarthrosis joints which allow extensive mobility between two or more articular heads; synarthrosis or false joints which are joints that do not provide mobility and amphiarthrosis joints which allow little or very minimal movement.
Structural classification is based on the type of the material binding the bones together. Synovial joints (Figure 3) are the joints where the bones are lubricated by a solution called synovial fluid that is produced by the synovial membranes. This fluid lowers the friction between the articular surfaces and is kept within an articular capsule allowing maximum mobility.
Anatomy of synovial joint.
Cartilaginous joints are the joints where bone ends are tied by cartilage, and fibrous joints are the joints where the bone ends are united by fibrous tissue; the latter two types vary in mobility according to their subclassifications and position in the body [2].
A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to bones [4]. The extracellular connective tissue between muscle fibers binds to tendons at the distal and proximal ends, and the tendon binds to the periosteum of individual bones at the muscle’s origin and insertion. As muscles contract, tendons transmit the forces to the relatively rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing them to function as springs during locomotion, thereby saving energy.
A ligament is a small band of dense, white, fibrous elastic connective tissue [2] that connects both ends of bones together in order to form a joint and they transfer force from one bone to the other allowing movement [6]. Most ligaments limit dislocation or prevent certain movements that can cause injury or tears. Since they are elastic tissue, they increasingly lengthen when under pressure; when the force exceeds the limit of elasticity, the ligament can handle; it becomes susceptible to damage which can result in severe injuries and tears or in an unstable joint movement. Ligaments may also restrict some actions and movements such as hyperextension or hyperflexion that is limited by the ligament ability to prevent this movement to an extent [7].
A bursa is a small synovial fluid-filled sac contained within white fibrous connective tissue which is lined internally with synovial membrane. It provides a cushion between bones and tendons and/or muscles around a joint. The fluid-filled sac can be found in multiple regions in the body mostly around joints [2].
It is valuable to have as much insight as possible about the incident, even the site of the incident, as any information may aid in weighing the level of trauma, things like the patient position, causative mechanism of injury (penetrating, blunt, crushing…), bleeding at the scene, exposed bone or fracture ends, open wounds, any deformity or dislocation, motor and/or sensory deficits, delays in transportation, limb function, perfusion, and neurological changes. Other things to keep in mind are to pay special attention to excessive pressure over prominences as they may result in a peripheral nerve compression, compartment syndromes, or crush syndromes.
A thorough history is the first step; always ask about the mechanism of the trauma, it is very essential in the management of musculoskeletal injuries and then past medical history to assess any morbidities, history of medications, any previous injuries, and the last meal the patient had and the timing of it.
Second in line is physical examination. The physical examination in the emergency department for these injuries is based on simple four steps:
Inspection (discoloration, swelling, or deformity).
Palpation (looking for tenderness and deformity).
Assess range of motion (both active and passive) with consideration to the joint above and below the injured part.
Neurovascular examination.
This should cover the basic general approach of these injuries.
The soft tissue is a term that encompasses all body tissue except the bones. It includes skin, muscles, vessels, ligaments, tendons, and nerves. Their injuries can range from the trivial, such as a scraped knee, to the critical that includes internal bleeding; those which involve the skin and underlying musculature are commonly divided either as closed or open wounds.
An injury where there is no open pathway from the outside to the injured site (Figure 4) and can be divided into:
Contusion: a traumatic injury to the tissues beneath the skin without a break in the skin.
Ecchymosis: discoloration under the skin that is caused when blood leaks out into the surrounding soft tissues causing the skin to turn different colors.
Edema: swelling as a result of inflammation or abnormal fluid under the skin.
Strain: stretching or tearing of a muscle resulting from overstretching or overexertion. Also known as a pulled muscle or torn muscle [8].
Sprain: a joint injury involving damage to supporting ligaments and partial or temporary dislocation of bone ends, partial tearing or stretching of supporting ligaments (Figure 5). Also known as a torn ligament [8].
Closed wound.
Ankle ligament sprain.
Closed injuries can be managed effectively by applying the
A patient with strain and/or sprain usually has pain and edema, a point of tenderness or burning sensation with or without ecchymosis. There may be a mild deformity of the injured joint in addition to complete or near complete loss of movement of joint; treatment consists of pain control, supportive strapping or bandaging, and immobilization by splinting so that affected muscle is in relaxed position. If injury is severe, R.I.C.E.R must be followed [9, 10].
Also, make sure to cover the following:
Reassure the patient.
Gently support the site.
Check circulation, motor, and sensation before and after splinting.
Apply ice pack.
Splint and immobilize injured limb.
Elevate injured limb.
Arrange for transport to appropriate care center.
An injury in which the skin is interrupted or broken, exposing the tissues underneath (Figure 6) and can be divided into:
Abrasions: where the top layer of the skin is removed.
Lacerations: these are cuts of the skin with jagged edges.
Incisions: which are characterized by smooth edges and resemble a paper cut.
Punctures: usually deep, narrow wounds such as a stab wound from a nail or knife.
Avulsions: where a flap of skin is forcefully torn from its attachment.
Amputations: partial or full detachment of a limb or other appendage of the body which may be iatrogenic or due to trauma.
Open wound.
Also called “brush burns,” “mat burns,” and “road rash” in which some bleeding may result, but usually oozes from injured capillaries. Extremely painful because nerve endings are involved (Figure 7).
Abrasion post road accident.
The management is usually so minimal requiring cleansing of the wound; small bandages may be applied but tactical situations will usually preclude applying field dressings that are needed for more serious injuries. A large amount of dirt may be ground into the wound; therefore, secondary treatment measures should focus on preventing or stopping infections.
May be smooth or jagged and can be caused by an object with a sharp edge (Figures 8 and 9) or may result from a severe blow or impact with a blunt object. Treatment is generally the same as for abrasions. It is very important to remember protecting yourself from disease by using medical gloves, wash or irrigate the injury with warm saline, remove all foreign bodies, control bleeding by applying local compression and dressing, start intravenous fluids when necessary (e.g., in cases of severe bleeding and possible hemodynamic compromise). Insure to keep the patient warm, elevate the injured part of the body. If major tendons and muscles are completely cut, immobilize the limb to prevent further damage.
Simple laceration.
More severe laceration of the forearm.
These should be assessed carefully to rule out vascular and/or neurological injury (Figure 10). Bleeding should be controlled by direct pressure on the bleeding site; the avulsed part should be managed by applying several pressure dressings or an air splint and followed by regular dressing. Contamination should be avoided; ensure avulsed flap is lying flat and that it is aligned in its normal position. If the avulsed part is completely pulled off, make every effort to preserve it. Wrap that part in a saline or water-soaked field dressing, pack wrapped part in ice, and whenever possible be careful to avoid direct contact between the tissue and ice. Transport the avulsed part with the patient but keep it well-protected from further damage and out of view of the patient [4].
Avulsion.
Amputation is a very traumatic event for the patient both physically and psychologically (Figure 11). With complete amputations, there is less bleeding than with partial or degloving cases. This is due to elastic nature of blood vessels as they are tended to spaz and retract into the surrounding tissue. It is very important to notice that replantation is performed only with an injury of isolated finger or extremity and should be performed by a skilled surgical team.
Severe bilateral amputation of the lower limbs.
Treatment should always be started by ABCDE, which is the management of airway, breathing, circulation, disabilities, and environment in addition to warmth of the patient and control of hemorrhage by direct pressure or application of a tourniquet (Figure 12). If a tourniquet is applied, it must occlude arterial inflow, as occluding only venous system can increase bleeding. In severe cases where the patient’s life might be at compromise, a tourniquet may remain in place for a prolonged period in order to save the patient’s life. The physician must be able to make such decision and be aware that this choice is for life and against limb.
Pneumatic tourniquet in place.
It is helpful to mark the patient’s forehead with a “T” (indicating the time it was applied) using a marker to be able to track time of which the tourniquet was applied. Place the patient in shock position (head down, feet elevated). Continue the management by treatment of shock via IV fluids and/or blood transfusion, vasopressors if necessary, pain control, and continuous monitoring of the patient’s vitals. Make every effort to preserve the amputated part and transfer the patient to the theater as soon as possible after stabilization of the ABCDE. Wrap the amputated part in a sterile dressing, place in ice and send with patient, and prevent direct contact between tissue and ice as possible [7].
A break in the continuity of bone which may result in partial or complete disruption of the bone. Fractures are further classified as open or closed.
Open versus closed fracture.
It can be
Inside-out open fracture.
Alternative classification to fractures can be applied in relation to the size of the wound and causative force:
Type I: Small wound (<1 cm), usually clean; low energy.
Type II: Moderate wound (>1 cm), minimal soft tissue damage or loss; low energy.
Type III: Severe skin wound, with extensive soft tissue damage; high velocity impact.
The following guidelines can be applied to any type of fracture, regardless of location:
Treat as any case of trauma by starting management of airway, breathing, circulation, disabilities, and patients’ environment (ABCDE).
Control hemorrhage.
Treatment for shock.
Relieve pain (can include opioids).
Treat any associated injuries and cover the injured area with sterile dressing.
Check distal pulses before and after splinting.
Immobilize the fracture using splints.
Check pulse, motor, and sensation (PMS).
Initiate IV antibiotics (usually broad-spectrum type to cover both Gram-positive and Gram-negative bacteria), in addition to tetanus prophylaxis.
DO NOT re-place protruding bone or explore the wound nor clamp any vessel at the emergency setting and wait for the orthopedic physician.
In general, during clinical examination for suspected fractures, look for the following signs:
Discoloration.
Deformity.
Edema.
Crepitus.
Point tenderness.
Limited range of motion.
Direct or indirect pain.
Exposed bone fragments (open fractures).
Any open wounds over or near a joint should be assumed to extend to the joint till proven otherwise.
Soft tissue infection.
Osteomyelitis.
Gas gangrene.
Tetanus.
Crush syndrome.
Skin loss.
Malunion or Nonunion.
An appliance made of wood, metal, or plaster used for the fixation and protection of an injured part of the body aiming to:
immobilize the injured body part.
prevent further damage to muscles, nerves, or blood vessels caused by broken ends of bones.
prevent a closed fracture from converting into an open fracture.
decrease and control pain.
Control hemorrhage. Direct pressure and/or pressure dressings will control virtually all external hemorrhage.
Expose fracture site. Remove jewelry and watches.
Before splinting, check for distal pulses.
Splint in the position found unless limb is pulse-less.
An attempt should be made to straighten a severely deformed limb with gentle traction only if there are no distal pulses, if resistance is felt, stop and splint as it lies.
Move the fractured part as little as possible while applying the splint.
DO NOT retract the exposed bone of an open fracture back into the body.
Pad splint at bony prominence points (elbow, wrist, and ankle).
Splint the joints above and below the fracture site.
Reassess circulation and neurological status after splinting.
Volar short splint which is used for wrist fractures, fractures of the second to fifth metacarpal bones, carpal tunnel syndrome, and soft tissue injuries (Figure 15).
Finger splints which are used for phalangeal fractures (Figure 16).
Gutter splint which can be used for phalangeal fractures and metacarpal fractures; these are two types: radial and ulnar (Figure 17).
Buddy taping of toes used to secure the fractured toe to the adjacent one with adhesive strips; it is necessary to apply a small pad or sheet between toes to prevent maceration (Figure 18).
Thumb spica splint used for scaphoid fractures, extraarticular fractures of the thumb and ulnar collateral ligament injuries (Figure 19).
Stirrup splint is a below knee splint wrapping around the ankle to immobilize ankle fractures (Figure 20).
Posterior leg splint is used for distal leg fractures, ankle fractures, tarsal fractures, and metatarsal fractures (Figure 21).
A displacement of bone ends at the joints (Figures 22–24) resulting in an abnormal stretching of the ligaments around the joints. Also called luxation, occurs when there is an abnormal separation in the joint where two or more bones meet [9, 10]. Sometimes causes tearing or complete ligament separation; a partial dislocation is referred to as subluxation. They are easily recognized and diagnosed; the impact area may be swollen or look bruised with associated redness or discoloration. It may also have a strange shape or be deformed as a result of the unexpected or unbalanced trauma. Some of the other symptoms associated with dislocated joints include:
Limited or lost motion.
Pain during movement.
Numbness around the area.
Paresthesia and tingling feeling in the limb.
Posterior shoulder dislocation on X-ray.
Shoulder dislocation.
Ankle dislocation.
X-ray is usually the preferred method of imaging in the emergency department, on occasion, special imaging such as an MRI may be required for diagnosis to roll out associated fractures or tear in muscles and ligaments.
Treatment of dislocations and/or subluxations will depend on the site of joint; it may also depend on the severity of injury. According to Johns Hopkins University, initial treatment for any dislocation involves R.I.C.E: rest, ice, compression, and elevation. In some cases, the dislocated/subluxated joint might go back into place naturally after this treatment [11, 12, 13].
If the joint does not return to normal naturally, treatment options should be one or more of the following:
Manipulation or repositioning (sedatives or anesthetics are necessary to keep the patient comfortable and also to allow muscles near to the injured joint to relax, which eases the procedure).
Immobilization (a sling, splint, or cast for several weeks to prevent recurrence).
Medication (a pain reliever or a muscle relaxant).
Rehabilitation (to increase the joint’s strength and restore its range of motion).
Surgery is usually indicated only if there are damaged nerves or blood vessels, or if the doctor is unable to return bones to their anatomical position. Surgery may also be necessary for those who often dislocate the same joints, such as recurrent shoulder dislocations.
A prolonged elevation of interstitial tissue pressure within an enclosed fascial compartment leading to impaired tissue perfusion and damage. Associated with increased vessel permeability and plasma leak into the intercellular space causing further pressure on muscles and nerves (Figure 25); it might result in death if not treated before 8–12 h [14, 15, 16, 17, 18].
Acute compartment syndrome of the left foot.
This serious and critical musculoskeletal complication can be caused by direct blow or contusion, crush injury, burns, snake bites, fractures, hematoma, and prolonged pressure from splinting.
It is characterized by severe pain especially with stretching, tense compartment, tight and shiny skin. Late findings can be paresthesia, loss of pulses, and pain out of proportion.
Treatment of ACS is urgent surgical exploration with fasciotomy (Figure 26).
Fasciotomy.
It should be noted that any case with prolonged ACS of more than 8–12 h can have permanent deformity and limb viability may possibly be lost.
During management, every effort should be used to release all compartments; the main focus is on reducing the dangerous pressure in the body compartment. Dressings, casts, or splints that are constricting the affected body part must be removed. Early recognition and diagnosis, pain control, keeping the body part with ACS below the level of the heart (to improve blood flow into the compartment), treatment of shock, prevention of metabolic acidosis and acute kidney injury (AKI) are all mandatory and crucial to save the patient limb [18, 19, 20].
The incidence and socioeconomic impact of musculoskeletal diseases globally is increasing due to multiple factors. Prevention of these injuries can be achieved by providing an environment in which the worker has a safe surrounding, improved awareness about what possible danger injuries might occur, a clear path to elevation of such danger in the time of need. Occupational safety measures should always be optimal with nearby kits to aid in on-site management. With the increased demand for building and aiming to touch the clouds with sky-high skyscrapers comes great responsibility to care more about providing a healthy working environment. The frequency of musculoskeletal injury and its concomitant burden on the healthcare system is expected to increase greatly in the coming decades. Physicians are required to keep up with this leap. A well-established basic knowledge of such injuries is very crucial and can be lifesaving and cost-effective especially in the emergency department.
The previous injuries we discussed are not by any chance everything in the musculoskeletal system; we chose the most common and the most essential ones, discussed briefly. We strongly encourage every physician to take this chapter and consider it as a base and build upon it with further reading and practice.
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