Effect of reduction quality on post-operative outcomes in 31-A2 intertrochanteric fractures following intramedullary fixation: a retrospective study based on computerised tomography   findings
ConclusionPatients with good reduction quality of the medial and anteromedial sustainable cortices had better clinical outcomes and lower complication rates. The sustainable stability and anti-rotational function of these validated reductions might play a critical role in maintaining the fragment positions and reducing the incidence of complications in patients. (Source: International Orthopaedics)
Source: International Orthopaedics - August 16, 2018 Category: Orthopaedics Source Type: research

Clinical study of anterior hip ultrasound (van Douveren ’s method)-assisted Pavlik harness
ConclusionThe anterior hip ultrasound (van Douveren ’s method) can be used to detect the reduction and stability of hip after Pavlik harness treatment in children with DDH. The majority of Graf type D and III hips can achieve a stable concentric reduction right after the help of Pavlik harness, while severely dislocated type IV hips have a low succ ess rate for harness treatment, and abandonment of harness therapy should be considered in early stage. (Source: International Orthopaedics)
Source: International Orthopaedics - August 16, 2018 Category: Orthopaedics Source Type: research

Comment on Smeets et al.: ‘The patellar pubic percussion test: a simple bedside tool for suspected occult hip fractures’
(Source: International Orthopaedics)
Source: International Orthopaedics - August 16, 2018 Category: Orthopaedics Source Type: research

Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study
ConclusionsWe did not find CS clearly efficacious clinically or cost effective, even in the more severely injured patients or when different surgical approaches were used. We do not advocate the routine use of CS in pelvic and acetabular surgery, but selectively, based on surgeon and patient preference. (Source: International Orthopaedics)
Source: International Orthopaedics - August 15, 2018 Category: Orthopaedics Source Type: research

Post-operative pain control following arthroscopic rotator cuff repair: peri-articular injection versus interscalene brachial plexus block
AbstractPurposeTo compare post-operative pain relief with peri-articular injection (PI) versus interscalene brachial plexus block (IBPB) after arthroscopic rotator cuff repair (ARCR) surgery.MethodsWe retrospectively reviewed 121 consecutive patients undergoing ARCR surgery divided into two groups: the PI group and the IBPB group. We compared complications and self-reported pain score measured using a Numerical Rating Scale (NRS) during the initial 24  hours after surgery.ResultsThe NRS scores recorded in the recovery room (0), 0.5, and four hours post-operatively were higher in the PI group (n = 38) tha...
Source: International Orthopaedics - August 15, 2018 Category: Orthopaedics Source Type: research

Procedure for single-stage implant retention for chronic periprosthetic infection using topical degradable calcium-based antibiotics
ConclusionDAIR usually shows low levels of success in difficult-to-treat cases. However, we could demonstrate the successful treatment of patients with recurrent PJI (typically considered DAIR-inappropriate) using degradable antibiogram-based topical calcium-based antibiotics. Over 70% of the cases went to remission and over 85% of the implants could be retained. (Source: International Orthopaedics)
Source: International Orthopaedics - August 15, 2018 Category: Orthopaedics Source Type: research

Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: does a slight residual varus improve the results?
The objective of this study is to compare the results of total knee replacement (TKR) performed for significant varus deformity (HKA  
Source: International Orthopaedics - August 14, 2018 Category: Orthopaedics Source Type: research

Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial
ConclusionThe results of this study suggest that autologous adipose-derived SVF treatment is safe and can effectively relief pain, improve function, and repair cartilage defects in patients with knee osteoarthritis. (Source: International Orthopaedics)
Source: International Orthopaedics - August 14, 2018 Category: Orthopaedics Source Type: research

Femoral anteversion does not predict redislocation in children with hip dysplasia treated by closed reduction
ConclusionIn patients with unilateral DDH, anteversion angle (AA) was found to be significantly different between affected and unaffected sides. However, the difference had very limited or no clinical significance, as redislocation/sub-luxation was not influenced by AA values. (Source: International Orthopaedics)
Source: International Orthopaedics - August 14, 2018 Category: Orthopaedics Source Type: research

The influence of bearing surfaces on periprosthetic hip infections: analysis of thirty nine thousand, two hundred and six   cementless total hip arthroplasties
ConclusionsBearing surfaces influenced the rate of PHI; in particular, stemmed MOM implants were at higher risk, probably due to metal debris consequent to taperosis. Despite the preliminary results, stemmed MOM THAs should be used with care, and diabetic patients should be warned about increased septic risks. (Source: International Orthopaedics)
Source: International Orthopaedics - August 11, 2018 Category: Orthopaedics Source Type: research

Curettage, phenolization, and cementation in paediatric Ewing ’s sarcoma with a complete radiological response to neoadjuvant chemotherapy
In this study, we compared the oncologic and functional outcomes of wide resection with extended curettage and local adjuvant therapy (phenolization and cementation), as a less extensive surgery for paediatric ES with a complete radiolo gic response to neoadjuvant chemotherapy.MethodsChildren aged ≤ ten years, with ES of non-expendable long-bones and complete radiologic response to neoadjuvant chemotherapy, were included in this case-control study. Twenty-six patients were treated with extended curettage and local adjuvant therapy (case group) and 17 were managed with wide resection (cont rol group). The average ...
Source: International Orthopaedics - August 11, 2018 Category: Orthopaedics Source Type: research

Denosumab does not decrease the risk of lung metastases from bone giant cell tumour
ConclusionDenosumab does not decrease the risk of lung metastases in patients with bone GCT; the only important predictors for lung metastases in these patients are type of surgery and local recurrence. However, because the number of patients with lung metastases was small for a multivariate analysis, the possibility of denosumab ’s effect could not be completely eliminated. (Source: International Orthopaedics)
Source: International Orthopaedics - August 11, 2018 Category: Orthopaedics Source Type: research

Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival
ConclusionCentral wall acetabular fractures, although unrecognized intra- and post-operatively may impair implant survival after THA. (Source: International Orthopaedics)
Source: International Orthopaedics - August 10, 2018 Category: Orthopaedics Source Type: research

Escherichia coli -derived BMP-2-absorbed β-TCP granules induce bone regeneration in rabbit critical-sized femoral segmental defects
ConclusionE-BMP-2-loaded β-TCP granules can effectively promote bone regeneration in long bone defects. (Source: International Orthopaedics)
Source: International Orthopaedics - August 10, 2018 Category: Orthopaedics Source Type: research

Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score
ConclusionsThe worse CMS and SW-CMS scores found in RTSA patients at six months may be due to the biomechanics of the reverse prosthesis and to the weakness of deltoid and periscapular muscles. (Source: International Orthopaedics)
Source: International Orthopaedics - August 10, 2018 Category: Orthopaedics Source Type: research

Radial head arthroplasty: a historical perspective
AbstractThere has been lively debate regarding the rationale behind the use of radial head arthroplasty (RHA) for more than 80  years. Currently, its primary indication is for treatment of non-reconstructible RH fractures. The first RH implant, released in 1941, was a ferrul cap used to prevent heterotopic ossification. Biomechanical studies in the 1980s stimulated a revolution in RHA design by promoting modular implants t hat replicated the native bony anatomy of the elbow. Subsequent data-driven evolution in design led to the creation of a variety of devices that also accommodated for common ligamentous injuries occ...
Source: International Orthopaedics - August 10, 2018 Category: Orthopaedics Source Type: research

Excellence in orthopaedic surgery: an overview of Nobel Prize nominees 1901 –1960 with focus on Friedrich Pauwels and Gerhard Küntscher
ConclusionsAlthough no orthopaedic surgeon has yet received a Nobel Prize for an orthopaedic achievement, Nobel archive files can help reconstruct important trends in the field during the twentieth century. (Source: International Orthopaedics)
Source: International Orthopaedics - August 10, 2018 Category: Orthopaedics Source Type: research

Morphometry evaluations of cervical osseous endplates based on three dimensional reconstructions
ConclusionThese results will give appropriate guidelines to design cervical prostheses without sacrificing valuable bone stock. The parametric equations applied for generating surface profile of cervical endplates may provide great convenience for subsequent studies. (Source: International Orthopaedics)
Source: International Orthopaedics - August 9, 2018 Category: Orthopaedics Source Type: research

An evidence-based etiology study of synovial cyst of knee cruciate ligament: a real or pseudo-cyst
ConclusionOur findings provided evidence that SCKCL is not a mature synovial cyst but rather an inflammatory pseudo-cyst. It may have resulted from past minor hemorrhage and intra-ligament chronic inflammation. (Source: International Orthopaedics)
Source: International Orthopaedics - August 8, 2018 Category: Orthopaedics Source Type: research

Causes and treatment outcomes of revision surgery after open reduction and internal fixation of tibial plateau fractures
ConclusionsAlthough complications cannot be avoided in some cases, good clinical outcomes are possible when patients are divided according to the presence or absence of infection, with selection of appropriate revision surgery as shown in the flow chart. If an infection is present, treatment should be based on the presence or absence of bone union. If there is no infection, treatment should be based on the presence or absence of nonunion, post-traumatic arthritis, malunion, or immediate post-operative malreduction. (Source: International Orthopaedics)
Source: International Orthopaedics - August 8, 2018 Category: Orthopaedics Source Type: research

Fibular donor site following non vascularized harvest: clinico-radiological outcome at minimal five year follow-up
ConclusionsFibular regeneration was complete in more than 75% legs at follow-up of>  five years but remodeling and reformation of medullary canal was delayed. Long-term fibular non regeneration was persistently responsible for development of ankle valgus deformity. Middle lower third fibular junction is critical area for non restoration of medullary canal and non continuity. (Source: International Orthopaedics)
Source: International Orthopaedics - August 7, 2018 Category: Orthopaedics Source Type: research

Arthroscopic treatment of popliteal cyst using a figure-of-four position and double posteromedial portals
ConclusionsOur modified arthroscopic treatment technique, using a figure-of-four position and double posteromedial portals, is effective and safe for treating popliteal cyst. (Source: International Orthopaedics)
Source: International Orthopaedics - August 7, 2018 Category: Orthopaedics Source Type: research

Surgical treatment for shepherd ’s crook deformity in fibrous dysplasia: THERE IS NO BEST, ONLY BETTER
Conclusions3D printing osteotomy templates facilitate the correction of shepherd ’s crook deformity. Dynamic hip screw (DHS), combined with polymethylmethacrylate (PMMA) augmentation, yields excellent outcomes and ensures easy placement and non-intramedullary manipulation, lower bleeding volume, and reduced operation time. Prior to the correction of shepherd’s crook deformit y, the mechanical axis of the lower limb should be carefully examined, and any evidence of valgus knee deformity should be addressed in advance. (Source: International Orthopaedics)
Source: International Orthopaedics - August 6, 2018 Category: Orthopaedics Source Type: research

The impact of body mass index on metatarsalgia surgical outcomes
ConclusionObesity does not negatively influence functional outcomes after surgery for metatarsalgia in short to medium term. Regardless of their BMI, patients with propulsive metatarsalgia improve in functionality after surgical treatment. (Source: International Orthopaedics)
Source: International Orthopaedics - August 3, 2018 Category: Orthopaedics Source Type: research

Differences in total blood loss and transfusion rate between different indications for shoulder arthroplasty
This study included 419 patients that were divided in three different groups: primary (n = 278), fracture (n = 110) and secondary (following prior osteosynthesis;n = 31) shoulder arthroplasty. The demographic and clinical data were collected. The total blood loss (TBL) was calculated and transfusions recorded.ResultsThe transfusion rate and mean amount of transfused blood units (BU) were higher in fracture (32.7% and 0.69BU,p 
Source: International Orthopaedics - August 3, 2018 Category: Orthopaedics Source Type: research

Microbiological profile and susceptibility pattern of surgical site infections related to orthopaedic trauma
ConclusionSSI in orthopaedic trauma can be associated with gram-negative bacilli, the susceptibility profile of which suggested that most infections occur after discharge.Staphylococcus aureus infections were commonly caused by methicillin-susceptible isolates, and this susceptibility to oral antibiotic options helps in the dehospitalization of patients. (Source: International Orthopaedics)
Source: International Orthopaedics - August 2, 2018 Category: Orthopaedics Source Type: research

Correction to: Functional outcome following a locked fracture-dislocation of the calcaneus
The published online version contains a mistake in the author list for the name of the author “J. Carel Goslings” was incorrectly presented in the HTML version. (Source: International Orthopaedics)
Source: International Orthopaedics - August 2, 2018 Category: Orthopaedics Source Type: research

Assessment of relationship between three dimensional femoral notch volume and anterior cruciate ligament injury in Chinese Han adults: a retrospective MRI study
AbstractPurposeThe studies of the relationship between anterior cruciate ligament (ACL) injury and notch size were in 2-D parameters in Han Chinese, the largest nation in the world, while few studies referred to the 3-D notch volume. The purpose of this study was to determine the differences in notch volume between individuals with and without ACL injuries and the optimal criterion value for abnormal notch volume and its sensitivity in predicting the risk of ACL injuries.MethodsTwo hundred eighty individuals were included in this study, including 140 patients with non-contact sports ACL injuries only and 140 age- and gende...
Source: International Orthopaedics - August 1, 2018 Category: Orthopaedics Source Type: research

Arthroscopic scoring system of meniscal healing following medial meniscus posterior root repair
ConclusionsThis study demonstrated that our semi-quantitative scoring system of meniscal healing correlated with the KOOS QOL subscale following MMPRT transtibial pullout repair. Our results suggest that the second-look arthroscopic score using this system may be a useful scale to determine and compare the healing status of the MM posterior root. (Source: International Orthopaedics)
Source: International Orthopaedics - August 1, 2018 Category: Orthopaedics Source Type: research

Predictors for secondary patellar resurfacing after primary total knee arthroplasty using a “patella-friendly” total knee arthroplasty system
ConclusionsEasy and accessible radiographic measurements have been identified as possible predictors of SPR following primary TKA. Although indication for primary PR may still remain a controversial topic, a rationale has been proposed in this study to support surgeons in objectively estimating an individual patient ’s risk for SPR prior to primary TKA measuring the patella tilt, width, and thickness. Overmore, regarding surgical aspects of TKA, tibial component positioning has also been shown to be of importance to reduce the risk of SPR. (Source: International Orthopaedics)
Source: International Orthopaedics - August 1, 2018 Category: Orthopaedics Source Type: research

Antibiotic-induced fever in orthopaedic patients —a diagnostic challenge
ConclusionsAntibiotics should be considered as the possible cause of fever in orthopaedic patients receiving antimicrobial treament  whenever clinical signs of new or persisting infection are lacking. Important hints suggestive for antibiotic-induced fever are good general condition despite high temperature and progressive leukopenia. Discontinuation or change to another substance leads to prompt defervescence, preventing unnec essary diagnostic procedures and antibiotic treatment. (Source: International Orthopaedics)
Source: International Orthopaedics - July 12, 2018 Category: Orthopaedics Source Type: research

Lateral unicompartmental knee replacement: a systematic review of reasons for failure
ConclusionsProgression of OA and aseptic loosening are the major overall failure modes in lat UKR. Bearing dislocation was the main failure mode in early years and in mobile-bearing implants, whereas OA progression caused most failures in late years and in fixed-bearing implants.Level of evidence: Systematic Review of minimum level IV studies. (Source: International Orthopaedics)
Source: International Orthopaedics - July 12, 2018 Category: Orthopaedics Source Type: research

Effect of arthroscopic resection for discoid lateral meniscus on the axial alignment of the lower limb
ConclusionFor those with considerable genu varum or genu valgum after surgery, individualized therapy should be developed to correct the lower limb axial alignment and to prevent articular cartilage degeneration. Arthroscopic resection of a discoid lateral meniscus greatly improves knee joint function. (Source: International Orthopaedics)
Source: International Orthopaedics - July 12, 2018 Category: Orthopaedics Source Type: research

Hemiarthroplasty for proximal humerus fractures with conservation of the whole humeral head as autograft: does it improve greater tuberosity healing?
ConclusionWhole conservation of the humeral head as an autograft along with proper surgical technique yielded in 20 consolidations of GT without displacement in 22 cases of PHF treated with hemiarthroplasty. (Source: International Orthopaedics)
Source: International Orthopaedics - July 11, 2018 Category: Orthopaedics Source Type: research

Multicentre comparative study of Z-shape elevating –pulling reduction and skull traction reduction for treatment of lower cervical locked facets
ConclusionsHalo vest –assisted Z-shape elevating–pulling reduction appears to be a simple, safe, and effective technique for pre-operative reduction of lower cervical locked facets. (Source: International Orthopaedics)
Source: International Orthopaedics - July 9, 2018 Category: Orthopaedics Source Type: research

Clinical outcomes of anterior correction and reconstruction for n eurofibromatosis-associated severe cervical kyphotic deformity
In this study, we reviewed a series of seven patients who underwent anterior procedures for correction of NF-1-associated cervical kyphotic deformity. After continuous preoperative skull traction, all patients received anterior corpectomy and fusion (ACCF), anterior discectomy and fusion (ACDF), or combined ACCF and ACDF for surgical correction and reconstruction. Pre- and postoperative local and global Cobb angles, correction rate, sagittal vertical axis (SVA), and T1-slope were assessed by X-ray. Japanese Orthopaedic Association (JOA) score, JOA recovery rate, visual analog scale (VAS), and Neck Disability Index (NDI) sc...
Source: International Orthopaedics - July 9, 2018 Category: Orthopaedics Source Type: research

The contribution of the scapula to active shoulder motion and self-assessed function in three hundred and fifty two patients prior to elective shoulder surgery
This study determined the contribution of the scapula to active shoulder motion in control subjects and patients with loss of shoulder function.MethodsThe Kinect system was used to assess active scapulothoracic (ST) and humerothoracic (HT) abduction in 12 controls and in 352 patients before elective shoulder surgery.ResultsFor the controls, ST abduction averaged 26  ± 7° or 19% of the active HT abduction (135 ± 5°). For the 352 patients having elective surgery, active ST abduction averaged 12 ± 10°, or 17% of the active HT abduction (72 &plus...
Source: International Orthopaedics - July 9, 2018 Category: Orthopaedics Source Type: research

Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis
ConclusionThe outcome of immediate arthroscopic repair of primary anterior shoulder dislocation is superior and encouraging with significant reduction in failure and revision rates compared to conservative treatment. Nevertheless, the failure and revision rates are statistically insignificant compared to arthroscopic reconstruction of recurrent dislocation. Hence, there is evidence to support immediate arthroscopic repair option for primary anterior shoulder dislocations over conservative treatment in young active patients, in order to reduce the risk of failure and revision rates. However, the evidence is inconclusive com...
Source: International Orthopaedics - July 7, 2018 Category: Orthopaedics Source Type: research

Outcomes of total knee arthroplasty in the adult Kashin-Beck disease with severe osteoarthritis
ConclusionsTKA can reduce knee pain, improve knee function, and improve the quality life in KBD patients. KBDQOL questionnaire may be a promising instrument for assessing the quality life in KBD patients. (Source: International Orthopaedics)
Source: International Orthopaedics - July 3, 2018 Category: Orthopaedics Source Type: research

Anatomical features and significance of the anterolateral ligament of the knee
ConclusionThe best site for a bone tunnel is the region on the lateral epicondyle of the femur, lying posterior and proximal to the origin of the lateral collateral ligament. The identified anatomical pattern in the course of the lateral inferior genicular vessels will help to spare these important blood suppliers in the course of a reconstructive surgery of the anterolateral knee joint region. (Source: International Orthopaedics)
Source: International Orthopaedics - July 3, 2018 Category: Orthopaedics Source Type: research

Electric cautery does not reduce blood loss in primary total knee arthroplasty compared with scalpel only surgery a double-blinded randomized controlled trial
ConclusionsUsing electric cautery does not reduce total blood loss as we thought it would be in primary TKA compare to scalpel only surgery and it is also associated with a greater systemic inflammatory response. Cautery used in TKA which operated under tourniquet may not be worthwhile for the risk of hazardous smoke and the increasing cost. (Source: International Orthopaedics)
Source: International Orthopaedics - July 3, 2018 Category: Orthopaedics Source Type: research

Proper benefit of a three dimensional pre-operative planning software for glenoid component positioning in total shoulder arthroplasty
Conclusion3D pre-operative planning allowed accurate glenoid component positioning with a freehand method. Compared to the freehand method, patient-specific guides slightly improved the position of the central point, especially for severely retroverted glenoids, but not the orientation of the component. (Source: International Orthopaedics)
Source: International Orthopaedics - July 2, 2018 Category: Orthopaedics Source Type: research

Association of reduced sclerostin expression with collapse process in patients with osteonecrosis of the femoral head
ConclusionsThe reduced expression of sclerostin may play a key role in the collapse process of ONFH and be predictive of the disease progression of ONFH. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

Mid-term results of concentrated autologous bone marrow aspirate  transplantation for corticosteroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus
ConclusionThe conversion rate to THA was lower than that in the natural course and core decompression, but was higher than that seen in other bone marrow transplantation and osteotomy. Since sex, pre-operative type, and pre-operative stage were significantly correlated with conversion to THA, it is suggested that the higher proportion of women, advanced stage (stage 3A or above), and advanced type (type C or above) in this study affected the THA conversion rate. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

MicroRNA-mediated interacting circuits predict hypoxia and inhibited osteogenesis of stem cells, and dysregulated angiogenesis are involved in osteonecrosis of the femoral head
ConclusionsThis study combined the miRNA analysis with the bioinformatics and predicts that hypoxia, inhibited osteogenesis of stem cells, and dysregulated angiogenesis might be orchestrated through the miRNA interacting circuits in the pathogenesis of ONFH. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

History of concentrated or expanded mesenchymal stem cells for hip osteonecrosis: is there a target number for osteonecrosis repair?
ConclusionIn this review, we analyzed current clinical experience regarding cell therapy and address issues that should be a guide for future cell-based therapeutic application in osteonecrosis. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

Raman spectroscopy reveals differences in molecular structure between human femoral heads affected by steroid-associated and alcohol-associated osteonecrosis
ConclusionsWe systematically found a decrease in Raman intensity for sphingomyelin and phenylalanine fingerprint bands in the necrotic zones, and these differences may be related to the etiology of osteonecrosis. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

Lesion size measurement in femoral head necrosis
ConclusionsSimple visual estimates of lesion size from serial MRI images are reasonably accurate and are satisfactory for clinical use. Angular measurements provide some indication of prognosis and treatment; however, they have limited accuracy, with considerable variability between techniques. 3-D MRI volumetric measurements are the most accurate. Using current techniques and software, they are easier to use, requiring similar time and effort to angular measurements. They should be considered for clinical research and publications when the most accurate measurements are required. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

Radiological analysis of cystic lesion in osteonecrosis of the femoral head
This study will discuss the cause of cystic lesion formation and the feature of cystic lesion distribution in ONFH. According to the feature of cystic lesion in ONFH, we will discuss the possible mechanisms of cystic lesions and their   influence on collapse of the femoral head.Materials and methodsWe retrospectively gathered 102 ONFH patients (168 hips) from November in 2015 to August in 2016 on China-Japan Friendship Hospital. Three categories of patients ’ medical information were collected: demographic characteristics, bone cystic lesion location, and pathological finding on CT and MRI imaging (microfracture...
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research

Stem cell therapy in bilateral osteonecrosis: computer-assisted surgery versus conventional fluoroscopic technique on the contralateral side
ConclusionsThe findings of this study suggest that computer navigation may be safely used in a basic procedure for injection of stem cells. (Source: International Orthopaedics)
Source: International Orthopaedics - June 26, 2018 Category: Orthopaedics Source Type: research