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Pillukat T, van Schoonhoven J. [Treatment reality of distal radius fractures in a center]. Unfallchirurgie (Heidelb) 2024:10.1007/s00113-024-01436-y. [PMID: 38684524 DOI: 10.1007/s00113-024-01436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
Distal radius fractures are the third most common type of fracture in Germany after fractures of the femoral neck and peritrochanteric femoral fractures. In 2019 a total of 72,087 cases were registered with an incidence of 106 cases per 100,000 inhabitants (81,570 fractures of the femoral neck, 73,785 peritrochanteric fractures). Many of these fractures are surgically treated also in this hospital but with controversial views on the optimal treatment. Against the background of the coronavirus disease 2019 (COVID-19) pandemic, disappearing personnel resources and the political pressure to form centers and a switch to outpatient treatment, the authors ask the question what the treatment reality in this hospital looks like and whether the general changes in the framework conditions also have an affect in this context. This is not a strictly scientific study but a stocktaking without any claims of completeness and the retrospective evaluation of a larger data pool with all its weaknesses. On the contrary, the data provide interesting aspects that are explained in detail in the individual sections.
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Affiliation(s)
- Thomas Pillukat
- Klinik für Handchirurgie, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt a. d. Saale, Deutschland.
| | - Jörg van Schoonhoven
- Klinik für Handchirurgie, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt a. d. Saale, Deutschland
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2
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Beyer F, Oppermann J, Prasse T, Müller LP, Eysel P, Bredow J. How Preoperative Closed Reduction and Time to Surgery Impact Postoperative Palmar Inclination in Distal Radius Fractures. J Clin Med 2024; 13:2316. [PMID: 38673588 PMCID: PMC11051345 DOI: 10.3390/jcm13082316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The anatomical reconstruction of the wrist is the aim when treating distal radius fractures. Current literature on the importance of preoperative reduction in fractures that are treated operatively is limited. Methods: This study investigated the effect of the preoperative closed reduction of distal radius fractures on the day of trauma and the time to surgery on postoperative palmar inclination. A total of eighty patients (48 females and 32 males, mean age 55.6 years) were studied retrospectively. All patients were treated with an open reduction and internal fixation. The palmar inclination angle was measured using X-rays by two investigators, and the interobservers and pre- and post-reduction parameters were compared. Results: When the surgical management of closed distal radius fractures is required, neither initial repositioning nor a delay of up to 14 days to the surgical treatment influences postoperative palmar inclination. Conclusions: The significance of preoperative reduction of distal radius fractures without neurovascular or extensive soft tissue damage is limited and is not leading to improved outcomes. When surgery is about to be performed, surgeons should carefully consider if reduction is really vital preoperatively. Level of evidence: III.
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Affiliation(s)
- Frank Beyer
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149 Cologne, Germany;
| | - Johannes Oppermann
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (J.O.); (T.P.); (L.P.M.); (P.E.)
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (J.O.); (T.P.); (L.P.M.); (P.E.)
| | - Lars Peter Müller
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (J.O.); (T.P.); (L.P.M.); (P.E.)
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; (J.O.); (T.P.); (L.P.M.); (P.E.)
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149 Cologne, Germany;
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3
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Townsley SH, Pulos N, Shin AY. Complications of operatively treated distal radial fractures. J Hand Surg Eur Vol 2024; 49:215-225. [PMID: 38315130 DOI: 10.1177/17531934231192836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Distal radial fractures represent the most common fractures of the upper extremity. Operative treatment is performed for approximately one-third of distal radial fractures in the adult population. Complications following operative treatment of distal radial fractures vary depending on the treatment modality and can be stratified into preoperative and postoperative complications. Complications can occur in the near, intermediate and long term. The most common complications seen are tendon irritation and rupture, chronic regional pain syndrome (CRPS), carpal tunnel syndrome, ulnar or radial neuropathy, compartment syndrome, malunion, inadequate fixation or loss of fixation, symptomatic hardware, post-traumatic arthritis, stiffness and infection. Careful planning, treatment and patient selection can help to mitigate these complications.Level of evidence: V.
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Affiliation(s)
- Sarah H Townsley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Rust A, Samade R, Campbell AB, McManus T, Jain SA. Time to surgery and outcomes following open reduction and internal fixation of both-bone forearm fractures. Eur J Orthop Surg Traumatol 2024; 34:135-142. [PMID: 37368153 DOI: 10.1007/s00590-023-03560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/23/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To determine the effect of time to surgery on outcomes following open reduction and internal fixation (ORIF) of both-bone forearm fractures (BBFFs). METHODS Ninety-nine patients who underwent ORIF of BBFFs in a single academic medical center over a 16-year time period were retrospectively reviewed. Demographic and clinical data including age, sex, current smoking status, time from injury to surgery (tsurg), presence of open injury, polytrauma status, and complications were obtained. Radiographs of the affected extremity were reviewed for fracture morphology, reduction quality, and time to union (or presence of nonunion). In addition to descriptive statistics, Chi-square and Wilcoxon-Mann-Whitney tests were used to compare categorical and interval, respectively, with a significance level of 0.05. RESULTS A tsurg > 48 h was associated with increased rate of delayed unions (tsurg < 48 h: 25% vs tsurg > 48 h: 59%, p = 0.03), but not complications (tsurg < 48 h: 44% vs tsurg > 48 h: 47%, p = 0.79). Open BBFFs were not associated with increased rates of delayed unions (closed: 16% vs open: 19%, p = 0.77) or complications (closed: 42% vs open: 53%, p = 0.29). A trend toward increased time to union with tsurg > 48 h was also seen, but did not reach significance (tsurg < 48 h: 13.5 weeks vs tsurg > 48 h: 15.7 weeks, p = 0.11). CONCLUSION A tsurg > 48 h is associated with an increased rate of delayed union, but not complications, after ORIF of BBFFs. LEVEL OF EVIDENCE Therapeutic Level III (Retrospective Cohort).
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Affiliation(s)
- Andrew Rust
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Richard Samade
- Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Andrew B Campbell
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Timothy McManus
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sonu A Jain
- Departments of Orthopaedics and Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH, 43212, USA.
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Zhuang T, Kamal RN. Strategies for Perioperative Optimization in Upper Extremity Fracture Care. Hand Clin 2023; 39:617-625. [PMID: 37827614 DOI: 10.1016/j.hcl.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed.
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Affiliation(s)
- Thompson Zhuang
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA.
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Julian KR, Truong NM, Leversedge C, Kwong JW, Rosinski A, Kamal RN, Shapiro LM. Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review. Curr Orthop Pract 2023; 34:229-235. [PMID: 38264709 PMCID: PMC10802167 DOI: 10.1097/bco.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
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Affiliation(s)
- Kaitlyn R Julian
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Chelsea Leversedge
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street Redwood City, CA
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Alexander Rosinski
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program 450 Stanyan Street San Francisco, CA 94117
| | - Robin N Kamal
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street MC: 6342 Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
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Grier AJ, Chen KJ, Paul AV, Green CL, Richard MJ, Ruch DS, Pidgeon TS. Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures. Hand (N Y) 2023:15589447231174642. [PMID: 37243339 DOI: 10.1177/15589447231174642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes. METHODS We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication. RESULTS Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%). CONCLUSIONS Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.
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Affiliation(s)
| | - Kallie J Chen
- University Hospitals Cleveland Medical Center, OH, USA
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Khan S, Persitz J, Shrouder-Henry J, Khan M, Chan A, Paul R. Effect of Time-To-Surgery on Distal Radius Fracture Outcomes: A Systematic Review. J Hand Surg Am 2023; 48:435-443. [PMID: 36890081 DOI: 10.1016/j.jhsa.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 03/10/2023]
Abstract
PURPOSE It remains unclear whether time-to-surgery for distal radius fractures affects clinical, functional, or radiographic outcomes or health care costs/use. This systematic review investigated the outcomes of early versus delayed surgery for closed, isolated distal radius fractures in adult patients. METHODS A comprehensive search of MEDLINE, Embase, and CINAHL databases was completed for all original case series, observational studies, and randomized controlled trials reporting clinical outcomes of both early and delayed surgically-treated distal radius fractures from database inception to July 01, 2022. A consistent threshold of two weeks was used to define early versus delayed treatment arms. RESULTS Nine studies, including 16 intervention arms and 1,189 patients (858 early, 331 delayed), were included. Mean age was 58 years (range, 33-76). At more than one year, the frequency-weighted mean Disabilities of the Arm, Shoulder, and Hand score was 4 in the early group (n = 208; range, 1-17) and 21 in the delayed group (n = 181; range, 4-27). Range of motion, grip strength, and radiographic outcomes were comparable. The pooled mean complication rate (7% vs 5%) and revision rate (3.6% vs 1%) were very low in both groups. CONCLUSIONS A delay in time-to-surgery greater than two weeks for distal radius fractures may be associated with inferior patient-reported outcomes. Early surgery was associated with improved long-term Disabilities of the Arm, Shoulder, and Hand scores. On the basis of the available evidence, range of motion, grip strength, and radiographic outcomes are similar. The complication and revision rates were very low in both groups and comparable. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Shawn Khan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jonathan Persitz
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Moin Khan
- Sports Medicine and Shoulder Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Andrea Chan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Paul
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada; Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rahman R, Xu AL, Dhanjani SA, Zhang B, Nayar SK, Humbyrd CJ, LaPorte D. Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage? Hand (N Y) 2022; 17:95S-102S. [PMID: 35189731 PMCID: PMC9793622 DOI: 10.1177/15589447221075669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs. METHODS We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient's ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05. RESULTS There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] (P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage. CONCLUSIONS Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Rafa Rahman
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Amy L. Xu
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Bo Zhang
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Suresh K. Nayar
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Dawn LaPorte
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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Pulos N, Shin AY. Strategies for Specific Reduction in High-Energy Distal Radius Fractures. Hand Clin 2021; 37:267-278. [PMID: 33892880 DOI: 10.1016/j.hcl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
High-energy distal radius fractures frequently result in comminution with intra-articular fragmentation. Knowledge of predictable patterns of injury allows the surgeon to develop a preoperative plan for anatomic reduction and stable fixation of individual fragments that are too small or too distal to be fixed with standard volar locked plating. We review the column model, which organizes the distal radius into an intermediate column, radial column, and pedestal as the basis of a reconstructive algorithm and emphasize the importance of the volar ulnar fragment. Specific reduction and fixation techniques are described to assist the surgeon in treating these injuries.
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Affiliation(s)
- Nicholas Pulos
- 200 1st Street Southwest, Rochester, MN 55905, USA. https://twitter.com/NickPulosMD
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