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Legrand T, Richard V, Bonnefoy-Mazure A, Armand S, Miozzari HH, Turcot K. The impact of body-mass index on the frontal knee alignment estimation using three-dimensional reconstruction based on movement analysis. Knee 2020; 27:89-94. [PMID: 31870700 DOI: 10.1016/j.knee.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/01/2019] [Accepted: 09/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND We evaluated the influence of the body-mass index (BMI) on the estimation of the static frontal knee alignment (FKA) using three-dimensional (3D) reconstruction method based on movement analysis. METHODS Two-hundred nineteen knees (120 individuals with end-stage osteoarthritis) were analyzed. The validity of the 3D method was evaluated under comparison with a reference method based on weight bearing full-leg length radiography. Extensive statistical analyses (Pearson's correlation, one-way ANOVA, linear regression, boxplot diagram) over four groups of BMI (normal, overweight, obese class I and obese classes II and III) were performed. RESULTS For BMI below 25 kg/m2, the validity of the 3D method was confirmed. For BMI over 25 kg/m2, there was an increasing error of the 3D method, especially for the obese groups affected with a large varus alignment. CONCLUSIONS In a biomechanical context of movement analysis, the results of the study suggest that the 3D method may represent a satisfying alternative to the full-leg radiograph method with limitations regarding to BMI over 25 kg/m2.
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Affiliation(s)
- Thomas Legrand
- Department of Kinesiology, Medicine Faculty, Laval University, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada
| | - Vincent Richard
- Department of Kinesiology, Medicine Faculty, Laval University, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada
| | - Alice Bonnefoy-Mazure
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals, Geneva University, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals, Geneva University, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Hermes H Miozzari
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Katia Turcot
- Department of Kinesiology, Medicine Faculty, Laval University, Quebec, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada.
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Kreitz TM, Maltenfort MG, Lonner JH. The Valgus Stress Radiograph Does Not Determine the Full Extent of Correction of Deformity Prior to Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2015; 30:1233-6. [PMID: 25737388 DOI: 10.1016/j.arth.2015.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 02/01/2023] Open
Abstract
Routine preoperative stress radiographs have been advocated, in part, to determine "full correctability" of deformities before proceeding with unicompartmental knee arthroplasty (UKA) despite limited data supporting their utility. Fifty consecutive patients undergoing medial UKA with robotic navigation were studied. In 20° of flexion, significantly greater correctability was achieved after removal of osteophytes by an additional 1.8°, with a mean corrected alignment of 2.5° varus. Seventy-four percent of knees were not correctable to neutral alignment or more. In conclusion, preoperative stress radiographs have overstated value in patients undergoing medial UKA since the full extent of correctability of varus deformity cannot be determined until after removal of osteophytes and since most deformities are not fully correctable to neutral in UKA.
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Affiliation(s)
- Tyler M Kreitz
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Jess H Lonner
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Dexel J, Kirschner S, Günther KP, Lützner J. Agreement between radiological and computer navigation measurement of lower limb alignment. Knee Surg Sports Traumatol Arthrosc 2014; 22:2721-7. [PMID: 23832176 DOI: 10.1007/s00167-013-2599-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 06/26/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Accurate and reproducible measurements of limb alignment are necessary for planning, performing and evaluation of reconstructive knee surgery. Aim of this study was the comparison of the alignment measured on long-leg standing radiographs with the intraoperative data from a navigation system. METHODS The records of 135 consecutive patients who received computer-assisted TKA were examined. Technical quality of the long-leg radiographs (LLRs) was classified good, acceptable or poor according to the rotation of the leg. The difference between radiographic and navigation measurements of leg alignment was assessed. RESULTS Preoperative LLRs were rated as good 56.3% (71.1% postoperatively), acceptable in 37.0% (20.0% postoperatively) and poor in 6.7% (8.9% postoperatively). The median difference between radiographic and navigation measurements increased with reduced quality of the LLR [good 1.5° (range 0.0°-9.9°), acceptable 2.5° (range 0.0°-15.0°), poor 4.5° (range 0.2°-9.5°)], but not with greater deformity. Median difference between both measurements in good radiographs was 1.7° (range 0.0°-9.9°) preoperatively and 1.2° (range 0.0°-7.0°) postoperatively. CONCLUSION Difference between radiographic and navigation measurements of lower limb alignment is low if the LLR are obtained in neutral rotation. Larger differences between both measurements can occur even under these ideal conditions, and it is still unclear which measurement is closer to reality. Therefore, even if a navigation system is used during surgery, long-leg standing radiographs should currently not be abandoned. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julian Dexel
- Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany,
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Babazadeh S, Dowsey MM, Bingham RJ, Ek ET, Stoney JD, Choong PFM. The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography. Knee 2013; 20:242-9. [PMID: 22892197 DOI: 10.1016/j.knee.2012.07.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The mechanical alignment of the knee is an important factor in planning for, and subsequently assessing the success of a knee replacement. It is most commonly measured using a long-leg anteroposterior radiograph (LLR) encompassing the hip, knee and ankle. Other modalities of measuring alignment include computer tomography (CT) and intra-operative computer navigation (Cas). Recent studies comparing LLRs to Cas in measuring alignment have shown significant differences between the two and have hypothesized that Cas is a more accurate modality. This study aims to investigate the accuracy of the above mentioned modalities. METHODOLOGY A prospective study was undertaken comparing alignment as measured by long-leg radiographs and computer tomography to intra-operative navigation measurements in 40 patients undergoing a primary total knee replacement to test this hypothesis. Alignment was measured three times by three observers. Intra- and inter-observer correlation was sought between modalities. RESULTS Intra-observer correlation was excellent in all cases (>0.98) with a coefficient of repeatability <1.1°. Inter-observer correlation was also excellent measuring >0.960 using LLRs and >0.970 using CT with coefficient of repeatability <2.8°. Inter-modality correlation proved to be higher when comparing LLRs and CT (>0.893), than when comparing either of these modalities with Cas (>0.643 and >0.671 respectively). Pre-operative values had the greatest variability. CONCLUSION Given its availability and reduced radiation dose when compared to CT, LLRs should remain the mainstay of measuring the mechanical alignment of the lower limb, especially post-operatively. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sina Babazadeh
- Department of Orthopaedics, St. Vincent's Hospital, and Department of Surgery, The University of Melbourne, Australia
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Shetty GM, Mullaji A, Bhayde S. Computer guided restoration of joint line and femoral offset in cruciate substituting total knee arthroplasty. Knee 2012; 19:611-6. [PMID: 22178624 DOI: 10.1016/j.knee.2011.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 11/18/2011] [Accepted: 11/20/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE This prospective study aimed to evaluate radiographically, change in joint line and femoral condylar offset with the optimized gap balancing technique in computer-assisted, primary, cruciate-substituting total knee arthroplasties (TKAs). METHODS One hundred and twenty-nine consecutive computer-assisted TKAs were evaluated radiographically using pre- and postoperative full-length standing hip-to-ankle, antero-posterior and lateral radiographs to assess change in knee deformity, joint line height and posterior condylar offset. RESULTS In 49% of knees, there was a net decrease (mean 2.2mm, range 0.2-8.4mm) in joint line height postoperatively whereas 46.5% of knees had a net increase in joint line height (mean 2.5mm, range 0.2-11.2mm). In 93% of the knees, joint line was restored to within ± 5 mm of preoperative values. In 53% of knees, there was a net increase (mean 2.9 mm, range 0.2-12 mm) in posterior offset postoperatively whereas 40% of knees had a net decrease in posterior offset (mean 4.2mm, range 0.6-20mm). In 82% of knees, the posterior offset was restored within ± 5 mm of preoperative values. CONCLUSIONS Based on radiographic evaluation in extension and at 30° flexion, the current study clearly demonstrates that joint line and posterior femoral condylar offset can be restored in the majority of computer-assisted, cruciate-substituting TKAs to within 5mm of their preoperative value. The optimized gap balancing feature of the computer software allows the surgeon to simulate the effect of simultaneously adjusting femoral component size, position and distal femoral resection level on joint line and posterior femoral offset.
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Affiliation(s)
- Gautam M Shetty
- Department of Orthopaedic Surgery, Breach Candy Hospital, Mumbai, India.
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Chang CW, Chang CH, Yang CY, Lai KA, Lin CL, Lin CJ. Kinematic analysis of leg alignment during conventional versus navigated total knee arthroplasty: initial results of a prospective study. Kaohsiung J Med Sci 2012; 28:484-9. [PMID: 22974667 DOI: 10.1016/j.kjms.2012.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 10/26/2011] [Indexed: 11/16/2022] Open
Abstract
Current kinematic navigation systems provide real-time spatial analyses of leg alignments during total knee arthroplasty (TKA) instead of delayed radiographic verification after surgery. A prospective study was conducted to investigate leg alignments of TKAs that underwent different surgical guidance [intramedullary (IM) jig-based vs. navigation-assisted] using a kinematic navigation system. Since May 2007, patients admitted for primary TKA were considered for inclusion. Within 6 months, 38 sets of intraoperative analyses on the operated legs have been performed. Excluding seven unreliable data sets, 15 conventional IM jig-based TKAs and 16 navigation-assisted TKAs were available. The leg alignments in maximum knee extension were retrieved for comparison. Although similar final coronal alignments were accurately achieved in both groups (0.21 valgus in the IM group vs. 0.17 valgus in the NA group, p=0.993), a more flexed sagittal axis was constructed with conventional IM jigs (1.93 flexion in the IM group vs. 0.58 extension in the NA group, p<0.05). The study suggests that comparable coronal precision could be achieved with conventional IM jigs by trained surgeons, although computer-assisted navigation is a documented method to restore accurate alignment. Different sagittal alignments observed in this study indicate the inherent discrepancy between different surgical guides as well as their according concepts.
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Affiliation(s)
- Chih-Wei Chang
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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Kim TK, Chang CB, Kang YG, Chung BJ, Cho HJ, Seong SC. Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty. Knee 2010; 17:23-8. [PMID: 19581096 DOI: 10.1016/j.knee.2009.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 06/03/2009] [Accepted: 06/09/2009] [Indexed: 02/02/2023]
Abstract
While computer assisted total knee arthroplasty (TKA) has been documented to increase the surgical accuracy in the planning process, there is little information about the accuracy in execution processes. We aimed to determine the accuracy of execution processes for bone resections and implant fixation in TKAs performed with the techniques of computer assisted navigation and minimally invasive surgery. Execution deviations, defined as the differences between planned targets and executed results, were evaluated for bone resections and implant fixation in 107 TKAs. In tibia resection, the mean resection thickness, coronal alignment, and sagittal alignment were 0.2mm smaller, 0.3 degrees more valgus, 0.3 degrees less posterior slope than the planned, respectively. In femur resection, the mean resection thicknesses in the medial and lateral femoral condyles, coronal alignment, and sagittal alignment were 0.6mm smaller, 0.8mm smaller, 0.1 degrees more varus, and 0.7 degrees less posterior slope than the planned, respectively. In implant fixation, the mean coronal alignment and degree of extension was 0.7 degrees more valgus and 1.6 degrees decrease than the planned, respectively. Only the occurrence of unacceptable executions in implant fixation had significant effects on the final coronal alignment. The density of a bone and the quality of saw blade had significant effect on the accuracy of bone resections. Execution deviations from planned alignment commonly occur in computer-assisted minimally invasive TKA, resulting typically from the techniques of bone resections and implant fixation, and this information should be considered to improve the surgical accuracy of navigated TKAs.
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Affiliation(s)
- Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnamsi, Gyunggido 463-707, South
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How precise can bony landmarks be determined on a CT scan of the knee? Knee 2009; 16:358-65. [PMID: 19195896 DOI: 10.1016/j.knee.2009.01.001] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 12/29/2008] [Accepted: 01/02/2009] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to describe the intra- and inter-observer variability of the registration of bony landmarks and alignment axes on a Computed Axial Tomography (CT) scan. Six cadaver specimens were scanned. Three-dimensional surface models of the knee were created. Three observers marked anatomic surface landmarks and alignment landmarks. The intra- and inter-observer variability of the point and axis registration was performed. Mean intra-observer precision ranks around 1 mm for all landmarks. The intra-class correlation coefficient (ICC) for inter-observer variability ranked higher than 0.98 for all landmarks. The highest recorded intra- and inter-observer variability was 1.3 mm and 3.5 mm respectively and was observed for the lateral femoral epicondyle. The lowest variability in the determination of axes was found for the femoral mechanical axis (intra-observer 0.12 degrees and inter-observer 0.19 degrees) and for the tibial mechanical axis (respectively 0.15 degrees and 0.28 degrees). In the horizontal plane the lowest variability was observed for the posterior condylar line of the femur (intra-observer 0.17 degrees and inter-observer 0.78 degrees) and for the transverse axis (respectively 1.89 degrees and 2.03) on the tibia. This study demonstrates low intra- and inter-observer variability in the CT registration of landmarks that define the coordinate system of the femur and the tibia. In the femur, the horizontal plane projections of the posterior condylar line and the surgical and anatomical transepicondylar axis can be determined precisely on a CT scan, using the described methodology. In the tibia, the best result is obtained for the tibial transverse axis.
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Reliability of leg alignment using the OrthoPilot system depends on knee position: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2009; 17:1143-51. [PMID: 19495724 DOI: 10.1007/s00167-009-0825-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
Despite the increase in clinical use of navigation systems in total knee arthroplasty, few studies have focused on the reproducibility of these systems. The aim of the present study was to assess the influence of knee position and observer experience on intra- and inter-observer agreement in limb alignment assessment with the OrthoPilot system. Limb alignment in the coronal plane and extension range of the knee were assessed in four embalmed cadaveric specimens by five independent observers and measurements were repeated four times to determine intra- and inter-observer agreement, expressed as intraclass correlation coefficients (ICCs). Additionally, navigation results were compared against figures from conventional measurement of leg alignment (ground truth). Intra- and inter-observer agreements were excellent for assessing the extension range (ICC, 0.97 and 0.95) and the coronal femuro-tibial axis in knee extension (ICC, 0.92 and 0.88) but were generally worse in knee flexion (ICC, 0.62 and 0.55). There was an increased tendency of intraobserver errors in observers with less clinical experience. Mean correlation with conventional measurements was fair (Spearman's rho 0.61). The OrthoPilot system showed excellent reproducibility for assessment of extension range and coronal limb alignment. However, assessments of coronal limb alignment in flexion were prone to error and caution should be taken when relying on these measurements.
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Abstract
UNLABELLED Precise pre- and postoperative anatomic measurements are necessary to plan, perform, and evaluate total knee arthroplasty (TKA). We evaluated the relationship between radiographic and navigation alignment measurements, identified sources of error in radiographic and navigated alignment assessment, and determined the differences between desired and clinically accepted alignment. Fifty-eight computer-assisted TKAs were performed and limb alignment measurements were recorded both pre- and postoperatively with standard radiographs and with an intraoperative navigation system. Intraoperative navigation produced consistent navigation-generated alignment results that were within 1 degrees of the desired alignment. The difference between preoperative radiographic and navigation measurements varied by as much as 12 degrees and the difference between postoperative radiographic and navigation measurements varied by as much as 8 degrees. This discrepancy depended on the degree of limb deformity. Postoperative radiographic measurements have inherent limitations. Navigation can generate precise, accurate, and reproducible alignment measurements. This technology can function as an effective tool for assessing pre- and postoperative limb alignment and relating intraoperative alignment measurements to clinical and functional outcomes. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Abstract
INTRODUCTION Within a 15-month period, 64 patients underwent 71 primary total knee arthroplasties in a randomized trial comparing the navigated versus the conventional implantation technique. CT scans were chosen for use as imaging procedures pre- and post-operatively to collect data concerning alignment and rotation of the leg as well as the prosthesis. RESULTS There was no difference between pre- and post-operative data in rotation of the femoral component for navigated versus conventional implantation. The average deviation from the correct long-leg axis was found to be 1.8 +/- 1.3 degrees in the navigated group and 2.5 +/- 1.6 degrees in the conventional group (P < 0.05).
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Bertsch C, Holz U, Konrad G, Vakili A, Oberst M. [Early clinical outcome after navigated total knee arthroplasty. Comparison with conventional implantation in TKA: a controlled and prospective analysis]. DER ORTHOPADE 2007; 36:739-45. [PMID: 17634921 DOI: 10.1007/s00132-007-1122-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Navigated implantation of total knee prostheses has become more and more popular within the last decade in orthopaedic surgery. Although improved alignment after navigated knee surgery has been reported previously in the literature, only a few studies meet the criteria of a level-1 evidence-based medicine study. We present the results of a controlled and prospective study comparing early clinical outcomes after computer-assisted versus conventional implantation in total knee arthroplasty (TKA). METHODS Within a 15-month period, all patients admitted for primary TKA were followed prospectively. Each patient was evaluated using the Knee Society Score (KSS) preoperatively, 10 days after surgery, and 3 months after surgery. The patients were divided into two groups, and the implantation technique altered between the two treatment options: each conventional implantation was strictly followed by a computer-assisted procedure and vice versa. RESULTS From March 2003 to June 2004, we did 34 computer-assisted (group A) and 35 conventional knee arthroplasties (group B) in 62 patients. There was no difference in the preoperative status of the patients. Surgeries in group A took significantly longer than in group B. The average deviation from correct alignment was significantly reduced in group A. 66 of 69 of the TKAs were available for follow-up examinations after 10 days and after 3 months. No significant differences were found in the overall KSS scores or in the subgroups. CONCLUSIONS The intraoperative use of a computer-assisted navigation system during implantation of a total knee prosthesis reduced the average varus/valgus deviation from the anatomical long leg axis. A disadvantage of the computer-assisted surgical procedure may be the longer operating time. Long-term follow-up of the presented data is needed in order to show whether the improved average alignment is advantageous for patients and/or results in a longer service life of the TKA.
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Affiliation(s)
- C Bertsch
- Klinik für Unfall- und Wiederherstellungschirurgie, Katharinenhospital Stuttgart, Stuttgart.
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