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Mahapatra B, Pal B. Biomechanical analysis of various internal fracture fixation devices used for treating femoral neck fractures: A comparative finite element analysis. Injury 2024; 55:111717. [PMID: 39002322 DOI: 10.1016/j.injury.2024.111717] [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: 03/22/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Several internal fixation devices are available for treating Pauwels type I, II and III femoral neck fractures. The present study compared various fixation implants for all Pauwels fracture types using a CT-based subject-specific finite element model of the femur and determined the most effective implant for each fracture type. MATERIALS AND METHODS The analysis included four different configurations of cannulated screw models, Femoral Neck System, Dynamic Hip Screw and Dynamic Condylar Screw (with and without anti-rotational screw). Ti-alloy was considered as the implant material. Heterogeneous bone material property was assigned based on CT grey value. Frictional contact was assumed in the contact interfaces. Peak loading corresponding to normal walking and stair-climbing were considered. Equivalent strain in bone, equivalent stress in the implants, femoral head deformation and rotation, micromotion in the contact interfaces, and strain-shielding in bone were evaluated for each implanted model. RESULTS Stresses generated in the implants were within the yield limit of the implant material. In Pauwels I and II, the micromotion predicted at the contact regions in all the implanted models was within 100 µm, which is suitable for bone integration. However, in Pauwels III fracture, most of the implanted models other than DHS with AR-screw model exhibited micromotion of more than 150 µm in the contact regions, which is expected to inhibit bone growth. CONCLUSIONS The DHS with AR-screw implanted model was identified as the most effective in treating Pauwels I and III fractures. However, for Pauwels type II, DCS with an AR-screw implant was deemed superior to the other configurations.
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Affiliation(s)
- Biswajit Mahapatra
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India
| | - Bidyut Pal
- Department of Mechanical Engineering, Indian Institute of Engineering Science and Technology, Shibpur, Howrah 711103, West Bengal, India.
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Uhrenholt L, Bakkegaard JH, Hansen K, Doktor KK. Towards the diagnosis of osteoporosis - contributions from coincidental diagnostic imaging findings in chiropractors' practice. Chiropr Man Therap 2024; 32:24. [PMID: 38915085 PMCID: PMC11194920 DOI: 10.1186/s12998-024-00545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded. METHODS This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication. RESULTS National guidelines are available regarding referral for X-rays in chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed. CONCLUSIONS This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients' health.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Nortvig & Uhrenholt Kiropraktisk Klinik, Jens Baggesens Vej 88A, 8200, Aarhus N, Denmark.
| | | | - Kasper Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Klaus Knarberg Doktor
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Rygcenter Midtvest, Dalgas Alle 2, 7400, Herning, Denmark
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Lopez-Hualda A, García-Cabrera EM, Lobato-Perez M, Martinez-Martin J, Rossettini G, Leigheb M, Villafañe JH. Mechanical Complications of Proximal Femur Fractures Treated with Intramedullary Nailing: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:718. [PMID: 38792901 PMCID: PMC11123330 DOI: 10.3390/medicina60050718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: This retrospective cohort study analyzes mechanical complications in hip fracture surgery using the Trochanteric Fixation Nail-Advanced (TFNA) implant. It investigates the correlation of these complications with demographic, intraoperative, and radiological factors, aiming to identify associated risk factors and suggest improvements in clinical surveillance and treatment strategies. Materials and Methods: We enrolled 253 patients diagnosed with pertrochanteric hip fractures treated between 2017 and 2021, with 126 meeting the criteria for a minimum 6-month follow-up. Data on demographics, American Anesthesia Association Classification (ASA), comorbidities, AO/OTA [AO (Arbeitsgemeinschaft für Osteosynthesefragen)/OTA (Orthopedic Trauma Association)] fracture classification, procedural details, and time to failure were collected. Radiographs were evaluated for reduction quality, the tip-apex distance (TAD), progressive varus deviation, and identification of mechanical complications. Statistical analysis was performed using SPSS software. Results: The predominant AO/OTA fracture classification was 31A2 in 67 cases (52.7%). Reduction quality was deemed good or acceptable in 123 cases (97.6%). The mean time to failure was 4.5 months (range: 2.2-6). The average TAD was 18 mm (range: 1.2-36), with a mean progressive varus deviation of 2.44° (range: 1.30-4.14). A good or acceptable reduction quality was observed in 97.6% of cases. Mechanical complications occurred in 21.4% of patients, with significant associations found with the lateral cortex fracture, use of a TFNA implant with a 130° angle, open reduction, and absence of prior osteoporosis treatment. Conclusions: The study provides insights into mechanical complications in proximal femur fractures treated with the TFNA nail, emphasizing the need for enhanced clinical and radiographic surveillance, especially in patients without osteoporosis treatment. Our findings support the necessity for further clinical studies comparing these outcomes with other implant designs and underscore the importance of personalized treatment strategies to reduce complication rates.
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Affiliation(s)
- Alvaro Lopez-Hualda
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Fundación Alcorcon, 28922 Alcorcón, Spain; (A.L.-H.); (E.M.G.-C.); (M.L.-P.); (J.M.-M.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Esperanza Marin García-Cabrera
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Fundación Alcorcon, 28922 Alcorcón, Spain; (A.L.-H.); (E.M.G.-C.); (M.L.-P.); (J.M.-M.)
| | - Marina Lobato-Perez
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Fundación Alcorcon, 28922 Alcorcón, Spain; (A.L.-H.); (E.M.G.-C.); (M.L.-P.); (J.M.-M.)
| | - Javier Martinez-Martin
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Fundación Alcorcon, 28922 Alcorcón, Spain; (A.L.-H.); (E.M.G.-C.); (M.L.-P.); (J.M.-M.)
| | - Giacomo Rossettini
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, Tenerife, 38300 Canary Islands, Spain
- Department of Human Neurosciences, University of Roma “Sapienza Roma”, 00184 Rome, Italy
- School of Physiotherapy, University of Verona, 37129 Verona, Italy
| | | | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Wulbrand C, Müller F, Füchtmeier B, Hanke A. Therapy aspects of peri-implant femoral fractures-a retrospective analysis of 64 patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02508-9. [PMID: 38530409 DOI: 10.1007/s00068-024-02508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The incidence of peri-implant femoral fractures (PIFF) is increasing. Information regarding outcomes, timing of surgery, risk factors, and a clinically applicable treatment algorithm are lacking. The aim of this study was to identify outcome-related risk factors and to derive a treatment algorithm. METHODS Sixty-four PIFFs treated between 01.01.2006 and 31.12.2020 in a level I trauma centre were evaluated retrospectively for fracture pattern, surgical technique, risk factors, complications, and 1-year mortality. The study was approved by the ethics committee (No. 21-2714-104). RESULTS One-year mortality was 24.1%. Surgical complications occurred in 4.7%, and general complications in 15.6% of the patients. General complications, low haemoglobin level at admission, elevated CHA2DS2-VASc, and Charlson score resulted in increased 1-year mortality. Time to surgery > 24 h did not increase complication or mortality rates. The three predominant fracture patterns were fractures close or distal to cephalomedullary nails, close or proximal to distal lateral plates, and close or distal to sliding hip screws. Recommendations for surgical treatment were derived: Osteosynthesis should enable as much weight-bearing as possible; the initial implant should only be removed, if this is essential for the new osteosynthesis; lateral locking plates should span the whole femur; antegrade nails should have a cephalomedullary component to avoid consecutive femoral neck fractures; implants should overlap to reduce the risk of consecutive inter-implant fractures. CONCLUSION Risk factors for 1-year mortality in patients with PIFFs were identified. A treatment algorithm and general principles for surgery of PIFFs were developed.
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Affiliation(s)
- Christian Wulbrand
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Bernd Füchtmeier
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Alexander Hanke
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
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Hoehmann CL, Mubin NF, Hinnenkamp G, Modica EJ, Eckardt PA, Cuellar JC. Predicting Instability Risk Following Hemiarthroplasty for Femoral Neck Hip Fractures in Geriatric Patients. J Arthroplasty 2024; 39:708-715. [PMID: 37776983 DOI: 10.1016/j.arth.2023.09.030] [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: 06/22/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Although a rare complication, dislocation following hemiarthroplasty (HA) for a femoral neck hip fracture is associated with increased mortality, readmission, and possible revision surgery. To date many of the specific risk factors have been difficult to demonstrate. Patient factors, surgical factors, as well as morphological factors need to be assessed. Therefore, the purpose of this study was to elucidate the risk factors for dislocation of HA following femoral neck hip fractures in the geriatric population. METHODS This was a retrospective review of 270 patients who had hip fractures. Medical records between the years 2016 and 2022 informed binomial regression predictive models. The discriminative ability of variables in the final model and acetabular anteversion to predict dislocation was assessed with area under the curve (AUC) estimates. RESULTS Center edge angle (odds ratio 1.23), abduction angle (odds ratio 1.17), and depth width ratio (2.96e-11) were significant predictors of dislocation (P = .003, .028, and <.001, respectively). Center edge angle and depth width ratio (<44.1 ° and .298), respectively, were cut scores for risk. Dementia had a high discriminative of ability, as did men (AUC = 0.617, 0.558, respectively). Acetabular anteversion was not predictive of dislocation (P = .259) and theorized anteversion safe zones had poor discriminative ability with AUCs of 0.510 and 0.503, respectively. CONCLUSIONS Morphological factors related to hip dysplasia and a shallow acetabulum, which can be assessed with a radiograph alone, were found to be predictors of instability following HA in the elderly. Hemiarthroplasty implant design and manufacturer, and also acetabular version did not contribute to instability risk.
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Affiliation(s)
- Christopher L Hoehmann
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Nailah F Mubin
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Glyn Hinnenkamp
- Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, New York
| | - Edward J Modica
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | | | - John C Cuellar
- Department of Orthopaedic Surgery, Good Samaritan Hospital, West Islip, New York
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Guyan F, Gianduzzo E, Waltenspül M, Dietrich M, Kabelitz M. Cortical Thickness Index and Canal Calcar Ratio: A Comparison of Proximal Femoral Fractures and Non-Fractured Femora in Octogenarians to Centenarians. J Clin Med 2024; 13:981. [PMID: 38398294 PMCID: PMC10889276 DOI: 10.3390/jcm13040981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The cortical thickness index (CTI) is a measure of bone quality and it correlates with the risk of proximal femoral fractures. The purpose of this study was to investigate the CTI in femoral neck, trochanteric fractures and non-fractured femora in geriatric patients and to determine whether there is a correlation between the CTI and the presence of a fracture. Methods: One hundred and fifty patients (fifty femoral neck- (FNFx), fifty trochanteric fractures (TFx) and fifty non-fractured (NFx)) with a mean age of 91 (range 80-104) years were included. Hip radiographs (antero-posterior (ap), lateral) were evaluated retrospectively. Measurements on the proximal femoral inner and outer cortices, including CTI and Dorr's canal calcar ratio (CCR), were assessed for inter-observer reliability (ICC), differences of each fracture and correlation of parameters. Results: The mean ap CTI on the affected side was 0.43, 0.45 and 0.55 for FNFx, TFx and NFx, respectively. There was a significant difference of the ap CTI and CCR comparing the injured and healthy side for both fracture cohorts (p < 0.001). Patients with FNFx or TFx had significantly lower CTI on both sides compared to the NFx group (p < 0.05). There was no difference for CTI (p = 0.527) or CCR (p = 0.291) when comparing both sides in the NFx group. The mean inter-observer reliability was good to excellent (ICC 0.88). Conclusions: In proximal femoral fractures, the CTI and CCR are reduced compared with those in non-fractured femora. Both parameters are reliable and show a good correlation in geriatric patients. Therefore, especially for geriatric patients, the CTI and CCR may help to predict fracture risk and consult patients in daily practice.
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Affiliation(s)
| | | | | | | | - Method Kabelitz
- Clinic for Orthopaedics, Hand Surgery and Trauma Surgery, Stadtspital Zürich, Tièchestrasse 99, 8037 Zürich, Switzerland; (F.G.); (E.G.)
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Búřilová P, Melišková M, Búřil J, Haršány M, Pokorná A. The Use of Screening Tests in Differential Diagnosis in Nursing Care. Crit Care Nurs Q 2024; 47:83-89. [PMID: 38031311 DOI: 10.1097/cnq.0000000000000493] [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: 12/01/2023]
Abstract
Geriatric syndromes involving instability are associated with a higher risk of further complications in patients with trauma requiring subsequent surgery. Acute stroke symptoms require prompt recognition and initiation of reperfusion treatment. This case study describes the patient's stroke symptoms in a timeline and explores the benefit of objective assessment using screening tests and their importance in the differential diagnosis in nursing. Dysphagia is one of the stroke symptoms that can lead to aspiration pneumonia and increase the risk of mortality. This article aims to inform general nurses about the importance of early recognition of dysphagia and other stroke symptoms using adequate screening tests to ensure quality care. Geriatric syndromes encompass instability, resulting in a higher risk of complications, especially in trauma patients. This case study describes a patient with acute ischemic stroke with vague and unrecognized symptoms of dysphagia and explores the rationale for objective screening tests in nursing care.
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Affiliation(s)
- Petra Búřilová
- Departments of Health Sciences (Mss Búřilová and Melišková and Dr Pokorná) and Public Health (Ms Búřilová), Faculty of Medicine (Drs Búřil and Haršány), Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic (Ms Búřilová and Drs Búřil and Pokorná); and Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (Drs Búřil and Haršány)
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Deichsel A, Katthagen JC, Raschke MJ, Riesenbeck O. Medial migration of the helical blade with penetration into the acetabulum: a rare complication using the TFNA nail. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:113-117. [PMID: 37351646 PMCID: PMC10771584 DOI: 10.1007/s00590-023-03615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To determine the frequency and possible reasons of medial migration with penetration into the acetabulum (MMPA) of the helical blade when using the Trochanteric Fixation Nail Advanced (TFNA) is used for treatment of pertrochanteric fractures. METHODS All patients with pertrochanteric femoral fracture, treated by intramedullary femoral nailing with the TFNA, were retrospectively reviewed for MMPA of the helical blade. Epidemiological parameters, additional procedures, distance of medial migration, time from primary operation to revision as well as type of revision were assessed. RESULTS 4 of 153 patients treated with the TFNA developed an MMPA of the helical blade (risk = 2.6%), with a mean medial migration of the blade of 11.6 mm (SD 8.8). The mean time from initial operation to revision surgery was 70 days (SD 30). All patients were revised by conversion to cemented total hip arthroplasty. CONCLUSION MMPA of the helical blade is a rare but potentially hazardous complication of femoral nailing with the TFNA femoral nail, resulting in the necessity for revision surgery and total hip arthroplasty.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
| | - J Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Oliver Riesenbeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
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Rincón-Hoyos JA, Vallejo-Yepes P, Restrepo-Giraldo JN, Torres-Valencia H, Buitrago-Vanegas M, Valencia-Rivas M, Casas-Galindo J, López-Trujillo JC. Morbidity and mortality in hip surgery patients due to fracture during the COVID-19 pandemic. Injury 2023; 54 Suppl 6:110731. [PMID: 37085352 PMCID: PMC10105622 DOI: 10.1016/j.injury.2023.04.018] [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: 01/09/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The COVID-19 epidemic generated major changes in general surgical management protocols. The literature has reported high mortality rates for hip fracture surgery in patients with COVID-19. This study describes the morbidity and mortality in patients undergoing surgery due to hip fractures in 12 Colombian institutions between March and September 2020. METHODOLOGY This was a retrospective observational descriptive study. Medical records of 12 hospitals were reviewed. Consecutive patients who underwent hip fracture surgery from March 6 to September 6, 2020, were included. Data collected were sociodemographic profile, type of fracture, surgical treatment, complications, and early (1 month) or mid-term (1-6 months) mortality associated or not with COVID-19. RESULTS Five hundred twenty patients with hip fractures requiring surgery in the 12 institutions were included. 364 (70%) were women; mean age was 77.7 years (SD: 13.8), mean BMI was 25.1, 91.73% of patients had at least one comorbidity, 60.38% were classified as ASA II and 25.77% as ASA III. There were 267 (51.34%) pertrochanteric fractures, 227 (43.65%) femoral neck fractures, and 26 (5.0%) subtrochanteric fractures. 274 (52.69%) patients were treated with osteosynthesis, 244 (46.92%) with arthroplasty, and 2 (0.38%) with girdlestone. Surgery was performed less than 24 h after the fracture for 115 (22.11%) patients, between 24 and 72 h for 208 (40.0%) patients, and more than 72 h for 197 (37.88%) patients. One hundred six patients in total suffered a medical or surgical complication throughout the different follow-up stages, amongst the most frequent were respiratory failure, coronary events, surgical site infection, cutting-out and peri‑implant fracture. 25 (4.8%) patients required attention in the Intensive Care Unit (ICU). 13 patients had COVID-19 throughout the follow-up period. 27 patients died due to any cause, and 3 of them had reported a positive COVID-19 test any time during follow-up period, of which one died during the first month, and two died between 1 and 6 months. Statistically significant associations were found between age older than 75 years old, ASA classification, ICU requirement, and death. CONCLUSION 520 patients received surgical treatment for hip fracture during the first six months of the COVID-19 pandemic in 12 medical centers in Colombia. 21.10% suffered a complication during the early stage (30 days) and 4.77% during the midterm stage (1-6 months). 4.8% were admitted in the ICU during the early stage. All-cause death was 27 patients, early death was 11 (40.74%) and midterm death was 16 (59.25%). 13 patients were positive for COVID-19, 3 died, one (1/5=20%) on the first 30 days and the other two (2/8=25%) from month 1 to 6.
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Affiliation(s)
| | - Pablo Vallejo-Yepes
- Hip and Orthopedic Trauma Surgeon, Los Cobos Medical Center, Bogotá, Colombia
| | | | - Heiller Torres-Valencia
- Orthopedic and trauma surgeon, Hospital Departamental Universitario San Juan de Dios, Armenia, Colombia
| | | | | | - Jorge Casas-Galindo
- Hip and Orthopedic Trauma Surgeon, Clínica Universitaria Colombia, Bogotá, Colombia
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Ibrahim YB, Mohamed AY, Ibrahim HS, Mohamed AH, Cici H, Mohamed YG, Yasin NA, May H. Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia. Sci Rep 2023; 13:12847. [PMID: 37553483 PMCID: PMC10409861 DOI: 10.1038/s41598-023-39671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.
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Affiliation(s)
| | | | | | | | - Hakan Cici
- Izmir Democracy University, İzmir, Turkey
| | | | - Nor Abdi Yasin
- Mogadishu Somalia Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Hasan May
- Antalya Eğitim ve Araştırma Hastanesi, Antalya, Turkey
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Davis JM, Cuadra M, Roomian T, Wally MK, Seymour RB, Hymes RA, Ramsey L, Hsu JR. Impact of Anesthesia selection on Post-Op Pain Management in Operatively treated Hip Fractures. Injury 2023:110872. [PMID: 37394331 DOI: 10.1016/j.injury.2023.110872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/24/2023] [Accepted: 06/03/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To determine if the use of Peripheral Nerve Block (PNB) versus Local Infiltration Analgesia (LIA) for hip fracture patients, affected opioid consumption in the early post-operative period. DESIGN Retrospective cohort study SETTING: Two level 1 trauma centers PATIENTS/INTERVENTION: 588 patients with surgically treated AO/OTA 31A and 31B fractures between February 2016-October 2017 were included. 415 (70.6%) received general anesthesia (GA) alone, 152 received GA plus perioperative PNB (25.9%), and 21 had GA plus LIA intra-operatively (3.6%). Median age was 82 years; predominantly female (67%) and AO/OTA 31A fractures (55.37%). MAIN OUTCOME MEASURES Morphine Milligram Equivalents (MME) at 24 and 48 hours postoperatively, length of stay (LOS) and the occurrence of any complication after surgery RESULTS: The PNB cohort was less likely to use any opioid than the GA group at 24 and 48 hours postoperatively (OR: 0.36, 95% CI: 0.22-0.61 and OR: 0.56, 95% CI: 0.35-0.89 respectively). LOS ≥ 10 days had 3.24 times the odds of 24- and 48-hour opioid administration compared to LOS ≤ 10 days (OR: 3.24, 95% CI 1.11-9.42; OR: 2.98, 95% CI 1.38-6.41, respectively). The most common complication was post-operative delirium, with PNB more likely to present with any complication compared to GA (OR= 1.88, 95% CI 1.09-3.26). There was no difference when comparing LIA to general anesthesia. CONCLUSIONS Our findings suggest PNB for hip fracture can help limit the use of post-operative opioids with adequate pain relief. Regional analgesia does not seem to avoid complications such as delirium.
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Affiliation(s)
- Jana M Davis
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Mario Cuadra
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Tamar Roomian
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Meghan K Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Rachel B Seymour
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
| | - Robert A Hymes
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA
| | - Lolita Ramsey
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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12
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Horoz L, Cakmak MF. Studies on intramedullary nailing over 40 years by science mapping method. J Orthop Surg (Hong Kong) 2023; 31:10225536231181707. [PMID: 37386722 DOI: 10.1177/10225536231181707] [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] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE As the amount of knowledge in literature continues to increase. Seeing research as a whole and determining its development and direction has become increasingly difficult. To overcome this challenge, new methods are needed. Among the methods developed, bibliometric methods that allow for evaluating research models from different perspectives and identifying collaborations stand out. This article it is aimed to identify the main research themes and trends, highlight the gaps in the literature, and explore the potential for research in this field. METHODS Bibliometric analyses are conducted in databases that contain high-quality data. In this regard, the Web of Science Core Collection (WoS) was chosen in our study. The search was covered the years between 1982-2022. A total of 2556 articles. In our research, articles were examined in two sections. The first section provides an overview of articles on the intramedullary nailing. In the second stage, content analyses were conducted. RESULTS A total of 2556 articles were published in 352 journals. The total number of authors is 8992, and the average citation per article is 18.87. The United States, China, and England are the top three countries. Based on the H-index most influential authors are Schemitsch EH and Bhandari M. The Injury-International Journal of the Care of the Injured journal has published 10.44% of all articles. CONCLUSION Our study sheds light on the 40-year development dynamics of intramedullary nailing.
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Affiliation(s)
- Levent Horoz
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Mehmet Fevzi Cakmak
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
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13
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Buttongkum D, Tangpornprasert P, Virulsri C, Numkarunarunrote N, Amarase C, Kobchaisawat T, Chalidabhongse T. 3D reconstruction of proximal femoral fracture from biplanar radiographs with fractural representative learning. Sci Rep 2023; 13:455. [PMID: 36624184 PMCID: PMC9829664 DOI: 10.1038/s41598-023-27607-2] [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: 05/24/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
A femoral fracture is a severe injury occurring in traumatic and pathologic causes. Diagnosis and Preoperative planning are indispensable procedures relying on preoperative radiographs such as X-ray and CT images. Nevertheless, CT imaging has a higher cost, radiation dose, and longer acquisition time than X-ray imaging. Thus, the fracture 3D reconstruction from X-ray images had been needed and remains a challenging problem, as well as a lack of dataset. This paper proposes a 3D proximal femoral fracture reconstruction from biplanar radiographs to improve the 3D visualization of bone fragments during preoperative planning. A novel Fracture Reconstruction Network (FracReconNet) is proposed to retrieve the femoral bone shape with fracture details, including the 3D Reconstruction Network (3DReconNet), novel Auxiliary class (AC), and Fractural augmentation (FA). The 3D reconstruction network applies a deep learning-based, fully Convolutional Network with Feature Pyramid Network architecture. Specifically, the auxiliary class is proposed, which refers to fracture representation. It encourages network learning to reconstruct the fracture. Since the samples are scarce to acquire, the fractural augmentation is invented to enlarge the fracture training samples and improve reconstruction accuracy. The evaluation of FracReconNet achieved a mIoU of 0.851 and mASSD of 0.906 mm. The proposed FracReconNet's results show fracture detail similar to the real fracture, while the 3DReconNet cannot offer.
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Affiliation(s)
- Danupong Buttongkum
- grid.7922.e0000 0001 0244 7875Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330 Thailand ,grid.7922.e0000 0001 0244 7875Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Pairat Tangpornprasert
- Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330, Thailand. .,Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand. .,Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Chanyaphan Virulsri
- grid.7922.e0000 0001 0244 7875Center of Excellence for Prosthetic and Orthopedic Implant, Chulalongkorn University, Bangkok, 10330 Thailand ,grid.7922.e0000 0001 0244 7875Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330 Thailand ,grid.7922.e0000 0001 0244 7875Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Numphung Numkarunarunrote
- grid.7922.e0000 0001 0244 7875Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Chavarin Amarase
- grid.7922.e0000 0001 0244 7875Hip Fracture Research Unit, Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Thananop Kobchaisawat
- grid.7922.e0000 0001 0244 7875Perceptual Intelligent Computing Lab, Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Thanarat Chalidabhongse
- grid.7922.e0000 0001 0244 7875Perceptual Intelligent Computing Lab, Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, 10330 Thailand ,grid.7922.e0000 0001 0244 7875Applied Digital Technology in Medicine Research Group, Chulalongkorn University, Bangkok, 10330 Thailand
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Han Z, Ji NN, Ma JX, Dong Q, Ma XL. Effect of Resistance Training Combined with Beta-Hydroxy-Beta-Methylbutyric Acid Supplements in Elderly Patients with Sarcopenia after Hip Replacement. Orthop Surg 2022; 14:704-713. [PMID: 35195339 PMCID: PMC9002065 DOI: 10.1111/os.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the efficacy of resistance training (RT) combined with beta‐hydroxy‐beta‐methylbutyric acid (HMB) in the treatment of elderly patients with sarcopenia after hip replacement. Methods From January 1, 2018 to December 31, 2018, 200 elderly patients (68 men, mean age 76.3 years and 137 women, mean age 79.1 years) who experienced femoral neck fracture with sarcopenia after hip arthroplasty were assigned to four groups: RT + HMB group, RT group, HMB group, and negative control group. Baseline data, body composition, grip strength, Barthel index (BI), Harris hip score (HHS), and visual analog scale score (VAS) were compared among the four groups before and 3 months after surgery. Results A total of 177 participants completed the trial, including 43 in the HMB + RT group, 44 in the HMB group, 45 in the RT group, and 45 in the negative control group. At the 3‐month follow‐up, the body composition and grip strength of the HMB + RT group and RT group were significantly improved compared with those before operation. The HMB group had no significant change, while the measures in the negative control group significantly decreased. Postoperative BI and HSS did not reach pre‐injury levels in any of the four groups, but postoperative VAS score was significantly improved. However, there was no significant difference in BI, HSS, or VAS among the four groups. Conclusion RT, with or without HMB supplementation, can effectively improve body composition and grip strength in elderly patients with sarcopenia after hip replacement at short‐term follow‐up. Simultaneously, use of exclusive HMB supplementation alone may also help to prevent decreases in muscle mass and grip strength in these patients.
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Affiliation(s)
- Zhe Han
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.,Department of Hip Trauma, Tianjin Hospital, Tianjin, China
| | - Neng-Neng Ji
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jian-Xiong Ma
- Institute of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Qiang Dong
- Department of Hip Trauma, Tianjin Hospital, Tianjin, China
| | - Xin-Long Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.,Institute of Orthopaedics, Tianjin Hospital, Tianjin, China.,Department of Orthopaedics, Tianjin Hosptial, Tianjin, China
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15
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Cazzato G, Oliva MS, Masci G, Vitiello R, Smimmo A, Matrangolo MR, Palmacci O, D'Adamio S, Ziranu A. Femoral neck fracture: the reliability of radiologic classifications. BMC Musculoskelet Disord 2022; 22:1063. [PMID: 35078436 PMCID: PMC8787877 DOI: 10.1186/s12891-022-05007-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoral neck fractures (FNF) are one of the most common injury in the elderly. A valid radiographic classification system is mandatory to perform the correct treatment and to allow surgeons to facilitate communication. This study aims to evaluate reliability of 2018 AO/OTA Classification, AO/OTA simplified and Garden classification. METHODS Six Orthopaedic surgeons, divided in three groups based on trauma experience, evaluated 150 blinded antero-posterior and latero-lateral radiography of FNF using Garden classification, 2018 AO/OTA and simplified AO/OTA classification. One month later, the radiographs were renumbered and then each observer performed a second evaluation of the radiographs. The Kappa statistical analysis was used to determine the reliability of the classifications. Cohen's Kappa was calculated to determine intra and inter observer reliability. Fleiss' Kappa was used to determine multi-rater agreement. RESULTS The k values of interobserver reliability for Garden classification was from 0,28 to 0,73 with an average of 0,49. AO classification showed reliability from 0,2 to 0,42, with average of 0,30. Simplified AO/OTA classification showed a reliability from 0,38 to 0,58 with an average of 0,48. The values of intra observer reliability for Garden classification was from 0,48 to 0,79 with an average of 0,63. AO classification showed reliability from 0,2 to 0,64 with an average of 0,5. Simplified AO/OTA classification showed a reliability from 0,4 to 0,75 with an average of 0,61. CONCLUSION The revised 2018 AO/OTA classification simplified the previous classification of intracapsular fracture but remain unreliable with only fair interobserver reliability. The simplified AO/OTA classification show a reliability similar to Garden classification, with a moderate interobserver reliability. The experience of the surgeons seems not to improve reliability. No classification has been shown to be superior in terms of reliability.
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Affiliation(s)
- Gianpiero Cazzato
- RomaPRO Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Masci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Orthopaedic and Traumatology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Smimmo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano D'Adamio
- RomaPRO Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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16
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BAŞAR B. The effect of rehabilitation support on male and female after intertrochanteric femoral fracture treatment. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.985815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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