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Chirayath A, Dhaniwala N, Kawde K. A Comprehensive Review on Managing Fracture Calcaneum by Surgical and Non-surgical Modalities. Cureus 2024; 16:e54786. [PMID: 38529440 PMCID: PMC10961470 DOI: 10.7759/cureus.54786] [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: 12/08/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
This comprehensive review delves into the multifaceted landscape of calcaneal fractures, thoroughly examining their aetiology, clinical presentation, and diverse management strategies. Encompassing surgical and non-surgical approaches, the review scrutinises critical aspects such as patient compliance, rehabilitation protocols, and long-term follow-up considerations. Surgical modalities, propelled by recent innovations like minimally invasive techniques and advanced fixation materials, are juxtaposed with non-surgical interventions, emphasising the pivotal role of patient education and adherence to optimise outcomes. The synthesis of critical findings underscores the need for individualised care and multidisciplinary collaboration in clinical practice. Moreover, the review outlines recommendations for healthcare practitioners and identifies promising areas for future research, including biomechanical studies and telerehabilitation. This comprehensive exploration aims to contribute to the ongoing evolution of calcaneal fracture management, ultimately enhancing patient care and outcomes in this complex orthopaedic realm.
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Affiliation(s)
- Aditya Chirayath
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nareshkumar Dhaniwala
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kevin Kawde
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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陈 志, 李 强, 刘 瑞, 郭 浩, 唐 佩, 陈 华. [Research progress of pubic symphysis diastasis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1541-1547. [PMID: 38130199 PMCID: PMC10739657 DOI: 10.7507/1002-1892.202306093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/09/2023] [Indexed: 12/23/2023]
Abstract
Objective To review the research progress of pubic symphysis diastasis and provide effective reference for orthopedic surgeons in the diagnosis and treatment of pubic symphysis diastasis. Methods The anatomy, injury mechanism, treatment, and other aspects of pubic symphysis diastasis were summarized and analyzed by reviewing the relevant research literature at domestically and internationally in recent years. Results The incidence of pubic symphysis diastasis is high in pelvic fractures, which is caused by the injury of the ligaments and fibrocartilage disc around the pubic symphysis by external force. The treatment plan should be individualized according to the pelvic stability and the needs of patients, aiming to restore the stability and integrity of the pelvis and improve the quality of life of patients after surgery. Conclusion At present, the research on pubic symphysis diastasis still needs to be improved. In the future, high-quality, multi-center, and large-sample studies are of great significance for the selection of treatment methods and the evaluation of effectiveness for patients with pubic symphysis diastasis.
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Affiliation(s)
- 志广 陈
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
| | - 强 李
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
| | - 瑞 刘
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
| | - 浩 郭
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
- 内蒙古医科大学附属医院骨科(呼和浩特 010000)Department of Orthopaedic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
| | - 佩福 唐
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
| | - 华 陈
- 内蒙古医科大学第一临床医学院(呼和浩特 010000)First Clinical Medical College, Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
- 内蒙古医科大学附属医院骨科(呼和浩特 010000)Department of Orthopaedic Surgery, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia, 010000, P. R. China
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Zheng YB, Zhao X, Zheng Q, Sang XG. Safe surgical corridor for iliosacral screw placement in unstable pelvic fractures: a computed-tomography-guided validation study of the "triangulation method". Patient Saf Surg 2023; 17:28. [PMID: 37968701 PMCID: PMC10647156 DOI: 10.1186/s13037-023-00380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The percutaneous iliosacral screw technique represents a global standard fixation method for unstable fractures of the posterior pelvic ring. However, the inaccurate positioning of iliosacral screws is associated with a significant risk of severe intra-operative complications. Therefore, this study aimed to investigate the relationship between the skin entry point of the transverse iliosacral screw of the first sacral vertebral body and the anterior superior iliac spine and the greater trochanter of the femur using computed-tomography-guided validation. METHODS Overall, 91 consecutive patients admitted to a tertiary referral center in China for posterior pelvic ring fixation via the "triangulation method" using computed-tomography-guided validation between January 1, 2020, and December 31, 2020, were included in this retrospective observational cohort study. Modeling and simulated iliosacral screw placement were performed using the Mimics software. The distance between the three points of interest was measured, and their relationship in a rectangular coordinate system was determined. Patients were categorized according to gender, body mass index, and femoral rotation angle to investigate the factors affecting the positional relationship between the three points. RESULTS An equilateral triangular relationship was observed between the positioning points of the transverse iliosacral screw, anterior iliac spine, and greater trochanter. Additionally, 95% of the entry points were within a circle radius centered 12 mm at the apex of an equilateral triangle comprising the anterior superior iliac spine and the greater trochanter as the base. The entry point in the femoral external rotation was more dorsal than that in the internal femoral rotation. Furthermore, the entry point in females was more rostral than that in males, and the entry point in overweight patients was more dorsal than that in normal-weight patients. CONCLUSIONS The skin entry point of the percutaneous iliosacral screw can be located by drawing an equilateral triangle from the anterior superior iliac spine and the greater trochanter as the base to the dorsum end of the patient's head. In summary, this retrospective cohort study validated the safety and efficacy of the "triangulation methods" for percutaneous fixation of unstable posterior pelvic ring injuries.
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Affiliation(s)
- Yu-Bo Zheng
- Department of Emergency Surgery and Orthopaedic Surgery, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, PR China
| | - Xin Zhao
- Department of Emergency Surgery and Orthopaedic Surgery, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, PR China
| | - Qiang Zheng
- Department of Emergency Surgery and Orthopaedic Surgery, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, PR China
| | - Xi-Guang Sang
- Department of Emergency Surgery and Orthopaedic Surgery, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, PR China.
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Seekamp A. [Robotics and computer-assisted surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:289-291. [PMID: 36971811 PMCID: PMC10042745 DOI: 10.1007/s00104-023-01822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Andreas Seekamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller Straße 3, Haus C, 24105, Kiel, Deutschland.
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Oberthür S, Sehmisch S, Weiser L, Viezens L, Stübig T. [Does navigation still have a value in trauma surgery?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:719-726. [PMID: 35960322 DOI: 10.1007/s00132-022-04288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing. INDICATIONS There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine. REQUIREMENTS To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation. ADVANTAGES AND DISADVANTAGES Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high.
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Affiliation(s)
- Swantje Oberthür
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Stephan Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Lukas Weiser
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Lennart Viezens
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Timo Stübig
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Liu K, You M, Huang M, Chen C, Rui B, Gao H, Chen Y, Li X, Zhang W, Sun Y, Wang L. [Preliminary application study of dual-robotic navigated minimally invasive treatment by TiRobot and Artis Zeego on pelvic fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:929-933. [PMID: 35979781 DOI: 10.7507/1002-1892.202203026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the surgical learning curve and preliminary operative experience of dual-robotic navigated minimally invasive treatment on pelvic fractures by TiRobot and Artis Zeego. Methods Between July 2019 and February 2021, 90 patients with pelvic fractures were treated with dual-robotic navigated minimally invasive surgery by TiRobot and Artis Zeego. There were 64 males and 26 females, with an average age of 46.5 years (range, 13-78 years). Body mass index was 14.67-32.66 kg/m 2 (mean, 23.61 kg/m 2). Causes of injuries included traffic accident in 43 cases, falling from height in 37 cases, low-energy injuries such as flat falls in 10 cases. The interval between injury and surgery was 1-36 days (mean, 7.3 days). According to the location of the implanted screws, the patients were divided into sacroiliac screw group ( n=33), acetabular screw group (acetabulum anterior/posterior column, n=24), composite screws group (sacroiliac and acetabulum anterior/posterior column, n=33). According to the screw implantation time and accuracy, the surgical learning curve was plotted, and the differences in the relevant indicators between learning stage and skilled stage were compared. Results All 90 patients successfully completed the operation, the intraoperative bleeding volume was 5-200 mL (median, 20 mL). There was no vascular or nerve injury. All incisions healed by first intention. The screw implantation time ranged from 7.5 to 33.0 minutes (mean, 18.92 minutes), and the screw implantation accuracy ranged from 1.1 to 1.8 mm (mean, 1.56 mm). According to the learning curve, the practice stage of 3 groups was reached after 7, 10, and 11 cases, respectively. With the accumulation of surgical experience, the screw implantation time had a significant downward trend. Compared with the learning stage, the screw implantation time on skilled stage in 3 groups significantly shortened ( P<0.05), but the difference in the screw implantation accuracy was not significant ( P>0.05). Conclusion TiRobot and Artis Zeego assisted pelvic fracture surgery is safe and efficient, which helps the surgeon to quickly master the pelvic channel screw surgery, and the operation time is significantly shortened on the premise of ensuring the implantation accuracy.
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Affiliation(s)
- Kexin Liu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Mengzhen You
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Moran Huang
- Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Hefei Anhui, 230001, P. R. China
| | - Cheng Chen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Biyu Rui
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Hong Gao
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Yunfeng Chen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Xiaolin Li
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Wei Zhang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Yuqiang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
| | - Lei Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China
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Ge S, Zhang L, Zhou Z, Jia S, Zheng L. [TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:934-939. [PMID: 35979782 DOI: 10.7507/1002-1892.202203135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Methods The clinical data of 76 patients with posterior pelvic ring injury between January 2016 and June 2021 were retrospectively analyzed. Among them, 45 cases were treated with minimally invasive percutaneous sacroiliac screw fixation assisted by TiRobot and O-arm navigation system (study group), 31 cases were treated with minimally invasive percutaneous sacroiliac screw fixation under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, the times of nail track adjustment, and intraoperative fluoroscopy times were recorded. The quality of fracture reduction was evaluated by Matta score. At last follow-up, Majeed score was used to evaluate the recovery of pelvic function. Results A total of 72 screws were implanted in the study group, with a median of 1 (1, 2) screws per patient. In the control group, 47 screws were implanted, with a median of 1 (1, 2) screws per patient. There was no significant difference in the number of screws between the two groups ( Z=-0.392, P=0.695). The operation time, intraoperative blood loss, times of nail track adjustment, and intraoperative fluoroscopy times in the study group were significantly less than those in the control group ( P<0.05). All patients were followed up 6-24 months (mean, 14 months). No serious complications was found after operation and during follow-up. Matta score was used to evaluate the quality of fracture reduction at 1 week after operation, and there was no significant difference between the two groups ( Z=-1.135, P=0.256). At last follow-up, there was no significant difference of Majeed score between the two groups ( Z=-1.279, P=0.201). Conclusion TiRobot-assisted surgery by O-arm navigation system is a reliable surgical method for the treatment of posterior pelvic ring injury, which can reduce the operation time and fluoroscopy times when compared with the traditional operation under the guidance of C-arm X-ray machine. The safety, accuracy, and efficiency of the operation were improved.
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Affiliation(s)
- Shuo Ge
- Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, Shanghai Trauma Emergency Center, Shanghai, 200072, P. R. China
| | | | - Zifei Zhou
- Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, Shanghai Trauma Emergency Center, Shanghai, 200072, P. R. China
| | - Shaohua Jia
- Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, Shanghai Trauma Emergency Center, Shanghai, 200072, P. R. China
| | - Longpo Zheng
- Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai Tenth People's Hospital, Shanghai Trauma Emergency Center, Shanghai, 200072, P. R. China
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Kordon F, Maier A, Swartman B, Privalov M, El Barbari JS, Kunze H. Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery. J Imaging 2022; 8:jimaging8040108. [PMID: 35448235 PMCID: PMC9027971 DOI: 10.3390/jimaging8040108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 01/11/2023] Open
Abstract
Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization (ε<2.9mm) and low angulation errors for k-wire instrumentation (ε<0.75∘) on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.
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Affiliation(s)
- Florian Kordon
- Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany; (A.M.); (H.K.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, 91052 Erlangen, Germany
- Advanced Therapies, Siemens Healthcare GmbH, 91031 Forchheim, Germany
- Correspondence:
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany; (A.M.); (H.K.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, 91052 Erlangen, Germany
| | - Benedict Swartman
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany; (B.S.); (M.P.); (J.S.E.B.)
| | - Maxim Privalov
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany; (B.S.); (M.P.); (J.S.E.B.)
| | - Jan Siad El Barbari
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center, Ludwigshafen, 67071 Ludwigshafen, Germany; (B.S.); (M.P.); (J.S.E.B.)
| | - Holger Kunze
- Pattern Recognition Lab, Friedrich-Alexander University Erlangen-Nuremberg, 91058 Erlangen, Germany; (A.M.); (H.K.)
- Advanced Therapies, Siemens Healthcare GmbH, 91031 Forchheim, Germany
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Ettinger M. [Digital technologies]. DER ORTHOPADE 2021; 50:785-788. [PMID: 34505909 DOI: 10.1007/s00132-021-04156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Max Ettinger
- MHH Klinik für Orthopädie, Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
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