The future of disc surgery and regeneration
AbstractLow back and neck pain are among the top contributors for years lived with disability, causing patients to seek substantial non-operative and operative care. Intervertebral disc herniation is one of the most common spinal pathologies leading to low back pain. Patient comorbidities and other risk factors contribute to the onset and magnitude of disc herniation. Spine fusions have been the treatment of choice for disc herniation, due to the conflicting evidence on conservative treatments. However, re-operation and costs have been among the main challenges. Novel technologies including cage surface modifications, biol...
Source: International Orthopaedics - November 30, 2018 Category: Orthopaedics Source Type: research

Post-operative nerve injuries after cervical spine surgery
AbstractAlthough relatively rare, post-operative nerve injuries may occur after cervical spine procedures. The most common post-operative neural disorder is C5 nerve palsy. The risk factors for C5 nerve palsy are male gender, OPLL, and posterior cervical approaches. It generally presents with deltoid and/or biceps weakness, and may present immediately or several days after surgery. Treatment is generally conservative due to transient duration of symptoms, but evaluation of residual compression at C4 –5 is essential. PTS (Parsonage-Turner syndrome) is an idiopathic plexopathy generally presenting with severe neuropath...
Source: International Orthopaedics - November 29, 2018 Category: Orthopaedics Source Type: research

Cell therapy for intervertebral disc herniation and degenerative disc disease: clinical trials
AbstractLow back pain is the primary cause of disability and is highly associated with progression of intervertebral disc degeneration. Current treatment options are limited and fail to address the origin of the problem. New advancements in cellular therapies might offer novel and potent strategies for low back pain patients. In this review, we summarize and discuss the contemporary status of in-human trials investigating cellular transplantation for treatment of low back pain. We aim to highlight current trends, shortcomings, and hurdles for effective clinical trials and consecutive commercialization. (Source: International Orthopaedics)
Source: International Orthopaedics - November 29, 2018 Category: Orthopaedics Source Type: research

Persistent radiculopathy after surgical treatment for lumbar disc herniation: causes and treatment options
ConclusionsPatients with persistent leg pain after surgical treatment of lumbar disc herniation can pose a challenging clinical problem. Summary of these topics and available treatment options are reviewed. (Source: International Orthopaedics)
Source: International Orthopaedics - November 29, 2018 Category: Orthopaedics Source Type: research

Clinical trials of intervertebral disc regeneration: current status and future developments
AbstractIntervertebral disc (IVD) degeneration (IDD) is considered as one of the major causes for low back pain (LBP). However, conventional surgical approaches for treating LBP do not aim to counter the degeneration. Biological interventions have been investigated with an attempt to regenerate the IVD by restoring its matrices and cell activities. This review summarizes the current clinical trials that explore the efficacy of covering cell-, growth factor-, and small molecule-based approaches. While investigations of growth factor- and small molecule-based therapies are still preliminary, intradiscal delivery of mesenchym...
Source: International Orthopaedics - November 29, 2018 Category: Orthopaedics Source Type: research

Differences in peri-operative serum inflammatory markers between normoponderal and obese patients undergoing large joint replacement for osteoarthritis —a descriptive study
ConclusionsBecause of its important clinical implications, an appropriate comprehension of the peri-operative changes in a patient ’s inflammatory status has the potential to influence therapeutic attitude. We failed to observe any significant post-operative differences in the mean values of the markers assessed, except those of IL-6, implying that serum levels of fibrinogen, hsCRP and TNF-alpha within 24 hours after large jo int replacements are not influenced by the patient’s ponderal status. (Source: International Orthopaedics)
Source: International Orthopaedics - November 28, 2018 Category: Orthopaedics Source Type: research

Treatment outcome of quality of life and clinical symptoms in patients with symptomatic lumbar degenerative disc diseases: which treatment modality is superior?
AbstractObjectiveThis was to assess the quality of life and clinical symptoms before and after treatment of patients with symptomatic lumbar degenerative disc disease (LDDD). It was also to determine the superior treatment for well-selected patients: conservative versus surgical treatment.Study DesignProspective interventional analytical study.MethodsWe studied 160 adult symptomatic patients aged 31 –60 years with diagnosis of LDDD who were enrolled between May 2016 and November 2017. Their pre- and post-treatment clinical symptoms and signs and quality of life were studied using the Oswestry disability index (O...
Source: International Orthopaedics - November 28, 2018 Category: Orthopaedics Source Type: research

Reduction of the dislocated hips with the T übingen hip flexion splint in infants
ConclusionsFor successful treatment with T übingen splints, the cut-off point of starting initial treatment was defined as the 15th week, with sensitivity of 84.62% and specificity of 62.50%. The success rate was 75% with a successful outcome in 78 hips. In view of these results, Graf type D, 3, and 4 dislocated hips can be successfully tre ated with Tübingen splints. (Source: International Orthopaedics)
Source: International Orthopaedics - November 27, 2018 Category: Orthopaedics Source Type: research

Quality of publications in “International Orthopaedics” and projects for the near future
(Source: International Orthopaedics)
Source: International Orthopaedics - November 26, 2018 Category: Orthopaedics Source Type: research

Factors that influence neurological deficit and recovery in lumbar disc prolapse —a narrative review
AbstractNeurodeficit due to lumbar disc herniation (LDH) is a serious complication and can range from sensory hypoesthesia in a single dermatome to a debilitating condition like cauda equina syndrome (CES). Many authors have described variable clinical and radiological risk factors for neurodeficit in LDH. Similarly the prognostic factors influencing recovery have been variable across the studies. This narrative review discusses the pathogenesis, most consistent factors associated with the occurrence of neurodeficit in LDH patients and also the factors which have a prognostic role in recovery. Pathological mechanisms like ...
Source: International Orthopaedics - November 24, 2018 Category: Orthopaedics Source Type: research

Effects of vitamin E incorporation in polyethylene on oxidative degradation, wear rates, immune response, and infections in total joint arthroplasty: a review of the current literature
AbstractHighly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this revi...
Source: International Orthopaedics - November 23, 2018 Category: Orthopaedics Source Type: research

Adjacent segment degeneration after fusion spinal surgery —a systematic review
ConclusionsThe existent literature points out variables involved in ASDeg and ASDis. High evidence-level studies should provide more relevant data to guide strategies for avoiding ASDeg and ASDis. (Source: International Orthopaedics)
Source: International Orthopaedics - November 23, 2018 Category: Orthopaedics Source Type: research

Three-dimension-printed custom-made prosthetic reconstructions: from revision surgery to oncologic reconstructions
Conclusion3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-term. (Source: International Orthopaedics)
Source: International Orthopaedics - November 22, 2018 Category: Orthopaedics Source Type: research

Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial
AbstractPurposeThe acute primary (first-time) lateral patellar dislocation is associated with a high rate of functional disability. There is no consensus as to the choice of surgical or non-surgical treatment for these patients. The aim of this study is to compare the clinical results between the surgical (reconstruction of the medial patellofemoral ligament [MPFL]) and non-surgical treatments for acute primary patellar dislocations.MethodsSixty-nine skeletally mature patients (69 knees) were included in this prospective non-randomized controlled trial. At least one predisposing factor for patellar dislocation (including p...
Source: International Orthopaedics - November 20, 2018 Category: Orthopaedics Source Type: research

Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees —myth or reality?—analysis of one hundred sixty two knees with varus greater than fifteen degrees
ConclusionThe results of our study showed that minimal under-correction gave superior functional outcomes at three  months. But this advantage was temporary and both, under-correction and neutral alignment achieved equally good outcomes at one year. Considering the increased prosthesis longevity associated with neutral alignment, we propose that neutral alignment must be aimed for during TKA for knees with sev ere varus.Study DesignProspective study (Source: International Orthopaedics)
Source: International Orthopaedics - November 20, 2018 Category: Orthopaedics Source Type: research

Robotic versus conventional primary total knee arthroplasty: clinical and radiological long-term results with a minimum follow-up of ten years
AbstractPurposeThe aim of this study was (1) to compare the clinical and radiological outcomes of robotic and conventional total knee arthroplasty with a minimum follow-up of ten  years, (2) to evaluate the survival rate, (3) and to estimate the accuracy of the two techniques by analyzing the outliers of the total knee arthroplasty (TKA) patients.MethodsWe evaluated 351 patients (390 knees), 155 patients undergoing robotic TKA, and 196 patients treated with conventional TKA with a mean follow-up of 11.0  years. HSS, KSS, WOMAC, and SF-12 questionnaires were used for clinical evaluation. Mechanical alignment, impl...
Source: International Orthopaedics - November 19, 2018 Category: Orthopaedics Source Type: research

The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study
This study aims to assess the impact of the radiological features of the third fragment, evaluated on post-operative X-rays, on the outcome of femoral shaft fractures type 32-B managed with intramedullary nailing, in order to obtain an algorithm which could predict the fracture healing time.Materials and methodsWe have retrospectively evaluated a series of 52 patients. On post-operative X-rays, four radiological parameters were evaluated: the third fragment angle, the fracture gap, the third fragment size, and the mean third fragment displacement. All the patients underwent a radiologic follow-up at one, two, three, six, n...
Source: International Orthopaedics - November 17, 2018 Category: Orthopaedics Source Type: research

Discrepant hypoxia tolerance aggravates subchondral delamination in osteonecrosis of the femoral head
(Source: International Orthopaedics)
Source: International Orthopaedics - November 17, 2018 Category: Orthopaedics Source Type: research

A new classification for proximal femur bone defects in conservative hip arthroplasty revisions
ConclusionsIf literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5  years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a “one time” opportunity for young and active people. A “conservative revision” is a valid option for at least a part of them, when an early failure of primary procedure occurred. (Source: International Orthopaedics)
Source: International Orthopaedics - November 15, 2018 Category: Orthopaedics Source Type: research

Indications for the monosegmental stabilization of thoraco-lumbar spine fractures
ConclusionsMonosegmental stabilization with fusion is a safe and effective method to treat well selected thoracolumbar spine fractures. The right indications are type A1, type B2, and type A3 with a load sharing of less than 7 points and some very well selected type C fractures in which there is not lateral and rotatory displacement. (Source: International Orthopaedics)
Source: International Orthopaedics - November 14, 2018 Category: Orthopaedics Source Type: research

Does the body mass index influence the long-term survival of unicompartmental knee prostheses? A retrospective multi-centre study
ConclusionsObese and morbidly obese patients have as much to gain from total knee replacement as non-obese patients. (Source: International Orthopaedics)
Source: International Orthopaedics - November 13, 2018 Category: Orthopaedics Source Type: research

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting
AbstractBackgroundThe lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.PurposeTo analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.Material and methodsTwenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7  years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-o...
Source: International Orthopaedics - November 13, 2018 Category: Orthopaedics Source Type: research

Failure of lumbar disc surgery: management by fusion or arthroplasty?
ConclusionIt is concluded that problems with anterior surgery, imbursement policy, and potential problems with salvage surgery are major reasons for loosing popularity of TDR surgery. (Source: International Orthopaedics)
Source: International Orthopaedics - November 13, 2018 Category: Orthopaedics Source Type: research

Response to letter to the editor concerning “partial extensor mechanism allograft reconstruction for chronic patellar tendon disruption shows superior outcomes in native knees when compared to same technique following total arthroplasty”
(Source: International Orthopaedics)
Source: International Orthopaedics - November 13, 2018 Category: Orthopaedics Source Type: research

Autogenic mesenchymal stem cells for intervertebral disc regeneration
ConclusionsThis systematic review of the literature proved MSC injection to be a safe and feasible option for intervertebral disc regeneration in the early-degeneration stage patients. Irrespective of the source of the MSCs, an overall clinical and radiological improvement of the patients has been evidenced, as indeed a very low complication rate during the follow-up. (Source: International Orthopaedics)
Source: International Orthopaedics - November 10, 2018 Category: Orthopaedics Source Type: research

Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty
ConclusionsProximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions. (Source: International Orthopaedics)
Source: International Orthopaedics - November 10, 2018 Category: Orthopaedics Source Type: research

Intra-operative diagnosis of periprosthetic joint infection can rely on frozen sections in patients without synovial fluid analyses
ConclusionsThis study reveals that intra-operative frozen sections significantly increased the performance of serum ESR and CRP in the diagnosis of PJI. The combination of serological tests and frozen sections for the assessment of PJI may be reliable in patients without synovial fluid analyses. (Source: International Orthopaedics)
Source: International Orthopaedics - November 10, 2018 Category: Orthopaedics Source Type: research

Pharmacies for pain and trauma in ancient Greece
ConclusionHistory showed a lot of experience obtained from empirical testing of pain treatment in ancient people. Experience and reasoning constructed an explanatory account of diseases, therapies and health and have provided for the epistemology of medicine. (Source: International Orthopaedics)
Source: International Orthopaedics - November 9, 2018 Category: Orthopaedics Source Type: research

“More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies
The objective of our study was to compare the accuracy of post-operative alignment following DFVO in the coronal and sagittal plane using either a conventional abacus technique or PSI guide.MethodTwenty-one patients that underwent lateral opening wedge osteotomy from a technique using PSI based on 3D CT-scans were matched 1:1 to 21 patients operated on using a conventional technique (pre-operative planning performed on standard radiographs). The accuracy of the correction was analyzed, comparing coronal and sagittal mechanical post-operative angles with pre-operative planning.ResultsWith regard to alignment in the coronal ...
Source: International Orthopaedics - November 9, 2018 Category: Orthopaedics Source Type: research

Fourteen-year experience with short cemented stems in total hip replacement
ConclusionsThis study confirms the effectiveness of a short, polished, collarless, tapered cemented stem implanted with contemporary cementing techniques which appears as successful as the standard sized components. (Source: International Orthopaedics)
Source: International Orthopaedics - November 8, 2018 Category: Orthopaedics Source Type: research

Cervical disc herniation: which surgery?
ConclusionAnterior cervical decompression and fusion remain the gold standard for surgical treatment of cervical disc herniation. (Source: International Orthopaedics)
Source: International Orthopaedics - November 8, 2018 Category: Orthopaedics Source Type: research

Surgical treatment of thoracic disc herniation: an overview
ConclusionFurther improvements are still warranted in thoracic spine surgery despite the advent of minimally invasive techniques. Intra-operative CT scan will probably enhance the safety of the TDH surgery. (Source: International Orthopaedics)
Source: International Orthopaedics - November 8, 2018 Category: Orthopaedics Source Type: research

Translation, cross-cultural adaptation, and validation of the Italian version of the Oxford Shoulder Instability Score
ConclusionsThe Italian version of the OSIS is a reliable, valid, and reproducible outcome measure for clinical evaluation of patients affected by shoulder instability, which remains simple and user-friendly as the original version.Level of evidenceProspective cohort study, Level II.Clinical relevanceThe availability of a validated translation of the OSIS will help surgeon to share their data on shoulder instability diagnostic and treatment in a more reproducible and comparable fashion. (Source: International Orthopaedics)
Source: International Orthopaedics - November 8, 2018 Category: Orthopaedics Source Type: research

Sagittal alignment assessment after short-segment lumbar fusion for degenerative disc disease
ConclusionsGreater SS, greater PI, and a PI-LL mismatch greater than 10 ° are associated with failed bony fusion, while ASD is related to a greater difference between the pre-operative and post-operative values of PT. Neither the type nor the size of cage seem to have a significant impact on either solid bony fusion, nonunion, or ASD rates. Thus, we recommend on the st udy of patients’ sagittal alignment in the pre-operative setting even when treating patients with short-segment lumbar interbody fusion. (Source: International Orthopaedics)
Source: International Orthopaedics - November 4, 2018 Category: Orthopaedics Source Type: research

Surgical strategy for benign lesions in proximal femur: internal fixation or endoprosthetic replacement
AbstractPurposeThe purpose of this study was to explore the indications for the two most frequently applied surgical procedures for benign lesions in the proximal femur.MethodsWe retrospectively reviewed 142 patients with benign lesions in the proximal femur from January 2010 to January 2015. Internal fixation (IF) was adopted in 110 patients, while endoprosthetic replacement (EPR) was applied in 32 patients. Clinical data, including operation time, blood loss, hospitalization time, and hospitalization expenses, were compared between the groups. Limb mobilization was evaluated by the Musculoskeletal Tumor Society Score-93 ...
Source: International Orthopaedics - October 13, 2018 Category: Orthopaedics Source Type: research

Subchondral stem cell therapy versus contralateral total knee arthroplasty for osteoarthritis following secondary osteonecrosis of the knee
ConclusionsSubchondral autologous bone marrow concentrate was an effective procedure for treating young patients with knee osteoarthritis following secondary ON of the knee related to corticosteroids with a lower complication rate and a quicker recovery as compared with TKA. (Source: International Orthopaedics)
Source: International Orthopaedics - October 13, 2018 Category: Orthopaedics Source Type: research

Irreparable rotator cuff tears: long-term follow-up, five to ten years, of arthroscopic debridement and tenotomy of the long head of the biceps
ConclusionsBoth arthroscopic debridement and debridement combined with a bicepstenotomy yields high satisfactory shoulder function in elderly patients at long term. (Source: International Orthopaedics)
Source: International Orthopaedics - October 13, 2018 Category: Orthopaedics Source Type: research

Patellar tendon shortening following patellofemoral joint replacement
ConclusionsPatellar tendon length shortening following PFJR occurs in 31% of knees at one year, and does not result in inferior PROs. (Source: International Orthopaedics)
Source: International Orthopaedics - October 12, 2018 Category: Orthopaedics Source Type: research

Concentrated adipose tissue infusion for the treatment of knee osteoarthritis: clinical and histological observations
ConclusionsOverall our data indicate that adipose tissue infusion stimulates tissue regeneration and might be considered a safe treatment for knee OA. (Source: International Orthopaedics)
Source: International Orthopaedics - October 11, 2018 Category: Orthopaedics Source Type: research

Functional recovery of daily living and sports activities after cosmetic bilateral tibia lengthening
ConclusionsPatients who had undergone bilateral cosmetic tibial lengthening may expect almost full recovery of daily and light sports activities at post-operativetwo  years. However, several patients may feel some limitation in moderate-to-strenuous sports activities. (Source: International Orthopaedics)
Source: International Orthopaedics - October 11, 2018 Category: Orthopaedics Source Type: research

Screw tip augmentation leads to improved primary stability in the minimally invasive treatment of displaced intra-articular fractures of the calcaneus: a biomechanical study
ConclusionScrew tip augmentation significantly improved the mechanical stability of the calcanei after osteosynthesis in terms of decreased tuber fragment tilts and less changes in B öhler’s angle. (Source: International Orthopaedics)
Source: International Orthopaedics - October 10, 2018 Category: Orthopaedics Source Type: research

Latarjet procedure versus open capsuloplasty in traumatic anterior shoulder dislocation: long-term clinical and functional results
ConclusionOpen capsuloplasty and Bristow-Latarjet procedure are both validated surgical techniques for the treatment of recurrent shoulder anterior instability. We found no statistical difference in terms of recurrent dislocation rates, clinical shoulder stability tests, and scoring scales. The rate of patients returning to sport was similar after both techniques. However, patients with open capsuloplasty reported a significantly lower recovery of external rotation than patients operated via the Latarjet procedure. (Source: International Orthopaedics)
Source: International Orthopaedics - October 10, 2018 Category: Orthopaedics Source Type: research

Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty
ConclusionCustom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up. (Source: International Orthopaedics)
Source: International Orthopaedics - October 10, 2018 Category: Orthopaedics Source Type: research

Quality of life after staged bilateral total knee arthroplasty: a minimum five-year follow-up study of seventy-eight patients
ConclusionsThis was the first longitudinal study to evaluate QOL and objective outcomes after staged bilateral TKA for a period of at least five  years. Improvements in QOL and objective outcomes reached a plateau one year after staged bilateral TKA and were prolonged for more than five years. No significant differences were observed in outcome scores between the younger and older age groups. (Source: International Orthopaedics)
Source: International Orthopaedics - October 10, 2018 Category: Orthopaedics Source Type: research

Citations, non-citations and visibility of International Orthopaedics in 2017
(Source: International Orthopaedics)
Source: International Orthopaedics - October 8, 2018 Category: Orthopaedics Source Type: research

Correction to: Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis
There is an error in the original publication. Affiliation of corresponding author (Giulia Merli) was incorrectly published. Correct presentation is Nano-Biotechnology Laboratory-NaBi IRCCS- Istituto Ortopedico, Rizzoli, Italy. (Source: International Orthopaedics)
Source: International Orthopaedics - October 8, 2018 Category: Orthopaedics Source Type: research

Total knee arthroplasty in Italy: reflections from the last fifteen  years and projections for the next thirty
ConclusionsAdopting the best fitting projection method, an increase of 45% in incidence rate is expected for 2050. (Source: International Orthopaedics)
Source: International Orthopaedics - October 6, 2018 Category: Orthopaedics Source Type: research

Robotic-assisted versus standard unicompartmental knee arthroplasty —evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics
AbstractPurposeRobotic-assisted unicompartmental knee arthroplasty (UKA) has gained popularity over the last decade claiming enhanced surgical precision and better joint kinematics, with peer-reviewed publications about this new technology also increasing over the past few years. The purpose of our study was to compare manuscripts about robotic-assisted UKA to those about standard UKA in terms of industry funding, author conflict of interest, scientific quality, and bibliometrics.MethodsA systematic search using PRISMA guidelines on PubMed and Google Scholar from 2012 to 2016 resulted in 45 papers where robotic technology ...
Source: International Orthopaedics - October 5, 2018 Category: Orthopaedics Source Type: research

Predatory journals: a major threat in orthopaedic research
AbstractPredatory publishing is a major threat to contemporary publishing, as it offers 'to unaware scientist ’s', a quick open-access publication against fees without peer-review procedures.. Lack of peer-review leads to unethical practices, as plagiarism, publication of unscientific falsified data, and even unsafe clinical practices. As these journals threaten the credibility of academic publishing, si gnificant work has been done from many scientific teams, in the last years, in establishing discriminating criteria between predatory and legitimate publishing. In the present review, we include mechanisms used ...
Source: International Orthopaedics - October 4, 2018 Category: Orthopaedics Source Type: research

Fractures in patients with osteopetrosis, insights from a single institution
ConclusionOsteopetrosis fractures present a unique challenge to the orthopedic surgeon. Careful pre-operative planning should be undertaken before proceeding with surgery in these cases. (Source: International Orthopaedics)
Source: International Orthopaedics - October 4, 2018 Category: Orthopaedics Source Type: research