Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010
ConclusionsWe observed declining trends in MOF and hip fracture for both sexes. However, a lower rate of decrease of hip fracture and an increasing trend in vertebral fracture was noticed among men. Considering our observations and the major economic burden which accompanies this devastating disease, more attention should be paid to MOF, especially in men. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 27, 2018 Category: Orthopaedics Source Type: research

Progressive bone impairment with age and pubertal development in neurofibromatosis type I
AbstractSummaryBone density impairment represents an established complication in adults with neurofibromatosis type 1, while few data exist in the pediatric population. Age- and gender-adjusted bone mass decreases with age and pubertal development, identifying childhood as the best time frame to introduce prevention strategies aiming at peak bone mass achievement.PurposeThe present study aims at evaluating bone mineral density (BMD) in a population of children with neurofibromatosis type I (NF-1), with particular focus on changes occurring during growth and pubertal development.MethodsBone metabolic markers and bone status...
Source: Archives of Orthopaedic and Trauma Surgery - August 27, 2018 Category: Orthopaedics Source Type: research

Grip strength cutpoints for youth based on a clinically relevant bone health outcome
ConclusionsGrip strength is strongly related to TBLH_BMC, and the proposed cutpoints demonstrated acceptable classification accuracy for screening healthy youth and tracking healthy bone development in community settings. The utility of the cutpoints should be further examined in more diverse populations of youth. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 27, 2018 Category: Orthopaedics Source Type: research

Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010
ConclusionsWe observed declining trends in MOF and hip fracture for both sexes. However, a lower rate of decrease of hip fracture and an increasing trend in vertebral fracture was noticed among men. Considering our observations and the major economic burden which accompanies this devastating disease, more attention should be paid to MOF, especially in men. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 27, 2018 Category: Orthopaedics Source Type: research

Consensus statement: osteoporosis prevention and treatment in Latin America —current structure and future directions
ConclusionsThe panel concluded that a comprehensive approach to osteoporosis prevention and treatment in Latin America is urgently needed. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 24, 2018 Category: Orthopaedics Source Type: research

Moderate-to-heavy smoking in women is potentially associated with compromised cortical porosity and stiffness at the distal radius
AbstractSummaryThough smokers have poor clinical outcomes after treatment for fractures, the skeletal effects of smoking are still debated. Our results showed that female smokers had 33% higher cortical bone porosity. Smoking targets cortical compartment microstructure and mechanics, and micron-scale variables are essential to better understand the specific effects of smoking.PurposeSmokers have poor outcomes in the clinic after treatment for fractures. However, skeletal effects of smoking are still debated. Inconsistencies in published data are likely due to macro-scale variables used to characterize bone differences due ...
Source: Archives of Orthopaedic and Trauma Surgery - August 23, 2018 Category: Orthopaedics Source Type: research

Effect of vertebral exclusion on TBS and FRAX calculations
This study examined how spinal degenerative changes affect TBS-adjusted fracture risk (FRAX). In a majority, but not all patients in this sample, TBS decreased after exclusion of vertebrae with degenerative change. Therefore, vertebral exclusion for TBS is suggested.IntroductionSpinal degenerative changes elevate DXA-measured BMD, but reports find trabecular bone score (TBS) relatively unaffected. However, we observed patients where degenerative changes elevated both. Consequently, this study explored whether vertebral exclusion impacts TBS and subsequently TBS-adjusted FRAX risk.MethodsClinical DXA interpretations of one ...
Source: Archives of Orthopaedic and Trauma Surgery - August 20, 2018 Category: Orthopaedics Source Type: research

Prevalence and associated risk factors for osteoporosis in Korean men
AbstractSummaryOsteoporosis has become an important health concern even in men. We aimed to analyze its prevalence and associated factors in Korean men. Low socioeconomic status, unhealthy lifestyle, and chronic kidney disease increased the risk. High-risk men even at young age need to evaluate bone mineral density, and proper interventions should be reinforced.PurposeOwing to an increase in the elderly population, osteoporosis and consequent fractures have become important health concerns even in men. We aimed to analyze the prevalence of osteoporosis in Korean men and identify risk factors associated with male osteoporos...
Source: Archives of Orthopaedic and Trauma Surgery - August 20, 2018 Category: Orthopaedics Source Type: research

Effect of vertebral exclusion on TBS and FRAX calculations
This study examined how spinal degenerative changes affect TBS-adjusted fracture risk (FRAX). In a majority, but not all patients in this sample, TBS decreased after exclusion of vertebrae with degenerative change. Therefore, vertebral exclusion for TBS is suggested.IntroductionSpinal degenerative changes elevate DXA-measured BMD, but reports find trabecular bone score (TBS) relatively unaffected. However, we observed patients where degenerative changes elevated both. Consequently, this study explored whether vertebral exclusion impacts TBS and subsequently TBS-adjusted FRAX risk.MethodsClinical DXA interpretations of one ...
Source: Archives of Orthopaedic and Trauma Surgery - August 20, 2018 Category: Orthopaedics Source Type: research

Prevalence and associated risk factors for osteoporosis in Korean men
AbstractSummaryOsteoporosis has become an important health concern even in men. We aimed to analyze its prevalence and associated factors in Korean men. Low socioeconomic status, unhealthy lifestyle, and chronic kidney disease increased the risk. High-risk men even at young age need to evaluate bone mineral density, and proper interventions should be reinforced.PurposeOwing to an increase in the elderly population, osteoporosis and consequent fractures have become important health concerns even in men. We aimed to analyze the prevalence of osteoporosis in Korean men and identify risk factors associated with male osteoporos...
Source: Archives of Orthopaedic and Trauma Surgery - August 20, 2018 Category: Orthopaedics Source Type: research

Dysmobility syndrome is associated with prevalent morphometric vertebral fracture in older adults: the Korean Urban-Rural Elderly (KURE) study
ConclusionsDysmobility syndrome was associated with elevated odds of morphometric VF in community-dwelling older adults, independent of age and covariates. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 14, 2018 Category: Orthopaedics Source Type: research

Persistence at 24  months with denosumab among postmenopausal women with osteoporosis: results of a prospective cohort study
ConclusionsPersistence with denosumab for 24  months yields improvement in BMD among postmenopausal women with osteoporosis treated in routine clinical practice in the USA and Canada. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 7, 2018 Category: Orthopaedics Source Type: research

Prenatal concentrations of perfluoroalkyl substances and bone health in British girls at age 17
ConclusionsPrenatal concentrations of some PFAS may be associated with reduced bone mass and size in adolescent girls, although it is not clear whether these associations are driven by body size. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - August 3, 2018 Category: Orthopaedics Source Type: research

Association between bone-specific physical activity scores and pQCT-derived measures of bone strength and geometry in healthy young and middle-aged premenopausal women
ConclusionsThe total BPAQ score-derived physical activity was more predictive of positive bone characteristics in young women than in middle-aged premenopausal women. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 28, 2018 Category: Orthopaedics Source Type: research

Single-level vertebral kyphoplasty is not associated with an increased risk of symptomatic secondary adjacent osteoporotic vertebral compression fractures: a matched case –control analysis
ConclusionsPatients with osteoporotic VCFs treated with kyphoplasty did not show an increased rate of additional symptomatic adjacent-level VCFs when compared to a non-operative control group matched for age, gender, fracture level, and bone mineral density.Level of Evidence: Level III. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 27, 2018 Category: Orthopaedics Source Type: research

Beyond orthogeriatric co-management model: benefits of implementing a process management system for hip fracture
AbstractSummaryHip fracture is a major health care problem worldwide. Business process management systems (PMSs) have made significant contributions in health care environments to improve patient care standards. The effectiveness of PMS applied to hip fracture in older adults in the acute phase has been demonstrated.IntroductionFragility fracture is a major health care problem worldwide. Business PMSs have made significant contributions in health care environments to improve patient care standards. It is a new way of management that defines a homogeneous application procedure involving eliminating steps that add no value a...
Source: Archives of Orthopaedic and Trauma Surgery - July 25, 2018 Category: Orthopaedics Source Type: research

Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study
ConclusionsThe IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip, and hand. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 21, 2018 Category: Orthopaedics Source Type: research

Age and sex effects on the relationship between body composition and hip geometric structure in males and females from East China
ConclusionsAmong all body composition parameters, hip BMD showed the largest correlation with hip geometric structure, with LM showing the second largest. The impact of FM and LM on hip geometry changed with aging and with different distributions of lean mass and fat mass. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 17, 2018 Category: Orthopaedics Source Type: research

A positive correlation between blood glucose level and bone mineral density in Taiwan
ConclusionsBoth obese and non-obese people with T2DM had higher BMD, at lumbar spine and femoral neck, compared with healthy subjects. In addition, the prevalence of osteoporosis significantly decreased with blood glucose and HbA1c. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 16, 2018 Category: Orthopaedics Source Type: research

Musculoskeletal health of Indigenous Australians
ConclusionData on more detailed musculoskeletal health outcomes are required in Indigenous Australians to better understand fracture risk and to formulate evidence-based strategies for fracture prevention and to minimise the risk of falls. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 14, 2018 Category: Orthopaedics Source Type: research

Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population
This study assessed the possibility of diagnosing and excluding osteoporosis with routine abdominal CT scans in a Chinese population who underwent both DXA and CT for unrelated reasons. Statistical correlation was made between the HU measured of the spine on CT and various parameters on DXA. Diagnostic cutoff points in terms of HU were established for the diagnosis ( ≤ 136 HU) and exclusion (≥ 175 HU) of osteoporosis on sagittal reformatted images. There was excellent positive and negative predictive value for the DXA-defined diagnostic subgroups and were also comparable with previous studies in Caucasian populations...
Source: Archives of Orthopaedic and Trauma Surgery - July 9, 2018 Category: Orthopaedics Source Type: research

Correction to: Geographic region, socioeconomic position and the utilisation of primary total joint replacement for hip or knee osteoarthritis across western Victoria: a cross-sectional multilevel study of the Australian Orthopaedic Association National Joint Replacement Registry
The names of the co-authors Steven Graves and Michelle Lorimer were missing from the manuscript supplied for publication. The lead authors regret this error and apologize for any inconvenience. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 9, 2018 Category: Orthopaedics Source Type: research

Effect of a patient-support program on once-daily teriparatide adherence and persistence in the Japan Fracture Observational Study (JFOS)
ConclusionsOnce-daily teriparatide adherence and persistence rates were higher among patients who enrolled in a patient-support program than among those who did not, highlighting the value of patient-support programs for improving adherence and persistence. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 5, 2018 Category: Orthopaedics Source Type: research

Correction to: Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region
In this article the name of the sixth author, E. Michael Lewiecki was rendered incorrectly. The publisher regrets this error and apologizes for the inconvenience caused. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 3, 2018 Category: Orthopaedics Source Type: research

Hip and spine bone mineral density are greater in master sprinters, but not endurance runners compared with non-athletic controls
ConclusionsRegular running is associated with greater BMD at the fracture-prone hip and spine sites in master sprinters but not endurance runners. These benefits cannot be explained by indicators of mechanical loading measured in this study including vertical impacts, body composition or muscular output. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - July 3, 2018 Category: Orthopaedics Source Type: research

Low physical performance determined by chair rising test muscle mechanography is associated with prevalent fragility fractures
This study examined associations between physical performance assessed by chair rising test muscle mechanography and DXA T-score as well as body composition in a large patient cohort. Next to various significant interrelationships between these muscle and bone parameters, lower physical performance was associated with prevalent fragility fractures.PurposeAlthough the interaction between muscle and bone has been demonstrated in various aspects, the clinical focus in the diagnosis of musculoskeletal disorders mainly lies on the skeletal assessments. Accordingly, the association between muscle function, bone mineral density (...
Source: Archives of Orthopaedic and Trauma Surgery - July 2, 2018 Category: Orthopaedics Source Type: research

Knowledge of risk factors and prevention of osteoporosis: the Israeli women ’s health at midlife study
ConclusionsThere is a need to improve knowledge of osteoporosis especially among less educated and minority women. Subjective perception of risk was more strongly related to knowledge than actual risk factors and should be targeted in public campaigns. The efforts should be aimed at strengthening women ’s perception of their own susceptibility to osteoporosis and of the severity of this disease. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - June 29, 2018 Category: Orthopaedics Source Type: research

Vitamin D and parathyroid hormone in relation to bone health in Croatian women
AbstractSummaryInN = 400 women (46.9 ± 15.5 years), the prevalence of severe (
Source: Archives of Orthopaedic and Trauma Surgery - June 24, 2018 Category: Orthopaedics Source Type: research

Prediction of changes in bone mineral density in the elderly: contribution of “osteogenomic profile”
ConclusionsWe conclude that the osteogenomic profile constructed from BMD-associated genetic variants is modestly associated with long-term changes in femoral neck BMD in women, but not in men. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - June 21, 2018 Category: Orthopaedics Source Type: research

Patient satisfaction and efficacy of switching from weekly bisphosphonates to monthly minodronate for treatment and prevention of glucocorticoid-induced osteoporosis in Japanese patients with systemic rheumatic diseases: a randomized, clinical trial
ConclusionsMonthly minodronate is more acceptable and may be more effective than weekly alendronate or risedronate for prevention and treatment of bone loss in patients with systemic rheumatic diseases on glucocorticoid therapy. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - June 13, 2018 Category: Orthopaedics Source Type: research

Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes
ConclusionsThis is the first study on prevalence and risk factors for falls suggesting that falls are common in T1D and severe hypoglycemia is a unique diabetes-related factor associated with threefold higher risk for falls. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - June 12, 2018 Category: Orthopaedics Source Type: research

Osteosarcopenic obesity and its relationship with dyslipidemia in women from different ethnic groups of China
ConclusionOSO may be a risk factor for dyslipidemia in the ethnic groups. Thus, efforts to promote healthy aging should be focused on preventing obesity and maintaining bone health and muscle mass. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - June 9, 2018 Category: Orthopaedics Source Type: research

Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015)
AbstractSummaryFracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend.PurposeFracture incidence in 0 –16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distributi...
Source: Archives of Orthopaedic and Trauma Surgery - June 2, 2018 Category: Orthopaedics Source Type: research

High prevalence of vitamin D deficiency and influencing factors among urban and rural residents in Tianjin, China
AbstractSummaryThere was a high prevalence of vitamin D deficiency among residents in Tianjin, China, especially among female residents, rural young adults, and elderly individuals. This is the first large-scale study evaluating vitamin D status in Tianjin, China, and we believe that it makes a significant contribution to the literature.PurposeVitamin D deficiency has been documented as a worldwide public health problem. To our knowledge, there has not been any large-scale study on vitamin D status in Tianjin, China. The aim of this study was to investigate vitamin D status among Tianjin residents and to determine influenc...
Source: Archives of Orthopaedic and Trauma Surgery - June 2, 2018 Category: Orthopaedics Source Type: research

All 25-hydroxyvitamin D-deficient Indian postmenopausal women do not have secondary hyperparathyroidism
ConclusionsMajority of postmenopausal women of India had 25-hydroxyvitamin D deficiency with raised PTH levels. The cutoff point of 25-hydroxyvitamin D at which PTH began to rise was found at 25  ng/ml which seems similar to that of the Caucasians. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 27, 2018 Category: Orthopaedics Source Type: research

Volumetric bone mineral density (vBMD), bone structure, and structural geometry among rural South Indian, US Caucasian, and Afro-Caribbean older men
ConclusionsIn comparison to US Caucasians, rural South Indian men have reduced bone strength (lower trabecular vBMD) and Afro-Caribbean men have greater bone strength (higher cortical vBMD). These results suggest an underlying higher risk of osteoporotic fractures and greater future fracture burden among rural South Indian men. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 22, 2018 Category: Orthopaedics Source Type: research

The effect of cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in postmenopausal women
AbstractSummaryVitamin D deficiency has been reported in patients with gastrointestinal disorders. Little is known on the potentially deleterious effect of cholecystectomy on vitamin D levels and osteoporosis. We found that 25-hydroxyvitamin D levels and bone mineral density were lower in patients with prior cholecystectomy.PurposeThe influence of bile salts on vitamin D absorption is well-known, and increased incidence of vitamin D deficiency has been reported in patients with gastrointestinal disorders. Little is known on the potentially deleterious effect of cholecystectomy on vitamin D levels and osteoporosis. Herein, ...
Source: Archives of Orthopaedic and Trauma Surgery - May 22, 2018 Category: Orthopaedics Source Type: research

Consensus on best practice standards for Fracture Liaison Service in the Asia-Pacific region
ConclusionsThe consensus on the 13 BPF standards reviewed in this meeting was that they were generally applicable and required only a few advanced clarifications to increase the quality of FLSs in the region. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 12, 2018 Category: Orthopaedics Source Type: research

Correction to: Treatment patterns in patients with osteoporosis at high risk of fracture in Japan: retrospective chart review
In this article it was mistakenly stated that Akimitsu Miyauchi is affiliated with both Miyauchi Medical Center, Osaka and Amgen Astellas BioPharma K.K., Tokyo. In fact he is affiliated only with Miyauchi Medical Center; he has no connection with Amgen Astellas. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 8, 2018 Category: Orthopaedics Source Type: research

Bone geometry in young male and female football players: a peripheral quantitative computed tomography (pQCT) study
AbstractSummaryThe present study shows that football practice during growth may improve bone geometry in male and female football players. However, only females had better bone strength in comparison with controls.PurposeThe aim of this study was to compare bone geometry in adolescent football players and controls.MethodsA total of 107 football players (71 males/36 females; mean age 12.7  ± 0.6/12.7 ± 0.6 years) and 42 controls (20 males/22 females; mean age 13.1 ± 1.4/12.7 ± 1.3 years) participated in this study. Total and trabec...
Source: Archives of Orthopaedic and Trauma Surgery - May 8, 2018 Category: Orthopaedics Source Type: research

Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50  years of age
ConclusionsThe prevalence of asymptomatic vertebral fractures is high in HIV-infected patients older than 50  years, and is not identified by the presence of osteoporosis in spine neither predicted by the FRAX equation. Spine and lumbar X-rays should be routinely performed in this aging population. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 8, 2018 Category: Orthopaedics Source Type: research

Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review
ConclusionThis is the first study to describe the information needs of patients with osteoporosis and fracture, the impact of this information gap and possible solutions. Further research is needed to co-design and evaluate educational interventions with patients. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 8, 2018 Category: Orthopaedics Source Type: research

Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population
AbstractSummaryThere still remains controversy on the pathomechanism of atypical femoral fracture (AFF). The angle of lateral bowing and bone mineral density showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. In addition to the use of bisphosphonate, mechanical factors might play important roles in the occurrence of AFFs.IntroductionAlthough AFF could be divided into subtrochanteric and diaphyseal fracture according to the location of fractures, there is a lack of evidence regarding differences between two fractures and etiology of the occurrence. The aim of study is to determin...
Source: Archives of Orthopaedic and Trauma Surgery - May 3, 2018 Category: Orthopaedics Source Type: research

Persistence of and switches from teriparatide treatment among women and men with osteoporosis in the real world: a claims database analysis
ConclusionsPersistence rate over 12  months of teriparatide treatment was 34.9% in Japan. Approximately one-third of patients had no subsequent treatment immediately after teriparatide. Monitoring persistence and considering subsequent drugs for osteoporosis are necessary for teriparatide treatment. (Source: Archives of Orthopaedic and Trauma Surgery)
Source: Archives of Orthopaedic and Trauma Surgery - May 3, 2018 Category: Orthopaedics Source Type: research

Multiple vertebral fractures sustained 5  months after Roux-en-Y gastric bypass: a case report
We report a case of a patient sustaining multiple simultaneous vertebral fractures 5  months after Roux-en-Y gastric bypass (RYGB) surgery. Obesity is associated with increased rates of morbidity and mortality and obesity rates globally continue to rise. Bariatric surgical procedures are successful in inducing sustained weight loss with many improved health outcomes. Potential comp lications include nutritional deficiencies and adverse effects on bone mineral metabolism with increased rates of fracture.Case StudyWe have recently cared for a 40-year-old female who sustained multiple vertebral fractures after bending fo...
Source: Archives of Orthopaedic and Trauma Surgery - May 2, 2018 Category: Orthopaedics Source Type: research