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Ippolito E, Farsetti P, Caterini R, Gorgolini G, Caterini A, De Maio F. Lower-limb intramedullary nailing in patients with polyostotic fibrous dysplasia who had a previous unsuccessful treatment. A report of 48 cases. J Orthop Traumatol 2023; 24:35. [PMID: 37402946 DOI: 10.1186/s10195-023-00705-7] [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] [Received: 11/28/2022] [Accepted: 05/01/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Intramedullary nailing (IN) seems to be the best primary surgical treatment for patients with either polyostotic fibrous dysplasia or McCune-Albright syndrome (PFD/MAS) when the femur and tibia are totally affected by fibrous dysplasia (FD) and pain, fracture and deformity are likely to occur. However, other management protocols have been applied in these cases, often leading to disabling sequelae. This study sought to evaluate if IN could also have been effective as a salvage procedure to provide patients with satisfactory results, regardless of the poor results due to the improper treatment previously performed. MATERIALS AND METHODS Twenty-four retrospectively registered PFD/MAS patients with 34 femurs and 14 tibias totally affected by fibrous dysplasia had received various treatments with unsatisfactory results in other institutions. Before the IN performed in our hospital, 3 patients were wheelchair bound; 4 were fractured; 17 limped; and many used an aid for walking. Salvage IN was performed in our hospital at a mean patient age of 23.66 ± 6.06 years (range, 15-37 years). The patients were evaluated before-except for the four fractured ones-and after IN using the validated Jung scoring system, and the data were statistically analyzed. RESULTS The mean length of follow-up after IN was 9.12 ± 3.68 years (range, 4-17 years). The patients' mean Jung score significantly improved from 2.52 ± 1.74 points before IN to 6.78 ± 2.23 at follow-up (p < 0.05). Ambulation was improved in ambulatory patients and restored in wheelchair users. The complication rate was 21%. CONCLUSIONS Regardless of the high rate of complications, IN may be considered a reliable surgical procedure to salvage a failed treatment in PFD/MAS, with long-lasting satisfactory results achieved in most patients. Trial registration statement: Not applicable. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Ippolito
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - P Farsetti
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - R Caterini
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - G Gorgolini
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - A Caterini
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - F De Maio
- Department of Clinical Science and Traslational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Oswal C, Patel S, Malhotra K, Sedki I, Cullen N, Welck M. Limb salvage versus below knee amputation for severe adult lower limb deformity - A retrospective, comparative series. Foot Ankle Surg 2022; 28:622-7. [PMID: 34274238 DOI: 10.1016/j.fas.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/12/2021] [Accepted: 07/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study compares outcomes of patients with severe, multiplanar, fixed, pantalar deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA). METHODS Fifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17-72 years) and median follow-up duration was 49.9 months (24.0-253.7 months). Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgery and whether they would have the same surgery again. RESULTS There was no statistically significant difference in functional outcomes, satisfaction, or complications between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p = 0.414). There was no difference in the proportion of patients who would opt for the same procedure again (p = 0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p = 0.692). CONCLUSION This study concludes that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative pantalar deformities. This data may be useful in counselling patients when considering salvage versus amputation in such cases. LEVEL OF EVIDENCE Level 3(Original) Clinical Research Article.
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Coppa V, Marinelli M, Procaccini R, Falcioni D, Farinelli L, Gigante A. Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment. World J Orthop 2022; 13:427-443. [PMID: 35633744 PMCID: PMC9124997 DOI: 10.5312/wjo.v13.i5.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/02/2021] [Accepted: 04/09/2022] [Indexed: 11/09/2022] Open
Abstract
Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.
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Affiliation(s)
- Valentino Coppa
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Mario Marinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Roberto Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Danya Falcioni
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
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Ray V, Popkov D, Lascombes P, Barbier D, Journeau P. Simultaneous multisegmental and multifocal corrections of complex lower limb deformities with a hexapod external fixator. Orthop Traumatol Surg Res 2021; 109:103042. [PMID: 34389499 DOI: 10.1016/j.otsr.2021.103042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/03/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION External fixators are a part of the therapeutic arsenal used in the correction of complex pediatric lower limb deformities. These long iterative procedures, which are commonly performed over several months, strongly impact the lives of these children and their families. To reduce these drawbacks, we perform, whenever possible, a simultaneous multisegmental and/or multifocal correction of these deformities. HYPOTHESIS Simultaneous multilevel correction of complex pediatric deformities using external fixators does not result in more complications than sequential corrections. MATERIALS AND METHODS Sixteen patients were treated with this hexapod external fixator correction procedure. The mean age was 13.9 years. The corrections involved 12 femurs and 20 tibias, representing 53 osteotomies on 23 limbs. The quality of the correction was assessed by measuring the mechanical axis deviation (MAD), residual limb length discrepancy (RLLD) and a new, specifically defined, criterion called the "angular healing index" (AHI). Complications were assessed according to Lascombes' classification. RESULTS The mean MAD went from 30 to 13.5 mm (P<.05) and the mean RLLD from 33.2 to 6.9 mm (P<.05). The mean AHI was 74.1 days/cm (16.7 to 319). The overall complication rate was 13/23 operated limbs or 56.5% (4.3% grade 1, 43.3% grade 2, 9.3% grade 3, and no grade 4). DISCUSSION One-stage multilevel corrections of complex pediatric lower limb deformities represent a difficult technical challenge, and any reduction in treatment time must not adversely impact the quality of the results. The rate and severity of complications compared to monofocal/segmental procedures were no higher than that reported in the literature. This study demonstrated the feasibility of multisegmental and multifocal corrections, which reduced the total treatment duration compared to successive corrections, without adversely affecting the result or increasing the complication rate. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Victor Ray
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital d'enfant, CHU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Dmitry Popkov
- Ilizarov Center, 6, rue M Ouljanova, 640014 Kourgan, Russia
| | - Pierre Lascombes
- Chirurgie orthopédique et traumatologique pédiatrique, Hôpitaux Universitaire de Genève, Hôpital d'enfant, CHU Nancy, 6, rue Willy-Donzé, 1211 Geneva, Switzerland
| | - Dominique Barbier
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital d'enfant, CHU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Pierre Journeau
- Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital d'enfant, CHU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Dermott JA, Wright FV, Salbach NM, Narayanan UG. Development of the gait outcomes assessment list for lower-limb differences (GOAL-LD) questionnaire: a child and parent reported outcome measure. Health Qual Life Outcomes 2021; 19:139. [PMID: 33952260 PMCID: PMC8097808 DOI: 10.1186/s12955-021-01775-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background To develop a priority-based patient/parent reported outcome measure for children with lower-limb differences (LD) by adapting the Gait Outcomes Assessment List (GOAL) questionnaire. Methods Guided by a conceptual framework of patient priorities, the GOAL questionnaire was iteratively modified and its sensibility evaluated by field-testing it on children with LD, and their parents. Cognitive interviews were conducted with a subgroup of these children, and an e-survey administered to a multidisciplinary group of health care professionals with expertise in paediatric LD. Findings were integrated to create the final version of the GOAL-LD. Results Twenty-five children (9–18 years), 20 parents, and 31 healthcare professionals evaluated the content and sensibility of the GOAL, with an emphasis on the relevance and importance of the items to patients’ health related quality of life (HRQL). This resulted in the retention of 26 of the original 50 items, elimination of 12, modification of 12, and addition of seven new items. The new 45-item GOAL-LD questionnaire was shown to be sensible, and its content deemed important. Conclusions The GOAL-LD questionnaire has a high level of face and content validity, and sensibility. It comprehensively captures the HRQL goals and outcomes that matter to children with LD and their parents. Following further psychometric evaluation, the GOAL-LD may serve as a much needed patient and parent reported outcome measure for this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01775-z.
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Affiliation(s)
- Jennifer A Dermott
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - F Virginia Wright
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Unni G Narayanan
- Division of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery and Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Roy A, Pesenti S, Chalopin A, Peltier E, Jouve JL, Launay F. Can the TrueLok Hexapod System™ be used to accurately correct lower limb deformity in children? Orthop Traumatol Surg Res 2020; 106:1361-6. [PMID: 33046433 DOI: 10.1016/j.otsr.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Progressive bone lengthening in children can be done using an external fixator, a lengthening nail, or plate with screws. The TrueLok Hexapod System™ (TL-HEX™) is the newest hexapod external fixator on the market. We hypothesized that the TL-HEX™ can accurately correct lower limb deformities in children. The goal of this study was to evaluate the clinical and radiographic outcomes after correcting lower limb deformities in children using the TL-HEX™ system. MATERIAL AND METHODS Data from 58 limbs that underwent bone lengthening with the TL-HEX™ were analyzed for this retrospective, single-center study. The average patient age was 11.4 years. The femur was lengthened in 23 limbs and the tibia in 35. The outcomes were evaluated using long leg standing radiographs preoperatively and at the final assessment. The variables of interest were the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical lateral proximal tibia angle (mMPTA), healing index (HI) and accuracy of the correction. The complications were graded on a 4-point scale summarizing three broad goals: planned correction, duration of treatment and sequelae. The accuracy of the correction was defined as the difference between the planned correction and the actual correction achieved. RESULTS The mean HI was 37 days/cm. Significant correction was achieved for leg length discrepancy (LLD) (60 mm vs. 20 mm; p<0.01) and mLDFA (88.6° vs. 89.9°; p=0.04) but not the MAD (17.7 vs. 14.7; p= 0.17) or mMPTA (87.3 vs. 88.1; p=0.08). In the entire cohort, the difference from planned was 12.5 mm (p<0.01) for lengthening, 1.3° for the mLDFA (p=0.5) and 3° for the mMPTA (p=0.02). Relative to the initial goal, the mean lengthening achieved was 118%. In the sub-group where the plan did not need to be modified, the accuracy of the correction was better. There were 40 complications (69%). CONCLUSION The TL-HEX™ is an effective and accurate system. The complication rate associated with its use is the same as other hexapod external fixators. Surgeons and patients must be aware of the high complication rate, which may require the plan to be modified and could potentially compromise the outcome.
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Boquan Q, Yi R, Tingjiang G, Xi L, Hui Z. Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release. J Orthop Surg Res 2020; 15:492. [PMID: 33097068 PMCID: PMC7585178 DOI: 10.1186/s13018-020-02021-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results. METHODS A retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted. RESULTS Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study. CONCLUSION The therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Qin Boquan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ren Yi
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Gan Tingjiang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liu Xi
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China.,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhang Hui
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan Province, China. .,Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Morasiewicz P, Burzyńska K, Orzechowski W, Dragan SŁ, Dragan SF, Filipiak J. Three-dimensional printing as a technology supporting the treatment of lower limb deformity and shortening with the Ilizarov method. Med Eng Phys 2018; 57:69-74. [PMID: 29685857 DOI: 10.1016/j.medengphy.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/31/2018] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treatment of multiplanar deformities, especially in younger children, requires construction of a complex Ilizarov fixator, frequently with small dimensions. The aim of this study is to verify clinical application of a3D-printed bone model in treatment with the Ilizarov method. METHODS The study involved a 6-year-old child in whom clinical and radiological examination revealed multiplanar deformity of the right leg. Then, 3D models of individual bones were printed by means of additive manufacturing and were used as a scaffold to install the Ilizarov apparatus. To compare the expected and factual axial correction and lengthening, we measured spatial orientation of bone fragments three times. The factual axial correction and lengthening were determined with a photometric technique. RESULTS Ilizarov fixator with a configuration developed using a 3D model of the treated bone was mounted on the patient's leg. Corticotomy was carried out at the proximal metaphysis of the right tibia, along with osteotomy of the right talus. The treatment resulted in a 3.5-cm lengthening of the limb and a 7° correction of valgus angle. The values of actual lengthening and axial correction were 4.1% lower than the expected values of these parameters. INTERPRETATION Orthopedists should consider differences between the expected and actual lengthening and axial correction in planning treatment with the Ilizarov method. Three-dimensional printing is a useful technology that can be used to support treatment with the Ilizarov method.
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Affiliation(s)
- Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland.
| | - Karolina Burzyńska
- Division of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wrocław University of Technology, Łukasiewicza 7/9, 50-371 Wrocław, Poland
| | - Wiktor Orzechowski
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Łukasz Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Szymon Feliks Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556 Wrocław, Poland
| | - Jarosław Filipiak
- Division of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wrocław University of Technology, Łukasiewicza 7/9, 50-371 Wrocław, Poland
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