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Li Z, Yu W, Lin S, Fu K, Fang Z. Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study. BMC Musculoskelet Disord 2024; 25:61. [PMID: 38216881 PMCID: PMC10787438 DOI: 10.1186/s12891-023-07156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO. METHODS Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated. RESULTS Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group. CONCLUSION MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.
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Affiliation(s)
- Zi Li
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Weiwei Yu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Shiwei Lin
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Ke Fu
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, No. 473 Hanzheng Street, Qiaokou District, Wuhan, Hubei, China.
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Ledermann G, Kuroiwa A, González N, Silva I, Villa A. Training Program for Orthopedic Residents in Forefoot Osteotomy Skills: Transference From a Simulator to a Cadaveric Surgical Scenario. Simul Healthc 2023; 18:181-186. [PMID: 35921612 DOI: 10.1097/sih.0000000000000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An effective simulation program allows both the acquisition of surgical skills on the simulated model and the transfer of these skills to a surgical scenario. We designed a forefoot osteotomy training program and sought to determine the transferability to a cadaveric surgical scenario. METHODS Eleven orthopedic residents and 2 foot and ankle surgeons were included. A foot simulator was used. All residents were instructed on the surgical techniques of Chevron, Akin, and triple Weil osteotomies. Eight junior residents (trainees) were enrolled in a supervised simulation program. Baseline assessment was performed on the simulator with the Objective Structured Assessment of Technical Skills (OSATS) and the Imperial College Surgical Assessment Device (ICSAD). After baseline, trainees completed a training program and had a final evaluation of proficiency on the simulator and on cadaveric specimens. Three senior residents with no simulated training (controls) and experts were assessed for comparison. RESULTS All trainees improved from a baseline OSATS score of 11 points (9-20) to a final score of 35 points (33-35) in the simulator and 34 points (32-34) in the cadaveric specimen ( P < 0.01). Compared with baseline, the ICSAD results improved in path length (391 [205-544] to 131 [73-278] meters, P < 0.01) and number of movements (2756 [1258-3338] to 992 [478-1908], P < 0.01). The final OSATS and ICSAD scores did not differ from experts ( P = 0.1) and were significantly different from untrained residents ( P = 0.02). CONCLUSIONS Simulated training of Chevron, Akin, and triple Weil osteotomies in orthopedic residents improved procedural proficiency, enabling successful skill transfer to a surgical scenario in cadavers. LEVEL OF EVIDENCE II (Prospective Cohort Study).
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Affiliation(s)
- Gerardo Ledermann
- From the Departamento de Traumatología (G.L., A.K., N.G., A.V.), Facultad de Medicina, Pontificia Universidad Católica de Chile; Servicio de Traumatología (G.L., A.K.); Servicio de Salud Metropolitano Sur-Oriente; and Facultad de Medicina (I.S.), Pontificia Universidad Católica de Chile, Santiago, Chile
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Toepfer A, Strässle M. The percutaneous learning curve of 3rd generation minimally-invasive Chevron and Akin osteotomy (MICA). Foot Ankle Surg 2022; 28:1389-1398. [PMID: 35882575 DOI: 10.1016/j.fas.2022.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/13/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular osteotomy, stable internal fixation and a high potential for correction. Compared to other percutaneous techniques of the foot, MICA is generally regarded as an advanced and demanding surgical procedure with a flat learning curve. The aim of this study is to analyze a single-surgeons experience with his first 50 consecutive MICA procedures. METHODS Between May 2018 and February 2021, 50 consecutive MICA procedures performed by the author with the "K-wires-First technique" were prospectively analyzed focusing on surgery duration, number of fluoroscopies, correction results and surgery-associated complications. A modification of the original MICA technique as described by its inaugurators Redfern and Vernois allows the use of a standard-sized C-arm and aims to reduce revison rates and conversion to open surgery by placing the guidewires prior to performing the osteotomy. RESULTS The average surgery time for all MICA procedures was 46.8 min (SD 12.1, range 31-90 min). The average amount of fluoro shots required to perform MICA was n = 126.6 (SD 40.8, range 65-231). Comparing the preoperative and 6-week postoperative radiographs, the IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°. One case required intraoperative conversion to open hallux correction. There were 4 feet in three patients with secondary screw removal of the Chevron fixation due to prominent proximal screw tips. CONCLUSIONS Although the learning curve of 3rd generation MICA is flat and requires specific training and intensive practice, the rate of complications is not elevated compared to other percutaneous hallux valgus techniques. Strict adherence to the principles of 3rd generation MICA with stable fixation and meticulous intraoperative control of each surgical step helps to reduce surgery-associated complications. The learning curve showed a continous improvement in regard to surgery time and use of fluoroscopy. After 40 procedures, the surgery time consistently dropped under 45 min and required less than 100 fluoro-shots. The modified surgical technique may help reduce Chevron screw mal-positioning when using large C-arm fluoroscopy for this procedure.
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Affiliation(s)
- Andreas Toepfer
- Kantonsspital St. Gallen, Department of Orthopaedic Surgery and Traumatology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland.
| | - Michael Strässle
- Kantonsspital St. Gallen, Department of Orthopaedic Surgery and Traumatology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland
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The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review with Meta-Analysis. J Foot Ankle Surg 2022:S1067-2516(22)00340-4. [PMID: 37097272 DOI: 10.1053/j.jfas.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022]
Abstract
The Scarf osteotomy is a surgical procedure performed to correct a hallux valgus deformity. Multiple studies have supported use of the procedure with favorable outcomes. In contrast, there have been studies showing a significant complication rate with the procedure. Incidence of complications remains underreported in the literature. We performed a systemic review and meta-analysis examining a wide range of reported complications and associated clinical outcomes from the Scarf osteotomy. One hundred and sixteen publications were identified and 25 (21.6%) met our inclusion criteria. A total of 1583 Scarf procedures were included. Weighted mean follow-up was 26.4 months [range 12-168 months]. We found a 5.1% rate of recurrence, 3.5% rate of troughing, 1.0% rate of avascular necrosis, 1.8% rate of nonunion, 2.7% rate of malunion, 2.4% rate of infection, 5.3% rate of complex regional pain syndrome, and 3.4% rate of hallux varus. An average decrease in intermetatarsal angle of 6.3° was observed. No statistical difference was found in outcomes when comparing Scarf versus Scarf with additional procedure performed at time of surgery. To our knowledge, this systematic review and meta-analysis contains the highest number of Scarf procedures analyzed and presents complication rates on multiple adverse outcomes.
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Clee S, Flanagan G, Pavier J, Reilly I. Correction of hallux abducto valgus by scarf osteotomy. A ten-year retrospective multicentre review of patient reported outcomes shows high satisfaction rates with podiatric surgery. J Foot Ankle Res 2022; 15:44. [PMID: 35650635 PMCID: PMC9159929 DOI: 10.1186/s13047-022-00546-3] [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: 11/23/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Corrective surgery for hallux abducto valgus is one of the most performed elective procedures in foot and ankle practice. Numerous methods of surgical correction have been reported within the literature, with varying clinical and patient reported outcomes. This study reviews the patient experience and outcomes in five podiatric surgery centres using the scarf diaphyseal osteotomy. METHOD Patient reported outcome measures (PROMs) were captured using the Patient Satisfaction Questionnaire 10 (PSQ-10), part of the PASCOM-10 podiatric surgery audit tool. PROMs were collated across five hospital sites over a 10-year period. RESULTS Of 1351 patients reported during the period, 1189 had complete retrospective data. The most common patient aim of surgery was 'no/less pain' reported in 70% of patients. 96.8% of patients reported their original foot complaint as 'better' or 'much better' after surgery. 92.8% of patients reported their expectations had been met with 96.6% reporting they would have surgery again under the same conditions. 98.5% of patients noted that the risks, complications, and expectations had been discussed prior to surgery. The most common complication was metatarsal fracture (4.6%). CONCLUSION The scarf osteotomy (with or without an Akin phalangeal osteotomy) consistently showed high patient satisfaction with low complication rates using PSQ-10 and this information can be used as part of the pre-operative consenting process. Patient expectations for surgery were often achieved, which may be attributed to the pre-operative work up of the patient. Further investigation into this correlation is suggested. LEVEL OF CLINICAL EVIDENCE IV (retrospective review).
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Affiliation(s)
- Sharon Clee
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - George Flanagan
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
| | - Julian Pavier
- Department of Podiatric Surgery Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Private Practice, The Park Hospital, Nottingham; and Circle Nottingham, Nottingham, UK
| | - Ian Reilly
- Department of Podiatric Surgery, Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northampton, UK
- Private Practice, Three Shires Hospital Northampton, Northamptonshire, UK
- Private Practice, Ramsay Woodlands Hospital, Kettering, Northamptonshire UK
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Patnaik S, Jones NJ, Dojode C, Narang A, Lal M, Iliopoulos E, Chougule S. Minimally invasive hallux valgus correction: Is it better than open surgery? Foot (Edinb) 2022; 50:101871. [PMID: 35219131 DOI: 10.1016/j.foot.2021.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim was to compare the minimally invasive (MIS) chevron osteotomy to the well-established open chevron osteotomy for the correction of hallux valgus deformity. METHODS Two retrospective cohorts of patients treated with MIS or open chevron osteotomy for hallux valgus correction, matched for age and gender with a minimum follow up of six months were reviewed. Functional outcomes were evaluated using pre and post-operative Manchester Oxford Foot and Ankle Questionnaire (MOXFQ), Visual Analog Score (VAS) for pain and the Unified Elective Orthopaedic Score (UnEOS). Two independent, blinded examiners evaluated the radiographic correction of hallux valgus (HV) and intermetatarsal (IM) angle. RESULTS A Total of 54 cases (27 per study group) with a mean follow-up of 25.9 months were included in the study. Pre-operatively, VAS (p = 0.76) and MOXFQ (p = 0.46) scores and HV angle (p = 0.1) were comparable in both groups. However, IM angle was significantly larger in the MIS group (p = 0.005). Post-operatively there was significant improvement in VAS and MOXFQ scores as well as significant correction of the HV and IM angles (p < 0.0001) for both groups. Comparing the two procedures, there was no significant difference between groups for VAS (p = 0.34), MOXFQ scores (p = 0.56) and HV angles (p = 0.069) but the MIS technique was significantly better in improving the IM angle (p = 0.016). The post-operative UnEOS score and the Satisfaction UnEOS domain reached excellent levels for the entire cohort with no statistical difference between the two groups (p = 0.2 and 0.28 respectively). CONCLUSION Results show MIS chevron osteotomy provides better radiographic correction of the IM angle but functional outcomes for all parameters were comparable to the open technique. It can therefore be considered at least equivalent to standard open surgery when compared using validated Patient Reported Outcome Measures (PROMs).
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Affiliation(s)
- Surendra Patnaik
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Neil John Jones
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Chetan Dojode
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Ashish Narang
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Mohan Lal
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
| | - Efthymios Iliopoulos
- Royal Sussex County Hospital, Barry Building, Eastern Road, Brighton, BN2 5BE, United Kingdom.
| | - Sanjay Chougule
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom.
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Ezzatvar Y, López-Bueno L, Fuentes-Aparicio L, Dueñas L. Prevalence and Predisposing Factors for Recurrence after Hallux Valgus Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245753. [PMID: 34945049 PMCID: PMC8708542 DOI: 10.3390/jcm10245753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 01/21/2023] Open
Abstract
Recurrence is a frequent and undesirable outcome after hallux valgus (HV) surgery. However, the prevalence of HV recurrence and the pre- and postoperatory factors associated with it have not been adequately studied. This study aimed to quantify the prevalence rate of HV recurrence and to analyze its predisposing factors. MEDLINE and EMBASE databases were systematically searched for observational studies including individuals undergoing HV surgical correction. The random-effects restricted maximum likelihood model was used to estimate the pooled effect size (correlation coefficient (r)). Twenty-three studies were included, yielding a total of 2914 individuals. Pooled prevalence of HV recurrence was 24.86% (95% confidence interval (CI), 19.15 to 30.57, I2 = 91.92%, p = 0.00). Preoperative HV angle (HVA) (r = 0.29; 95% CI, 0.14 to 0.43) and preoperative intermetatarsal angle (IMA) (r = 0.13; 95% CI, 0.00 to 0.27) showed a moderate positive relationship with recurrence. Postoperative HVA (r = 0.57; 95% CI, 0.21 to 0.94) and sesamoid position (r = 0.46; 95% CI, 0.31 to 0.60) showed strong relationships with recurrence. In conclusion, preoperative HVA, IMA, and postoperative HVA and sesamoid position are significant risk factors for HV recurrence, and the association of these factors with recurrence is affected by age.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Laura López-Bueno
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Laura Fuentes-Aparicio
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
| | - Lirios Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain; (L.F.-A.); (L.D.)
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Heyes GJ, Vosoughi AR, Weigelt L, Mason L, Molloy A. Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy. Foot Ankle Int 2020; 41:1212-1218. [PMID: 32672066 DOI: 10.1177/1071100720937645] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. METHODS A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under -4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). RESULTS Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender (P value = .66) or preoperative IMA (P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence (P value = .004). Those with T1MA less than -10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively (P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA -4 to -10 degrees it was 29% and in T1MA less than -10 degrees it was 47% (P value <.001). Breaks in T1MA less than -4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. CONCLUSION The prevalence of hallux valgus recurrence correlated with the severity of pes planus. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Gavin John Heyes
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Amir R Vosoughi
- Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lizzy Weigelt
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Lyndon Mason
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
| | - Andrew Molloy
- Trauma and Orthopaedics Department, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Lower Ln, Liverpool, United Kingdom
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Abstract
In this article the authors discuss their experience of performing minimally invasive surgery, with emphasis on technique and how to avoid pitfalls. They also discuss the educational literature for learning new techniques and how to shorten the "learning curve."
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Affiliation(s)
- Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, Victoria 3128, Australia.
| | - Ben Hickey
- Department of Orthopaedic Surgery, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, Wales
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