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Sun Q, Liu C, Sun X, Liu Z, Liu X, Li W, Zhang Y. The "blownknee" patient's stress fracture of distal tibial component after unilateral TKA: A case report. Medicine (Baltimore) 2024; 103:e39382. [PMID: 39183427 PMCID: PMC11346862 DOI: 10.1097/md.0000000000039382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/31/2024] [Indexed: 08/27/2024] Open
Abstract
RATIONALE Periprosthetic fractures (PPF) are rare complications of total knee arthroplasty (TKA). The most common PPF after TKA is supracondylar femoral fracture, which is a relatively rare complication that is usually associated with high-energy trauma, with a reported incidence ranging from 0.4 to 1.7% according to the AOANJRR. However, in TKA patients, it is rarer that the stress fracture around the tibial prosthesis occurs due to changes in the lower limb force line, increasing weight-bearing, and changes in walking gait. PATIENT CONCERNS A 68-year-old woman visited our hospital with "both knees had aggravated pain and deformity for 8 years." TKA was performed first on the left knee and the patient was discharged within 1 week. Three months later, the patient complained of pain in the upper middle 1/3 part of the medial tibia for 2 weeks, which gradually worsened and affected weight-bearing. DIAGNOSES Physical examination showed that the left knee joint presented varus deformity, and the right valgus deformity, which diagnosed as osteoarthritis of both knees and was so-called "blownknee". The disease was initially diagnosed as osteoarthritis of both knees on first admission and PPF of the tibia in second. INTERVENTIONS Three operations were performed on this patient. The first was TKA of the left knee, the second was open reduction and internal fixation of the PPF of the tibia 3 months after the first operation, and the third was TKA of the right knee. OUTCOMES Until now, the patient has had no recurrent PPF, and the fracture is healing from the last X-ray. LESSONS Clinicians should be aware of the possibility of PPF after TKA, especially in such patients, the most preferred surgical treatment method was open reduction and internal fixation of fractures using locking plates, and if the PPF with loosened implants, Revision TKA, or megaprosthesis was the better choice.
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Affiliation(s)
- Quanxiang Sun
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Changjie Liu
- Department of Orthopedics, Weifang Second People’s Hospital, Weifang, Shandong,China
| | - Xuedong Sun
- Department of Joint Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
| | - Zezhong Liu
- Department of Joint Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
| | - Xiaoguang Liu
- Department of Joint Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
| | - Wei Li
- Department of Joint Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
| | - Yimin Zhang
- Department of Joint Surgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang, Shandong, China
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Sebro R, Elmahdy M. Machine Learning for Opportunistic Screening for Osteoporosis and Osteopenia Using Knee CT Scans. Can Assoc Radiol J 2023; 74:676-687. [PMID: 36960893 DOI: 10.1177/08465371231164743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
PURPOSE To predict whether a patient has osteoporosis/osteopenia using the attenuation of trabecular bone obtained from knee computed tomography (CT) scans. METHODS Retrospective analysis of 273 patients who underwent contemporaneous knee CT scans and dual-energy X-ray absorptiometry (DXA) within 1 year. Volumetric segmentation of the trabecular bone of the distal femur, proximal tibia, patella, and proximal fibula was performed to obtain the bone CT attenuation. The data was randomly split into training/validation (78%) and test (22%) datasets and the performance in the test dataset were evaluated. The predictive properties of the CT attenuation of each bone to predict osteoporosis/osteopenia were assessed. Multivariable support vector machines (SVM) and random forest classifiers (RF) were used to predict osteoporosis/osteopenia. RESULTS Patients with a mean age (range) of 67.9 (50-87) years, 85% female were evaluated. Seventy-seven (28.2%) of patients had normal bone mineral density (BMD), 140 (51.3%) had osteopenia, and 56 (20.5%) had osteoporosis. The proximal tibia had the best predictive ability of all bones and a CT attenuation threshold of 96.0 Hounsfield Units (HU) had a sensitivity of .791, specificity of .706, and area under the curve (AUC) of .748. The AUC for the SVM with cubic kernel classifier (AUC = .912) was better than the RF classifier (AUC = .683, P < .001) and better than using the CT attenuation threshold of 96.0 HU at the proximal tibia (AUC = .748, P = .025). CONCLUSIONS Opportunistic screening for osteoporosis/osteopenia can be performed using knee CT scans. Multivariable machine learning models are more predictive than the CT attenuation of a single bone.
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Affiliation(s)
- Ronnie Sebro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Centre for Augmented Intelligence, Mayo Clinic, Jacksonville, FL, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Mahmoud Elmahdy
- Centre for Augmented Intelligence, Mayo Clinic, Jacksonville, FL, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Lewis DP, Tarrant SM, MacKenzie S, Cornford L, Sato T, Shiota N, Balogh ZJ. Managing periprosthetic tibia fractures: International perspectives. OTA Int 2023; 6:e241. [PMID: 37006449 PMCID: PMC10064641 DOI: 10.1097/oi9.0000000000000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 03/30/2023]
Abstract
Knee arthroplasty, both total knee and unicompartmental, has had a significant impact on millions of patients globally. Although satisfaction is usually high, complications such as periprosthetic fracture are increasingly common. Distal femur periprosthetic fractures are relatively well researched and understood in comparison with periprosthetic proximal tibia fractures (PTFs). The management of PTFs is essentially an evidence-free area. This review explores the literature (or lack thereof) and integrates cases from Australia and Japan. As it stands, there is scant literature relating to all facets of PTFs, including, most concerningly, the management of them. Larger studies are required to help further investigate this important interface between arthroplasty and orthopaedic trauma. As a guide, those with loose prostheses will likely benefit most from revision total knee arthroplasty, while those with well-fixed prostheses can be managad according to the fracture with homage paid to the presence of the prosthesis. The use of periarticular locked plates is likely a better option over conventional large or small fragment plates. Nonoperative management is a viable option for selected individuals and can be associated with favorable outcomes.
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Pai SN, Kumar MM. Combination-type periprosthetic tibial fracture: Felix type (II+IV)A. BMJ Case Rep 2023; 16:e252464. [PMID: 36750293 PMCID: PMC9906182 DOI: 10.1136/bcr-2022-252464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Mohan M Kumar
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Clinical Applications of Three-Dimensional Printing in Upper Extremity Surgery: A Systematic Review. J Pers Med 2023; 13:jpm13020294. [PMID: 36836528 PMCID: PMC9961947 DOI: 10.3390/jpm13020294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Three-dimensional printing for medical applications in surgery of the upper extremity has gained in popularity as reflected by the increasing number of publications. This systematic review aims to provide an overview of the clinical use of 3D printing in upper extremity surgery. METHODS We searched the databases PubMed and Web of Science for clinical studies that described clinical application of 3D printing for upper extremity surgery including trauma and malformations. We evaluated study characteristics, clinical entity, type of clinical application, concerned anatomical structures, reported outcomes, and evidence level. RESULTS We finally included 51 publications with a total of 355 patients, of which 12 were clinical studies (evidence level II/III) and 39 case series (evidence level IV/V). The types of clinical applications were for intraoperative templates (33% of a total of 51 studies), body implants (29%), preoperative planning (27%), prostheses (15%), and orthoses (1%). Over two third of studies were linked to trauma-related injuries (67%). CONCLUSION The clinical application of 3D printing in upper extremity surgery offers great potential for personalized approaches to aid in individualized perioperative management, improvement of function, and ultimately help to benefit certain aspects in the quality of life.
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Müller M, Kahl U, von Roth P, Hube R. Intraoperative Fractures of the Tibia and Femur in Knee Revision Surgery. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:85-91. [PMID: 34496426 DOI: 10.1055/a-1542-9192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intra-operative fractures in knee revision surgery are relatively rare and have not been well studied. They may occur during joint exposition, removal of the prosthesis or cement, or implantation of trial or original components. The fractures affect both the metaphyseal area and diaphysis of the tibia and femur. Tibial fractures are slightly more common than femur fractures. On the femur, the medial condyle is most frequently affected, followed by the femur diaphysis. The use of non-cemented stems is associated with a greater risk of intra-operative diaphyseal fractures than that of cemented stems. Overall, women and patients with an osteopenic bone structure have a higher risk of fractures. It is common that fractures are diagnosed post-operatively. In these cases, conservative therapy may be successful, depending on the stability of the prosthesis and bones. The most common surgical fixation options are cerclages and screws, followed by stem extensions for bridging the fracture. Plate fixation or use of strut grafts are also sensible therapy options. Overall, intraoperative fractures have a high healing potential with stable and good joint function. The revision rate is still 15%, which is most often caused by peri-prosthetic infection.
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Affiliation(s)
- Michael Müller
- Department of Orthopaedics, Charite - Universitaetsmedizin Berlin, Germany.,Sportklinik Erfurt, Erfurt, Germany
| | - Uwe Kahl
- Sportklinik Erfurt, Erfurt, Germany
| | | | - Robert Hube
- Orthopaedic Surgery, OCM Clinic Munich, Germany
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Mazur M, Beyer J, Elsamaloty M, Patel D, Liu J, Ebraheim NA. Surgical outcomes of periprosthetic distal femur fractures after total knee arthroplasty classified by Su et al. system. J Orthop 2022; 34:260-265. [PMID: 36148178 PMCID: PMC9486061 DOI: 10.1016/j.jor.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Periprosthetic fractures of the distal femur remain a challenge to treat due to variations in both patient- and fracture-specific factors. This study was designed to analyze the outcomes of different subtypes of periprosthetic distal femur fractures based on the Su et al. classification system. Methods Thirty-six patients were classified with Su et al. system. All Type I and II fractures were managed with a locking plate. Most Type III fractures were managed with locking plate, while two were managed with long-stem revision arthroplasty due to evidence of implant loosening. Outcomes were measured and analyzed based on healing time, revision rate, and complication rate. Results Of the 36 patients, 30 (83.3%) achieved acceptable fracture union, while the remaining 6 (16.7%) experienced either delayed union or non-union. Type I fractures showed a significantly lower healing time than Type II and III fractures managed by locking plate. Delayed union was present in the Type II group, while non-union was recorded for two Type III fractures. Need for revision was more prevalent in fracture Types II and III. Conclusion The Su et al. system of classification for periprosthetic fractures of the distal femur matches the clinical outcomes of this study and would seem to be useful in the approach to the treatment of these fractures. The majority of these fractures can be managed with locking plate with reasonable results. However, if the implant is loosened in Type III fractures, revision arthroplasty is suggested.
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Affiliation(s)
- Matthew Mazur
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Julia Beyer
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Mazzin Elsamaloty
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Devon Patel
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Jiayong Liu
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
| | - Nabil A. Ebraheim
- The University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH, 43614, USA
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van den Kieboom J, Tirumala V, Klemt C, Kwon YM. Outcome of Two-Stage Revision Total Hip and Knee Arthroplasty as a Salvage Procedure for Deep Infection of Peri-Articular Fracture Fixation: Propensity Score-Matched Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:576-584. [PMID: 36032643 PMCID: PMC9382256 DOI: 10.22038/abjs.2022.51393.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/02/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Failed open reduction internal fixation (ORIF) of peri-articular fractures due to deep infection is associated with decreased functional outcomes and increased mortality rates. Two-stage revision total joint arthroplasty (TJA) is often needed as a salvage procedure. The aim of this study was to evaluate the outcome of two-stage revision total hip and knee arthroplasty as a salvage procedure for the treatment of deep infection of peri-articular fracture fixation. METHODS Using propensity score-matching, a total of 120 patients was evaluated: 1) 40 consecutive patients were treated with planned salvage two-stage revision for the treatment of deep peri-articular infection, and 2) a control group of 80 patients who underwent two-stage revision for periprosthetic joint infection (PJI) after non-IF TJA. An infection occurred after a fracture of the acetabulum (27.5%), femoral neck (22.5%), intertrochanteric femur (15.0%), subtrochanteric femur (5.0%), femoral shaft (7.5%), distal femur (5.0%), and tibia (15.0%). RESULTS At an average follow up of 4.5 years (range, 1.0-25.8), the overall failure rate was 42.5% for the IF group compared to 21.3% for the non-ORIF group (P=0.03). There was a significantly higher reinfection rate for the IF group compared to the non-IF group (35.0% vs. 11.3%, p=0.005). Tissue cultures for the IF patients demonstrated significantly higher polymicrobial growth (30.0% vs. 11.3%, P=0.01) and methicillin-resistant Staphylococcus aureus (20.0% vs. 7.5%, P=0.04). CONCLUSION Salvage two-stage revision arthroplasty for infected IF of peri-articular fractures was associated with poor outcome. The overall post-operative complications after salvage two-stage revision for infected IF of peri-articular fractures was high with 35% reinfection rates associated with the presence of mixed and resistant pathogens.
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Affiliation(s)
- Janna van den Kieboom
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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9
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Surgical outcomes of subtypes of periprosthetic tibia fractures after total knee arthroplasty. J Orthop 2021; 29:11-14. [PMID: 35027813 PMCID: PMC8724926 DOI: 10.1016/j.jor.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/03/2023] Open
Abstract
Surgical outcomes of subtypes of periprosthetic tibia fractures after total knee arthroplasty were evaluated by using the Felix et al. classification system. Type 3 fractures were the most common classification of periprosthetic tibial fractures. Type 2 fractures had the highest rates of revision and nonunion. Type 3 fractures exhibited longer healing times than types 2 and 4. Far type 3 fractures showed the longest healing time of all fracture types but had very minimal complications. Type 4 fracture managed by K-wire/cerclage wire may require hardware removal or debridement but exhibited the shortest healing time compared to types 2 and 3.
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10
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Pannu TS, Villa JM, Cohen EM, Hayda RA, Higuera CA, Deren ME. Periprosthetic Tibial Fractures After Total Knee Arthroplasty: Early and Long-Term Clinical Outcomes. J Arthroplasty 2021; 36:1429-1436. [PMID: 33190998 DOI: 10.1016/j.arth.2020.10.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although periprosthetic fractures are increasing in prevalence, evidence-based guidelines for the optimal treatment of periprosthetic tibial fractures (PTx) are lacking. Thus, the purpose of this study is to assess the clinical outcomes in PTx after a total knee arthroplasty (TKA) which were treated with different treatment options. METHODS A retrospective review was performed on a consecutive series of 34 nontumor patients treated at 2 academic institutions who experienced a PTx after TKA (2008-2016). Felix classification was used to classify fractures (Felix = I-II-III; subgroup = A-B-C) which were treated by closed reduction, open reduction/internal fixation, revision TKA, or proximal tibial replacement. Patient demographics and surgical characteristics were collected. Failure of treatment was defined as any revision or reoperation. Independent t-tests, one-way analysis of variance, chi-squared analyses, and Fisher's exact tests were conducted. RESULTS Patients with Felix I had more nonsurgical complications when compared to Felix III patients (P = .006). Felix I group developed more postoperative anemia requiring transfusion than Felix III group (P = .009). All fracture types had >30% revision and >50% readmission rate with infection being the most common cause. These did not differ between Felix fracture types. Patients who underwent proximal tibial replacement had higher rate of postoperative infection (P = .030), revision surgery (P = .046), and required more flap reconstructions (P = .005). CONCLUSION PTx after a TKA is associated with high revision and readmission rates. Patients with Felix type I fractures are at higher risk of postoperative nonsurgical complications and anemia requiring transfusion. Fractures treated with proximal tibial replacement are more likely to develop postoperative infections and undergo revision surgery.
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Affiliation(s)
- Tejbir S Pannu
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Eric M Cohen
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Roman A Hayda
- Department of Orthopaedic Surgery, Brown University, Providence, RI
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Matthew E Deren
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
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11
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Smith TJ, Siddiqi A, Forte SA, Judice A, Sculco PK, Vigdorchik JM, Schwarzkopf R, Springer BD. Periprosthetic Fractures Through Tracking Pin Sites Following Computer Navigated and Robotic Total and Unicompartmental Knee Arthroplasty: A Systematic Review. JBJS Rev 2021; 9:e20.00091. [PMID: 33502139 DOI: 10.2106/jbjs.rvw.20.00091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Use of computer-assisted navigation (CAN) and robotic-assisted (RA) surgery in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) both necessitate the use of tracking pins rigidly fixed to the femur and tibia. Although periprosthetic fractures through tracking pin sites are rare, there is a paucity of literature on this potential complication. Therefore, the purpose of this study was to perform a systematic review of the current literature to assess the incidence and clinical outcomes of periprosthetic fractures through tracking pin sites following CAN and RA TKA and UKA. METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using the PubMed, MEDLINE, and Cochrane databases in April 2020. Studies were assessed for the presence of pin site fractures, fracture characteristics, and clinical outcomes. RESULTS Seventeen clinical studies (5 case series, 1 cohort study, and 11 case reports) involving 29 pin-related fractures were included for review. The overall incidence ranged from 0.06% to 4.8%. The mean time from index arthroplasty to fracture was 9.5 weeks (range, 0 to 40 weeks). The majority of fractures occurred in the femoral diaphysis (59%). Nineteen fractures (66%) were displaced and 10 (34%) were nondisplaced or occult. The majority of cases were atraumatic in nature or involved minor trauma and were typically preceded by persistent leg pain. A transcortical pin trajectory, large pin diameter (>4 mm), diaphyseal fixation, multiple placement attempts, and the use of non-self-drilling, non-self-tapping pins were the most commonly reported risk factors for pin-related periprosthetic fractures following CAN or RA TKA. CONCLUSIONS Surgeons should maintain a high index of suspicion for pin-related fractures in patients with ongoing leg or thigh pain after CAN or RA TKA in order to avoid fracture displacement and additional morbidity. As CAN and RA TKA have unique complication risks, the debate regarding the value of technology-assisted TKA and its cost-effectiveness continues. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tyler J Smith
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Ahmed Siddiqi
- Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Salvador A Forte
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Anthony Judice
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Peter K Sculco
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | | | - Ran Schwarzkopf
- Department of Orthopedics, New York University Langone Medical Center, New York, NY
| | - Bryan D Springer
- Department of Orthopedics, Atrium Musculoskeletal Institute, OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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12
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Periprosthetic tibial fracture after total knee arthroplasty with popliteal artery injury-A case report. Trauma Case Rep 2020; 30:100359. [PMID: 33102676 PMCID: PMC7578748 DOI: 10.1016/j.tcr.2020.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 11/20/2022] Open
Abstract
We present the case of a 79-year-old woman who presented at our center with a periprosthetic tibial fracture with a popliteal artery injury after total knee arthroplasty. Anastomosis of the popliteal artery was performed on the day of injury, and was later treated by open reduction and internal fixation. The patient was able to walk 3 months after injury. The present case was difficult to treat because of the arterial injury associated with periprosthetic fracture. Although revision of the implant was considered, open reduction and internal fixation was selected because of the severity of soft-tissue damage. The mechanism of injury is not uncommon, and it is expected that similar fractures will become more prevalent in the future as the number of knee replacement surgeries increases.
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13
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Taylor SK, Sephian A, Clader T. Intraoperative tibial plateau fracture during bone preparation in a cruciate retaining primary total knee arthroplasty. BMJ Case Rep 2020; 13:13/9/e233826. [PMID: 32963039 DOI: 10.1136/bcr-2019-233826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intraoperative fractures are a rare complication in total knee arthroplasty. Limited literature exists in regard to the incidence, mechanism of injury and management of intraoperative fractures. The authors report a unique case of an 80-year-old man who sustained a medial tibial plateau fracture that occurred intraoperatively during final tibia bone preparation with the use of the Woolley Tibia Punch (Innomed, Savannah, Georgia, USA). The fracture was managed with the addition of 4.5 mm cortical lag screws and the addition of a stemmed tibial implant to bypass the fracture. This is the first reported case in literature that describes an intraoperative medial tibial plateau that occurred through the use of a Woolley Tibia Punch. The authors recommend the consideration of drilling to prepare sclerotic bone for cement penetration rather than a punch in order to minimise the potential for intraoperative fractures that may occur with the use of a punch.
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Affiliation(s)
- Shea K Taylor
- Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Andrew Sephian
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Timothy Clader
- Orthopaedic Surgery Department, James A Haley Veterans Hospital, Tampa, Florida, USA
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14
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Carender CN, Wynn MS, Otero JE, Miller BJ, Brown TS. Nonoperative Treatment of a Pathologic Proximal Tibia Fracture in the Setting of Previous Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2020; 10:e0517. [PMID: 32649123 DOI: 10.2106/jbjs.cc.19.00517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of a super obese 51-year-old woman with a pathologic fracture of the proximal tibia in the setting of a previous total knee arthroplasty. Imaging demonstrated an osteolytic lesion distal to the keel and pathologic fracture of the proximal tibia. Nonoperative treatment with a 12-week course of nonweight-bearing resulted in fracture healing and ossification of osteolysis. CONCLUSION Pathologic fractures of the tibia secondary to osteolysis are frequently treated surgically. Patients may benefit from nonoperative management, even in the setting of super morbid obesity and significant osteolysis about the tibial component.
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Affiliation(s)
- Christopher N Carender
- 1Department of Orthopaedics and Rehabilitation, University of Iowa Hospital & Clinics, Iowa City, Iowa 2Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
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15
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Bauer C, Zaharia B, Galliot F, Parot J, Houfani F, Mayer J, Mainard D. Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years' follow-up. Orthop Traumatol Surg Res 2020; 106:449-458. [PMID: 32184065 DOI: 10.1016/j.otsr.2020.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess treatment efficacy, on the hypothesis that surgery provides good long-term results. MATERIAL AND METHODS A two-center retrospective study included 15 patients (6 male, 9 female: mean age, 71.8±10.2 years), managed between 1997 and 2017 for isolated tibial fracture after TKA. Patients were assessed clinically (IKS, inverted Oxford, Parker and SF-12 scores) and radiologically. Complications and revision surgeries were collated. Fractures were classified on the SoFCOT classification: 9 stable implants (4 type B1, 5 type C1), 4 periprosthetic osteolyses (1 type A3, 2 type B3, 1 type C3), and 2 loosenings (type A2). Treatments comprised: non-operative treatment (1 bed-ridden patient), 11 osteosyntheses for fracture on stable implant (2 standard plates, 7 locking plates, 2 intramedullary nailings), and 3 implant replacements by cemented long stem models for loosening. RESULTS Mean follow-up was 28 months (range, 12-120 months). Consolidation was achieved in 13 cases, at a mean 15 weeks. Complications comprised: 4 infections, 2 cases of secondary displacement, and 2 of non-union. Surgical revision was required in 8 cases, including 2 secondary implant revision procedures. Functional results were good in 10 cases. At last follow-up, mean Parker score was 7 (range, 4-8.5), Oxford score 32 (range, 16-39), and IKS score 150 (range, 85-167) with knee and function scores respectively 78 (range, 55-86) and 75 (range, 30-85). CONCLUSION Radiologic and clinical results were encouraging, but with impaired quality of life and a high rate of complications. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Camille Bauer
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - Bogdan Zaharia
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Florent Galliot
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Jauffrey Parot
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Fayçal Houfani
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - Julien Mayer
- Service de chirurgie orthopédique et traumatologique, hôpital de Mercy, CHR de Metz-Thionville, 1, allée du Château, 57245 Ars-Laquenexy, France
| | - Didier Mainard
- Service de chirurgie orthopédique et traumatologique, COTA, hôpital Central, CHRU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
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Nozaka K, Miyakoshi N, Sato T, Shimada Y. Ilizarov external fixation for a periprosthetic tibial fracture in severe osteoporosis: a case report. BMC Musculoskelet Disord 2020; 21:145. [PMID: 32131797 PMCID: PMC7057544 DOI: 10.1186/s12891-020-3176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of periprosthetic fractures after total knee arthroplasty (TKA) is rising due to the increasing number of TKAs performed annually and the growing elderly population. A periprosthetic fracture of the proximal tibia following TKA is a rare injury that may be a challenging clinical scenario. Case presentation The case of an 84-year-old woman who sustained a periprosthetic tibial fracture 10 years after a TKA is presented. This patient had multiple risk factors. The fracture was not deemed amenable to conventional treatment because the bone fragment was too small. This patient underwent fixation of her tibial fracture above the TKA using a five-ring Ilizarov external fixator. This allowed immediate full weight-bearing. The fixator was removed at 12 weeks, at which time the fracture was solidly healed. At the most recent follow-up, 2 years from injury, she was fully weight-bearing without walking aids and had a knee range of motion (ROM) of 0–110°. Conclusion To the best of our knowledge, this is the first report in which Ilizarov external fixation has been used for a periprosthetic tibial fracture after TKA.
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Affiliation(s)
- Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Takeshi Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Kong L, Yang G, Yu J, Zhou Y, Li S, Zheng Q, Zhang B. Surgical treatment of intra-articular distal radius fractures with the assistance of three-dimensional printing technique. Medicine (Baltimore) 2020; 99:e19259. [PMID: 32080133 PMCID: PMC7034683 DOI: 10.1097/md.0000000000019259] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.
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Affiliation(s)
- Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University
| | - Gang Yang
- Department of Orthopedics, Hebei Provincial Hospital of Traditional Chinese Medicine
| | - Jian Yu
- Department of Orthopedics, Hebei Provincial Hospital of Traditional Chinese Medicine
| | - Yanqing Zhou
- Department of Orthopedics, The Third Hospital of Hebei Medical University
| | - Sujuan Li
- Department of Medicine, Wuji County Hospital, Shijiazhuang
| | - Quanhui Zheng
- Department of Immunology, North China University of Science and Technology, Tangshan, Hebei, P.R. China
| | - Bing Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University
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Circadian rhythm disruption is associated with an increased risk of sarcopenia: a nationwide population-based study in Korea. Sci Rep 2019; 9:12015. [PMID: 31427694 PMCID: PMC6700184 DOI: 10.1038/s41598-019-48161-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
Reduced sleep quality is associated with an increased risk of sarcopenia. However, the potential effects of disturbing the regular circadian rhythm, as occurs with shift work, on the risk of sarcopenia have not been established. Data from 9105 workers from the 2008–2011 Korean National Health and Nutrition Examination Survey were analyzed. Sarcopenia, measured by dual-energy X-ray absorptiometry, was defined as one standard deviation below the mean of the appendicular skeletal muscle/body mass index value of a young reference group. Compared to the group that had never experienced shift work, the odds ratio (OR) for sarcopenia with a 95% confidence interval (95% CI) for the shift work group was 1.7 (1.5–1.9); the association remained even after adjusting for confounding variables, including age, sex, total fat mass, insulin resistance profile, smoking, alcohol intake, diet, and physical activity. The results of the subgroup analysis indicated that the highest risk of sarcopenia was among workers engaging in shift work with an irregular schedule (OR 1.8, 95% CI 1.3–2.4). Disruption of circadian rhythm by shift work was associated with increased risk of sarcopenia. Intervention strategies are needed to prevent sarcopenia in shift workers.
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Hoffmeyer P, Miozzari H, Holzer N. Non-hip/non-vertebral fractures - How to treat best? Best Pract Res Clin Rheumatol 2019; 33:236-263. [PMID: 31547981 DOI: 10.1016/j.berh.2019.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.
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Affiliation(s)
- Pierre Hoffmeyer
- Swiss Foundation for Innovation and Training in Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Hermes Miozzari
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Nicolas Holzer
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
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Wan L, Zhang X, Zhang S, Li K, Cao P, Li J, Wu G. Clinical feasibility and application value of computer virtual reduction combined with 3D printing technique in complex acetabular fractures. Exp Ther Med 2019; 17:3630-3636. [PMID: 30988746 PMCID: PMC6447803 DOI: 10.3892/etm.2019.7344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/22/2019] [Indexed: 01/17/2023] Open
Abstract
This study investigated the clinical feasibility and application value of computer virtual reduction combined with three-dimensional (3D) printing technique in patients with complex acetabular fracture. Ninety-six patients diagnosed with complex acetabular fracture in the Orthopedics Department in The Second Affiliated Hospital of Luohe Medical College from January 2016 to June 2017 were selected and randomly divided into the routine operation group (n=48) and the 3D model group (n=48) according to the admission number of the patients. In the 3D model group, computed tomography (CT) scan was performed preoperatively, and the model was made using the virtual technique and 3D printing technique. The surgical scheme was designed according to the model. Patients in the routine operation group were diagnosed with the conventional CT scan without using the computer virtual technique and 3D printing technique. During operation, the operation time, amount of intraoperative bleeding and times of intraoperative fluoroscopy were recorded in both groups. After operation, the incidence rate of such complications as inflammatory response, iatrogenic neurological symptoms and loss of reduction were recorded in both groups. Moreover, the reduction quality of acetabular fracture was evaluated according to the Matta imaging score at 3 days after operation, and the hip joint function was evaluated based on the Hariss score at 6 months after operation. In the 3D model group, the operation time was significantly shorter than that in the control group, the amount of intraoperative bleeding and times of intraoperative fluoroscopy were significantly less than those in the routine operation group, and the incidence rate of postoperative complications was obviously lower than that in the routine operation group (P<0.05). In conclusion, computer virtual reduction combined with the 3D printing technique can significantly reduce the operation time, amount of intraoperative bleeding, times of intraoperative fluoroscopy and incidence rate of postoperative complications without adverse effects on the reduction quality of acetabular fracture and hip joint function of patients, which has a higher clinical application value and greater social significance.
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Affiliation(s)
- Lei Wan
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Xiaoguang Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Shaoan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Kui Li
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Pengke Cao
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Junming Li
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
| | - Guangliang Wu
- Department of Orthopedics, The Second Affiliated Hospital of Luohe Medical College, Luohe, Henan 462300, P.R. China
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