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Jia L, Zhao H, Liu J. Meta-analysis of postoperative incision infection risk factors in colorectal cancer surgery. Front Surg 2024; 11:1415357. [PMID: 39193402 PMCID: PMC11347452 DOI: 10.3389/fsurg.2024.1415357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/09/2024] [Indexed: 08/29/2024] Open
Abstract
Objective To evaluate the risk factors for postoperative incision infection in colorectal cancer, this meta-analysis aimed to identify key variables impacting infection incidence following colorectal cancer surgery. Methods Utilizing a meta-analytical approach, studies published from January 2015 to December 2022 were systematically collected and analyzed through the assessment of factors like body mass index, diabetes, albumin levels, malnutrition, and surgical duration. Results The meta-analysis of eleven high-quality studies revealed that elevated BMI, diabetes, low albumin levels, malnutrition, and extended surgical duration were associated with increased infection risk, while laparoscopic procedures showed potential for risk reduction. Conclusions This study underscores the significance of preoperative risk assessment and management in mitigating postoperative incision infections in colorectal cancer patients. The findings present actionable insights for clinicians to enhance patient prognoses and overall quality of life.
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Affiliation(s)
- Li Jia
- Department of Infection Control, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Huacai Zhao
- Department of Urology, People's Hospital of Dayi County, Chengdu, Sichuan Province, China
| | - Jia Liu
- Department of Infection Control, Chengdu Fifth People’s Hospital, Chengdu, Sichuan Province, China
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Saeed A, Bradley CS, Verma Y, Kelley SP. Resolving residual acetabular dysplasia following successful brace treatment for developmental dysplasia of the hip in infants. Bone Joint J 2024; 106-B:744-750. [PMID: 38945534 DOI: 10.1302/0301-620x.106b7.bjj-2023-1169.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims Radiological residual acetabular dysplasia (RAD) has been reported in up to 30% of children who had successful brace treatment of infant developmental dysplasia of the hip (DDH). Predicting those who will resolve and those who may need corrective surgery is important to optimize follow-up protocols. In this study we have aimed to identify the prevalence and predictors of RAD at two years and five years post-bracing. Methods This was a single-centre, prospective longitudinal cohort study of infants with DDH managed using a published, standardized Pavlik harness protocol between January 2012 and December 2016. RAD was measured at two years' mean follow-up using acetabular index-lateral edge (AI-L) and acetabular index-sourcil (AI-S), and at five years using AI-L, AI-S, centre-edge angle (CEA), and acetabular depth ratio (ADR). Each hip was classified based on published normative values for normal, borderline (1 to 2 standard deviations (SDs)), or dysplastic (> 2 SDs) based on sex, age, and laterality. Results Of 202 infants who completed the protocol, 181 (90%) had two and five years' follow-up radiographs. At two years, in 304 initially pathological hips, the prevalence of RAD (dysplastic) was 10% and RAD (borderline) was 30%. At five years, RAD (dysplastic) decreased to 1% to 3% and RAD (borderline) decreased to < 1% to 2%. On logistic regression, no variables were predictive of RAD at two years. Only AI-L at two years was predictive of RAD at five years (p < 0.001). If both hips were normal at two years' follow-up (n = 96), all remained normal at five years. In those with bilateral borderline hips at two years (n = 21), only two were borderline at five years, none were dysplastic. In those with either borderline-dysplastic or bilateral dysplasia at two years (n = 26), three (12%) were dysplastic at five years. Conclusion The majority of patients with RAD at two years post-brace treatment, spontaneously resolved by five years. Therefore, children with normal radiographs at two years post-brace treatment can be discharged. Targeted follow-up for those with abnormal AI-L at two years will identify the few who may benefit from surgical correction at five years' follow-up.
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Affiliation(s)
- Ayesha Saeed
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Catharine S Bradley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Yashvi Verma
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Simon P Kelley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Singh A, Wade RG, Metcalfe D, Perry DC. Does This Infant Have a Dislocated Hip?: The Rational Clinical Examination Systematic Review. JAMA 2024; 331:1576-1585. [PMID: 38619828 DOI: 10.1001/jama.2024.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Importance Delayed diagnosis of a dislocated hip in infants can lead to complex childhood surgery, interruption to family life, and premature osteoarthritis. Objective To evaluate the diagnostic accuracy of clinical examination in identifying dislocated hips in infants. Data Sources Systematic search of CINAHL, Embase, MEDLINE, and the Cochrane Library from the inception of each database until October 31, 2023. Study Selection The 9 included studies reported the diagnostic accuracy of the clinical examination (index test) in infants aged 3 months or younger and a diagnostic hip ultrasound (reference test). The Graf method of ultrasound assessment was used to classify hip abnormalities. Data Extraction and Synthesis The Rational Clinical Examination scale was used to assign levels of evidence and the Quality Assessment of Diagnostic Accuracy Studies tool was used to assess bias. Data were extracted using the individual hip as the unit of analysis; the data were pooled when the clinical examinations were evaluated by 3 or more of the included studies. Main Outcomes and Measures Sensitivity, specificity, and likelihood ratios (LRs) of identifying a dislocated hip were calculated. Results Among infants screened with a clinical examination and a diagnostic ultrasound in 5 studies, the prevalence of a dislocated hip (n = 37 859 hips) was 0.94% (95% CI, 0.28%-2.0%). There were 8 studies (n = 44 827 hips) that evaluated use of the Barlow maneuver and the Ortolani maneuver (dislocate and relocate an unstable hip); the maneuvers had a sensitivity of 46% (95% CI, 26%-67%), a specificity of 99.1% (95% CI, 97.9%-99.6%), a positive LR of 52 (95% CI, 21-127), and a negative LR of 0.55 (95% CI, 0.37-0.82). There were 3 studies (n = 22 472 hips) that evaluated limited hip abduction and had a sensitivity of 13% (95% CI, 3.3%-37%), a specificity of 97% (95% CI, 87%-99%), a positive LR of 3.6 (95% CI, 0.72-18), and a negative LR of 0.91 (95% CI, 0.76-1.1). One study (n = 13 096 hips) evaluated a clicking sound and had a sensitivity of 13% (95% CI, 6.4%-21%), a specificity of 92% (95% CI, 92%-93%), a positive LR of 1.6 (95% CI, 0.91-2.8), and a negative LR of 0.95 (95% CI, 0.88-1.0). Conclusions and Relevance In studies in which all infant hips were screened for developmental dysplasia of the hip, the prevalence of a dislocated hip was 0.94%. A positive LR for the Barlow and Ortolani maneuvers was the finding most associated with an increased likelihood of a dislocated hip. Limited hip abduction or a clicking sound had no clear diagnostic utility.
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Affiliation(s)
- Abhinav Singh
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ryckie George Wade
- Academic Department of Plastic and Reconstructive Surgery, University of Leeds, Leeds, England
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Daniel C Perry
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
- Department of Child Health, Alder Hey Children's Hospital, University of Liverpool, Liverpool, England
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Ucpunar H, Sevencan A, Erbas A, Ozyalvac ON, Akpinar E, Bayhan AI. Effect of the Pavlik harness used in the treatment of developmental dysplasia of the hip on unaided sitting and independent walking age. J Child Orthop 2024; 18:79-84. [PMID: 38348432 PMCID: PMC10859113 DOI: 10.1177/18632521231217330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/11/2023] [Indexed: 02/15/2024] Open
Abstract
Background Pavlik harness is the most widely used orthosis in the treatment of developmental dysplasia of the hip. The aim of this study was to evaluate the effect of the Pavlik harness on the development of "unaided sitting" and "independent walking" in infants with developmental dysplasia of the hip. Methods This prospective study, conducted from 2017 to 2020, included infants undergoing Pavlik harness therapy. Inclusion criteria comprised gestational age > 37 weeks, treatment initiation before 6 months of age, and no prior treatment for developmental dysplasia of the hip. We assessed treatment initiation age, treatment duration, and the age of achieving unaided sitting and independent walking. Results In the patient group, unaided sitting commenced at a mean age of 6.8 ± 1.6 (range: 4-11) months, while independent walking began at a mean age of 12.7 ± 1.8 (range: 9-18) months. By 15 months, 92% of the patients achieved independent walking. In the control group, unaided sitting occurred at a mean age of 6.1 ± 1.1 (range: 4-8) months, and independent walking at 11.8 ± 1.6 (range: 9-18) months. A significant positive correlation was observed between the duration of Pavlik harness usage and the age of unaided sitting (p < 0.001) and independent walking (p < 0.001). Conclusion Our study indicates that Pavlik harness treatment for developmental dysplasia of the hip is generally safe and does not lead to clinically significant delays in unaided sitting and independent walking. However, some minor delays may occur due to extended orthosis use. Level of evidence level III-prospective cohort study.
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Affiliation(s)
- Hanifi Ucpunar
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Sevencan
- Department of Orthopedics, Medicana Ataköy Hospital, Istanbul, Turkey
| | - Anil Erbas
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Osman Nuri Ozyalvac
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Evren Akpinar
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Avni Ilhan Bayhan
- Department of Orthopaedics Surgery and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Bradley CS, Verma Y, Maddock CL, Wedge JH, Gargan MF, Kelley SP. A comprehensive nonoperative treatment protocol for developmental dysplasia of the hip in infants. Bone Joint J 2023; 105-B:935-942. [PMID: 37524345 DOI: 10.1302/0301-620x.105b8.bjj-2023-0149.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment. Methods This was a single-centre, prospective, longitudinal cohort study of a consecutive series of infants with ultrasound-confirmed DDH who underwent a comprehensive nonoperative brace management protocol in a unified multidisciplinary clinic between January 2012 and December 2016 with five-year follow-up radiographs. The radiological outcomes were acetabular index-lateral edge (AI-L), acetabular index-sourcil (AI-S), centre-edge angle (CEA), acetabular depth ratio (ADR), International Hip Dysplasia Institute (IHDI) grade, and evidence of avascular necrosis (AVN). At five years, each hip was classified as normal (< 1 SD), borderline dysplastic (1 to 2 SDs), or dysplastic (> 2 SDs) based on validated radiological norm-referenced values. Results Of 993 infants assessed clinically and sonographically, 21% (212 infants, 354 abnormal hips) had DDH and were included. Of these, 95% (202 infants, 335 hips) successfully completed bracing, and 5% (ten infants, 19 hips) failed bracing due to irreducible hip(s). The success rate of bracing for unilateral dislocations was 88% (45/51 infants) and for bilateral dislocations 83% (20/24 infants). The femoral nerve palsy rate was 1% (2/212 infants). At five-year follow-up (mean 63 months (SD 5.9; 49 to 83)) the prevalence of residual dysplasia after successful brace treatment was 1.6% (5/312 hips). All hips were IHDI grade I and none had AVN. Four children (4/186; 2%) subsequently underwent surgery for residual dysplasia. Conclusion Our comprehensive protocol for nonoperative treatment of infant DDH has shown high rates of success and extremely low rates of residual dysplasia at a mean age of five years.
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Affiliation(s)
- Catharine S Bradley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Yashvi Verma
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Connor L Maddock
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - John H Wedge
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Martin F Gargan
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Simon P Kelley
- Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Martín-Núñez J, Raya-Benítez J, López-López L, Calvache-Mateo A, Heredia-Ciuró A, Navas-Otero A, Valenza MC. Efficacy in urinary symptom burden, psychological distress, and self-efficacy of education-enhanced interventions in prostate cancer patients: a systematic review and meta-analyses. Support Care Cancer 2023; 31:340. [PMID: 37191890 DOI: 10.1007/s00520-023-07803-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Worldwide, prostate cancer is both the second-most diagnosed cancer and most common solid tumor in men. Prostate cancer patients present with a symptom burden that is compounded by the impact of medical oncology treatment, affecting different domains of their perceived health status. Education active techniques are a key role in chronic disease to increase participation in their recovery. PURPOSE The purpose of the current review was to examine the efficacy of education-enhanced in urinary symptom burden, psychological distress, and self-efficacy in patients diagnosed with prostate cancer. METHODS A wide search of the literature was conducted for articles from their inception to June 2022. Only randomized controlled trials were included. Data extraction and methodologic quality assessment of the studies were carried out by two reviewers. We previously registered the protocol of this systematic review on PROSPERO (CRD42022331954). RESULTS A total of six studies were included in the study. After education-enhanced intervention showed significant improvements in any of perceived urinary symptom burden, one in psychological distress, and one in self-efficacy in the experimental group. The meta-analysis showed that education-enhanced interventions have a significant effect on depression. CONCLUSION Education-enhanced could have positive effects on urinary symptom burden, psychological distress, and self-efficacy in prostate cancer survivors. Our review was unable to demonstrate the best timing to apply education-enhanced strategies.
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Affiliation(s)
- Javier Martín-Núñez
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Julia Raya-Benítez
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Laura López-López
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Andrés Calvache-Mateo
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Alba Navas-Otero
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain
| | - Marie Carmen Valenza
- Faculty of Health Sciences, Department of Physiotherapy, University of Granada, Av. De La Ilustración, 60, 18016, Granada, Spain.
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Dwan K, Kirkham J, Paton RW, Morley E, Newton AW, Perry DC. Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age. Cochrane Database Syst Rev 2022; 10:CD012717. [PMID: 36214650 PMCID: PMC9549867 DOI: 10.1002/14651858.cd012717.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) describes the abnormal development of a hip in childhood, ranging from complete dislocation of the hip joint to subtle immaturity of a hip that is enlocated and stable within the socket. DDH occurs in around 10 per 1000 live births, though only one per 1000 are completely dislocated. There is variation in treatment pathways for DDH, which differs between hospitals and even between clinicians within the same hospital. The variation is related to the severity of dysplasia that is believed to require treatment, and the techniques used to treat dysplasia. OBJECTIVES To determine the effectiveness of splinting and the optimal treatment strategy for the non-operative management of DDH in babies under six months of age. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, seven other electronic databases, and two trials registers up to November 2021. We also checked reference lists, contacted study authors, and handsearched relevant meetings abstracts. SELECTION CRITERIA Randomised controlled trials (RCTs), including quasi-RCTs, as well as non-RCTs and cohort studies conducted after 1980 were included. Participants were babies with all severities of DDH who were under six months of age. Interventions included dynamic splints, static splints or double nappies (diapers), compared to no splinting or delayed splinting. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and performed risk of bias and GRADE assessments. The primary outcomes were: measurement of acetabular index at years one, two and five, as determined by radiographs (angle): the need for operative intervention to achieve reduction and to address dysplasia; and complications. We also investigated other outcomes highlighted by parents as important, including the bond between parent and child and the ability of mothers to breastfeed. MAIN RESULTS We included six RCTs or quasi-RCTs (576 babies). These were supported by 16 non-RCTs (8237 babies). Five studies had non-commercial funding, three studies stated 'no funding' and 14 studies did not state funding source. The RCTs were generally at unclear risk of bias, although we judged three RCTs to be at high risk of bias for incomplete outcome data. The non-RCTs were of moderate and critical risk of bias. We did not undertake meta-analysis due to methodological and clinical differences between studies; instead, we have summarised the results narratively. Dynamic splinting versus delayed or no splinting Four RCTs and nine non-RCTs compared immediate dynamic splinting and delayed dynamic splinting or no splinting. Of the RCTs, two considered stable hips and one considered unstable (dislocatable) hips and one jointly considered unstable and stable hips. No studies considered only dislocated hips. Two RCTs (265 babies, very low-certainty evidence) reported acetabular index at one year amongst stable or dislocatable hips. Both studies found there may be no evidence of a difference in splinting stable hips at first diagnosis compared to a strategy of active surveillance: one reported a mean difference (MD) of 0.10 (95% confidence interval (CI) -0.74 to 0.94), and the other an MD of 0.20 (95% CI -1.65 to 2.05). Two RCTs of stable hips (181 babies, very low-certainty evidence) reported there may be no evidence of a difference between groups for acetabular index at two years: one study reported an MD of -1.90 (95% CI -4.76 to 0.96), and another study reported an MD of -0.10 (95% CI -1.93 to 1.73), but did not take into account hips from the same child. No study reported data at five years. Four RCTs (434 babies, very low-certainty evidence) reported the need for surgical intervention. Three studies reported that no surgical interventions occurred. In the remaining study, two babies in the dynamic splinting group developed instability and were subsequently treated surgically. This study did not explicitly state if this treatment was to achieve concentric reduction or address residual dysplasia. Three RCTs (390 babies, very low-certainty evidence) reported no complications (avascular necrosis and femoral nerve palsy). Dynamic splinting versus static splinting One RCT and five non-RCTs compared dynamic versus static splinting. The RCT (118 hips) reported no occurrences of avascular necrosis (very low-certainty evidence) and did not report radiological outcomes or need for operative intervention. One quasi-RCT compared double nappies versus delayed or no splinting but reported no outcomes of interest. Other comparisons No RCTs compared static splinting versus delayed or no splinting or staged weaning versus immediate removal. AUTHORS' CONCLUSIONS There is a paucity of RCT evidence for splinting for the non-operative management of DDH: we included only six RCTs with 576 babies. Moreover, there was considerable heterogeneity between the studies, precluding meta-analysis. We judged the RCT evidence for all primary outcomes as being of very low certainty, meaning we are very uncertain about the true effects. Results from individual studies provide limited evidence of intervention effects on different severities of DDH. Amongst stable dysplastic hips, there was no evidence to suggest that treatment at any stage expedited the development of the acetabulum. For dislocatable hips, a delay in treatment onset to six weeks does not appear to result in any evidence of a difference in the development of the acetabulum at one year or increased risk of surgery. However, delayed splinting may reduce the number of babies requiring treatment with a harness. No RCTs compared static splinting with delayed or no splinting, staged weaning versus immediate removal or double nappies versus delayed or no splinting. There were few operative interventions or complications amongst the RCTs and the non-randomised studies. There's no apparent signal to indicate a higher frequency of either outcome in either intervention group. Given the frequency of this disease, and the fact that many countries undertake mandatory DDH screening, there is a clear need to develop an evidence-based pathway for treatment. Particular uncertainties requiring future research are the effectiveness of splinting amongst stable dysplastic hips, the optimal timing for the onset of splinting, the optimal type of splint to use and the need for 'weaning of splints'. Only once a robust pathway for treatment is established, can we properly assess the cost-effectiveness of screening interventions for DDH.
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Affiliation(s)
- Kerry Dwan
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Jamie Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Robin W Paton
- East Lancashire Hospitals NHS Trust, Burnley, UK
- School of Medicine, University of Central Lancashire, Preston, Lancashire, UK
| | | | | | - Daniel C Perry
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Department of Orthopaedic Surgery, Alder Hey Hospital, Liverpool, UK
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