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1.
J Pediatr Orthop ; 2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32271317

RESUMEN

BACKGROUND: Closed reduction and percutaneous pinning in a crossed or lateral configuration is the standard treatment for supracondylar humerus (SCH) fractures. We compared mid-term patient-reported outcomes (PROs), radiographic outcomes, and complication rates between patients treated with crossed versus lateral pinning. METHODS: We reviewed 508 pediatric patients treated surgically for Gartland type-III SCH fractures from 2008 to 2017. We included patients aged 5 to 17 years at the time of telephone interviews, who had available radiographs. We excluded those unable to be reached by telephone; those who declined to be surveyed; and those lost to follow-up. Our sample comprised 142 participants (28%) (mean±SD age at surgery, 5.2±2.0 y), 93 (65%) of whom were treated with lateral pinning and 49 (35%) with crossed pinning. Participants' parents completed the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Reported Outcomes Measurement Information System Parent Proxy at a mean 4.4 years (range: 2 to 10 y) postoperatively. Postoperative radiographs were reviewed to assess reduction. Bivariate analysis was performed to determine whether outcomes differed by pinning technique (α=0.05). RESULTS: The proportions of participants achieving complete reduction were not significantly different between pin configuration groups (P=0.71). At follow-up, the 2 groups did not differ significantly in any PRO scores (all, P>0.05). CONCLUSION: We found no differences between crossed and lateral pinning of Gartland type-III SCH fractures in terms of radiographic reduction, PROs, or complication rates at mid-term follow-up. LEVEL OF EVIDENCE: Level III.

2.
Medicine (Baltimore) ; 99(9): e19328, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118764

RESUMEN

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ±â€Š2.2 years. Mean maximum fracture displacements were 6.6 ±â€Š6.5 mm initially, 2.7 ±â€Š2.0 mm postreduction, and 0.4 ±â€Š0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ±â€Š2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.


Asunto(s)
Fijación de Fractura/normas , Fracturas de Salter-Harris/terapia , Adolescente , Niño , Femenino , Fijación de Fractura/métodos , Fijación de Fractura/estadística & datos numéricos , Humanos , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Tibia/anatomía & histología , Tibia/lesiones , Tibia/fisiopatología , Resultado del Tratamiento
3.
JBJS Case Connect ; 10(1): e0032, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32044788

RESUMEN

CASE: Traumatic posterior sternoclavicular dislocation (PSCD) is an uncommon injury that often presents in a delayed fashion and can be difficult to diagnose. Standard treatments include reduction of acute injuries and possible reconstruction for chronic injuries. We describe a 16-year-old male football player with a traumatic PSCD and initial dyspnea and dysphagia. He returned to playing contact sports without undergoing reduction. CONCLUSIONS: Contrary to the literature that suggests reduction as a primary treatment of PSCD, this case shows that a contact-sport athlete may be able to return to competitive sports with a chronic PSCD.

4.
Orthop J Sports Med ; 7(8): 2325967119866162, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31489334

RESUMEN

Background: Tibial spine fractures, although relatively rare, account for a substantial proportion of pediatric knee injuries with effusions and can have significant complications. Meyers and McKeever type II fractures are displaced anteriorly with an intact posterior hinge. Whether this subtype of pediatric tibial spine fracture should be treated operatively or nonoperatively remains controversial. Surgical delay is associated with an increased risk of arthrofibrosis; thus, prompt treatment decision making is imperative. Purpose: To assess for variability among pediatric orthopaedic surgeons when treating pediatric type II tibial spine fractures. Study Design: Cross-sectional study. Methods: A discrete choice experiment was conducted to determine the patient and injury attributes that influence the management choice. A convenience sample of 20 pediatric orthopaedic surgeons reviewed 40 case vignettes, including physis-blinded radiographs displaying displaced fractures and a description of the patient's sex, age, mechanism of injury, and predominant sport. Surgeons were asked whether they would treat the fracture operatively or nonoperatively. A mixed-effects model was then used to determine the patient attributes most likely to influence the surgeon's decision, as well as surgeon training background, years in practice, and risk-taking behavior. Results: The majority of respondents selected operative treatment for 85% of the presented cases. The degree of fracture displacement was the only attribute significantly associated with treatment choice (P < .001). Surgeons were 28% more likely to treat the fracture operatively with each additional millimeter of displacement of fracture fragment. Over 64% of surgeons chose to treat operatively when the fracture fragment was displaced by ≥3.5 mm. Significant variation in surgeon's propensity for operative treatment of this fracture was observed (P = .01). Surgeon training, years in practice, and risk-taking scores were not associated with the respondent's preference for surgical treatment. Conclusion: There was substantial variation among pediatric orthopaedic surgeons when treating type II tibial spine fractures. The decision to operate was based on the degree of fracture displacement. Identifying current treatment preferences among surgeons given different patient factors can highlight current variation in practice patterns and direct efforts toward promoting the most optimal treatment strategies for controversial type II tibial spine fractures.

5.
J Pediatr Orthop ; 39(4): e318-e322, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30451813

RESUMEN

BACKGROUND: The spatial order of physeal maturation around the distal tibia has been shown to place adolescent patients at risk for certain transitional injuries, such as Tillaux or triplane fractures. Less is known about physeal maturation around the knee. The purpose of this study was to establish the spatial order of physeal maturation in the normal human knee using magnetic resonance imaging (MRI). METHODS: We retrospectively collected all knee MRI scans from patients presenting to our institution from January 2004 to January 2014. Patients who were suspected on the basis of clinical or radiographic findings of having abnormal knee physeal development or injury were excluded. We then applied a previously described MRI staging system of knee physeal maturation to the MRI scans of the remaining patients at 8 defined knee locations. Associations between the stage of maturation and mean chronological age were then evaluated across the 8 knee locations. Interrater and intrarater reliabilities were assessed. RESULTS: A total of 165 knee MRI scans (from 98 boys, 67 girls) met the inclusion criteria. Significant differences were found between each stage of physeal maturation and the mean chronological ages at all 8 knee locations for both boys and girls (each, P<0.001). Interestingly, within each stage of physeal maturation, no significant difference was found in the mean chronological ages at any of the 8 knee locations, suggesting that physeal development occurs uniformly in the normal human knee for both boys and girls. Interrater and intrarater reliability were nearly perfect at all locations. CONCLUSIONS: The spatial order of physeal maturation in the normal human knee was uniform across 8 knee locations for both boys and girls. This uniformity may help to explain why transitional injuries do not follow a recognizable pattern in the knee. Furthermore, the uniformity aids with surgical decision making, because minimal growth modulation or disturbance is likely when early physeal closure is present in a portion of the physis. LEVEL OF EVIDENCE: Level III.


Asunto(s)
Placa de Crecimiento/crecimiento & desarrollo , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adolescente , Niño , Femenino , Placa de Crecimiento/diagnóstico por imagen , Humanos , Articulación de la Rodilla/crecimiento & desarrollo , Masculino , Valores de Referencia , Reproducibilidad de los Resultados , Estudios Retrospectivos
6.
Orthop J Sports Med ; 6(11): 2325967118810389, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30480025

RESUMEN

Background: Risk factors for concomitant ligament injuries (CLIs) of the lateral collateral ligament (LCL) and medial collateral ligament (MCL) in children and adolescents with anterior cruciate ligament (ACL) tears are unknown. Purpose: To determine whether body mass index (BMI), sex, age, and injury mechanism are associated with CLIs in children and adolescents with ACL tears and whether CLIs are associated with meniscal and chondral injuries and a delay to surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of patients aged ≤18 years with ACL tears from 2009 through 2013 for sex, age, height, weight, CLI, injury mechanism, intra-articular injury, and time to surgery. Patients were assigned to groups according to the presence of a CLI (CLI group) compared with the presence of an isolated ACL tear (ACL group). BMI was categorized as underweight, normal weight, or overweight/obese. The older group was defined as age ≥14 years for girls and ≥16 years for boys. Logistic regression, Mann-Whitney U tests, and chi-square tests were performed (alpha = 0.05). Results: We included 509 patients (267 girls) with a mean age of 15 years (range, 6-18 years) at the time of injury. There were 396 patients (78%) in the ACL group and 113 patients (22%) in the CLI group (90 with MCL, 11 with LCL, and 12 with both MCL and LCL injuries). Groups had similar proportions of overweight/obese patients (P = .619) and girls (P = .104). Older age (odds ratio [OR], 2.0 [95% CI, 1.3-3.3]) and contact injuries (OR, 2.2 [95% CI, 1.4-3.4]) were associated with CLIs. The CLI group had a higher proportion of chondral injuries (P = .001) but not meniscal injuries (P = .295) and presented to surgery earlier than the ACL group (P = .002). Conclusion: Older age and contact injuries were associated with CLIs in children and adolescents with ACL tears, whereas BMI category and sex were not. CLIs were associated with a higher proportion of chondral injuries but not meniscal injuries and were not associated with a delay to surgery.

7.
J Orthop Surg (Hong Kong) ; 26(3): 2309499018806631, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30352544

RESUMEN

PURPOSE:: To explore factors influencing muscle strength after anterior cruciate ligament (ACL) reconstruction (ACLR) in pediatric patients. We hypothesized that obesity/overweight, autograft hamstring tendon, and concomitant injuries would be associated with slower muscle recovery. METHODS:: We retrospectively reviewed the records of pediatric ACLR patients during a 3-year period. Muscle recovery was defined as ≥85% of peak torque compared with the contralateral side. We categorized patients as either obese/overweight or normal weight. Statistical analysis was performed using Mann-Whitney U, analysis of variance, and χ2 tests ( α level < 0.05). RESULTS:: The study group consisted of 330 patients, of whom 198 (60%) and 231 (70%) met quadriceps and hamstring recovery criteria, respectively, at final testing (mean: 7.0 ± 3.2 months). Patients recovered hamstring and quadriceps strength at a mean of 5.3 ± 2.2 months and 6.1 ± 2.3 months, respectively. Hamstring muscle recovery took significantly longer in obese/overweight patients (mean: 5.7 ± 2.2 months) versus normal-weight patients (mean: 5.1 ± 2.1 months; p = 0.025), but quadriceps recovery did not (obese/overweight mean: 6.5 ± 2.6 months; normal-weight mean: 5.9 ± 2.1 months; p = 0.173). CONCLUSION:: Concomitant injuries and graft type were not associated with length of time to recovery of muscle strength. Obesity/overweight was associated with delay in recovery of hamstring but not quadriceps strength.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Músculos Isquiosurales/fisiología , Tendones Isquiotibiales/trasplante , Fuerza Muscular/fisiología , Obesidad Pediátrica/complicaciones , Recuperación de la Función/fisiología , Adolescente , Lesiones del Ligamento Cruzado Anterior/complicaciones , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Factores de Tiempo , Trasplante Autólogo
8.
Orthop J Sports Med ; 6(7): 2325967118786237, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30046635

RESUMEN

Background: Racquet sports have increased in popularity over the past decade. Although research is available regarding the epidemiological characteristics of tennis injuries, little is known about the frequency and characteristics of injuries in other racquet sports. Hypothesis: Given the increase in all racquet sport participation in the United States (US), it is hypothesized that injuries have accordingly become more frequent. Study Design: Descriptive epidemiology study. Methods: Using the National Electronic Injury Surveillance System database, we reviewed the numbers of badminton and squash/racquetball injuries presenting to a representative sample of US emergency departments (EDs). We used weighted estimates to extrapolate the data to the US population. Incidence estimates were compared with national participation data and stratified. Results: A total of 4330 injuries were reported, representing an estimated 173,000 injuries presenting to US EDs from 1997 through 2016. Despite the increase in the number of players from 2006 through 2016, the annual injury rate for squash/racquetball declined significantly, including the rates for each body region assessed. No similar trend was found for badminton injuries. Within our extrapolated ED cohort, the lower extremities were the most common body region injured (37%). Strains/sprains were the most common injury type in the trunk (73%), lower extremities (65%), and upper extremities (32%), whereas lacerations were most common in the head/neck (49%). In badminton, the youngest players (age range, 5-18 years) sustained twice as many fractures (relative risk [RR], 1.96; 95% CI, 1.14-3.38) and almost 3 times as many lacerations as patients in any other age group. Similarly, the youngest squash/racquetball players were at highest risk for lacerations (RR, 1.45; 95% CI, 1.22-1.73) and head and neck injuries (RR, 1.52; 95% CI, 1.26-1.83). Conclusion: Although declines in rates of squash/racquetball injuries were observed, the increasing popularity of badminton, squash, and racquetball necessitates further preventive measures to improve player safety, with an emphasis on the youngest players.

9.
Orthopedics ; 41(5): e676-e680, 2018 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-30052264

RESUMEN

Hand and wrist radiographs are the most common means for estimating skeletal bone age. There is no widely used scale for estimating skeletal bone age using knee radiographs. Do skeletal bone age estimates from knee-maturity scales correlate sufficiently with both chronologic age and estimates from a hand-wrist scale to potentially substitute for estimates from the latter? The authors reviewed the records of 503 patients 6 to 19 years old who had hand and knee radiographs obtained within 30 days of each other. They analyzed radiographs using the O'Connor knee scale (based on 10 maturation markers) and a new, abbreviated version of the O'Connor scale (based on 7 markers). The authors also analyzed radiographs of the hands of boys 12.5 to 16 years old and girls 10 to 16 years old using the shorthand method. Multivariate linear regression was used for analysis. Inter- and intrarater reliabilities were assessed. Skeletal bone age derived from the O'Connor and abbreviated knee scales correlated with chronologic age (adjusted R2=0.88 and 0.90, respectively). Compared with estimates from the hand-wrist scale, estimates were lower by a mean of 0.91 years for boys and 0.38 years for girls when using the O'Connor scale and 0.96 years for boys and 0.52 years for girls when using the abbreviated scale. Inter- and intrarater reliabilities were very good (κ=0.82 and 0.90, respectively) and were substantial at each bony landmark measured. Knee radiographs can be used to estimate skeletal bone age using an abbreviated knee scale. [Orthopedics. 2018; 41(5):e676-e680.].


Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Huesos de la Mano/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Adolescente , Adulto , Niño , Epífisis/diagnóstico por imagen , Epífisis/crecimiento & desarrollo , Femenino , Huesos de la Mano/crecimiento & desarrollo , Humanos , Articulación de la Rodilla/crecimiento & desarrollo , Masculino , Análisis Multivariante , Radiografía , Estudios Retrospectivos , Adulto Joven
10.
JBJS Case Connect ; 8(2): e41, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29952775

RESUMEN

CASE: The cause of osteochondritis dissecans is unknown. Various hypotheses suggest mechanical, ischemic, and hereditary causes. We describe a 13-year-old girl with spastic diplegia, a form of cerebral palsy, who had an associated crouch gait and presented with bilateral osteochondral defects of the medial and lateral femoral condyles. CONCLUSION: This case highlights the potential role of repetitive microtrauma, likely due to the poor biomechanical forces in a crouch gait, and provides support for a mechanical cause of osteochondritis dissecans.


Asunto(s)
Parálisis Cerebral/complicaciones , Trastornos Neurológicos de la Marcha/complicaciones , Osteoartritis de la Rodilla , Osteocondritis Disecante , Adolescente , Femenino , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía
11.
JBJS Case Connect ; 6(4): e94, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-29252748

RESUMEN

CASE: Most pediatric closed fractures of the proximal part of the humerus are treated nonoperatively. However, with open fractures of the proximal part of the humerus, nonoperative treatment typically is not indicated, and no such cases previously have been reported in the literature. We describe a 10-year-old boy with a completely displaced type-I open fracture of the proximal part of the humerus who was treated definitively in the emergency department with local irrigation and debridement, antibiotics, and the application of a hanging arm cast. One year later, he had complete radiographic union, no infectious sequelae, and no functional impairment of the shoulder. CONCLUSION: Nonoperative treatment of a pediatric type-I open fracture of the proximal part of the humerus can be successful.


Asunto(s)
Fracturas Abiertas/terapia , Fracturas del Hombro/terapia , Niño , Fracturas Abiertas/diagnóstico por imagen , Humanos , Masculino , Fracturas del Hombro/diagnóstico por imagen
12.
J Pediatr Orthop ; 36(6): 656-60, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-25929780

RESUMEN

BACKGROUND: Telescopic rods require alignment of 2 rods to enable lengthening. A telescopic rod converts functionally into a solid rod if either rod bends, preventing proper engagement. Our goal was to characterize implant bending as a mode of failure of telescopic rods used in the treatment of osteogenesis imperfecta in children. METHODS: We conducted a retrospective review of our osteogenesis imperfecta database for patients treated with intramedullary telescopic rods at our institution from 1992 through 2010 and identified 12 patients with bent rods. The 6 boys and 6 girls had an average age at the time of initial surgery of 3.1 years (range, 1.8 to 8.3 y) and a total of 51 telescoping rods. Clinic notes, operative reports, and radiographs were reviewed. The rods were analyzed for amount of lengthening, characteristics of bending, presence of cut out, or disengagement from an anchor point. Bends in the rods were characterized by their location on the implant component. The bent and straight rods were compared. Data were analyzed with the Mann-Whitney test (statistical significance set at P≤0.05). RESULTS: Of the 51 telescoping rods, 17 constructs (33%) bent. The average interval between surgery and rod bending was 4.0 years (range, 0.9 to 8.2 y). Before bending, 11 of 17 telescoping rods had routine follow-up radiographs for review. In 10 of the rods, bending was present when early signs of rod failure were first detected. Rod bending did not seem to be related to rod size. There was no area on the rod itself that seemed more susceptible to bending. CONCLUSIONS: Rod bending can be an early sign of impending rod failure. When rod bending is first noted, it may predispose the rod to other subsequent failures such as loss of proximal and distal fixation and cut out. Rod bending should be viewed as an indicator for closer monitoring of the patient and discussions regarding future need for rod exchange. LEVEL OF EVIDENCE: Level III-retrospective review.


Asunto(s)
Osteogénesis Imperfecta , Implantación de Prótesis , Niño , Preescolar , Análisis de Falla de Equipo , Femenino , Humanos , Fijadores Internos/normas , Masculino , Osteogénesis Imperfecta/diagnóstico , Osteogénesis Imperfecta/fisiopatología , Osteogénesis Imperfecta/cirugía , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Radiografía/métodos , Estudios Retrospectivos
13.
Orthopedics ; 38(5): e367-73, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25970362

RESUMEN

After axillary lymph node dissection (ALND), patients are cautioned against ipsilateral interventional procedures to avoid the theoretical increased risk of postoperative complications, particularly lymphedema. The authors' goal was to evaluate the complications of elective hand surgery after ALND. The authors reviewed patients presenting to their hand clinic from 1998 to 2011, selecting those with a diagnosis of breast cancer or melanoma and a history of previous ALND; the authors excluded those treated nonoperatively and those treated with elective surgery in the contralateral hand. Average age of the 22 patients meeting the criteria (20 with a history of breast cancer, 6 with preexisting lymphedema) was 53.9 years (range, 26.7 to 73.6 years) at the time of ALND and 63.1 years (range, 31.7 to 83.5 years) at the time of hand surgery. Average interval between surgeries was 9.2 years (range, 8 days to 37.3 years). Follow-up averaged 9.2 months (range, 8 days to 41.7 months). Fifteen patients were surveyed for long-term postoperative results (average surgery-to-survey interval, 4.3 years [range, 1 to 11.9 years]). Fifteen patients had uneventful postoperative recoveries, 4 had peri-incisional erythema requiring oral antibiotics, 1 had incisional pain and scarring, 1 had chronic wound-healing issues, and 1 had a dehiscence requiring a return to the operating room. In the 15 patients who completed the follow-up survey, there was no disease exacerbation in the 3 patients with preexisting lymphedema, and there were no new cases of lymphedema. Routine minor hand surgery did not result in lymphedema and did not increase existing lymphedema in these patients with previous ipsilateral ALND, but almost one-third of them had short-term complications in the postoperative recovery period.


Asunto(s)
Procedimientos Quirúrgicos Electivos/efectos adversos , Mano/cirugía , Escisión del Ganglio Linfático/efectos adversos , Ganglios Linfáticos/cirugía , Linfedema/epidemiología , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Axila , Neoplasias de la Mama/cirugía , Contraindicaciones , Femenino , Humanos , Incidencia , Melanoma/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/cirugía , Factores de Tiempo , Cicatrización de Heridas
14.
Am J Orthop (Belle Mead NJ) ; 40(6): E105-9, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21869943

RESUMEN

Forty-two patients treated with curettage, burring, direct pressurized cryotherapy, and bone grafting or cementation were retrospectively reviewed. There were no pathologic fractures in this study group, compared with a 17% fracture rate in recent studies using the "direct pour" technique. Direct pressurized cryotherapy was used in 3 separate freezing cycles in each case. This approach may significantly reduce the risk for fracture compared with historical controls using the direct-pour technique.


Asunto(s)
Neoplasias Óseas/cirugía , Criocirugia , Fracturas Óseas/etiología , Presión/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Criocirugia/efectos adversos , Criocirugia/métodos , Legrado/efectos adversos , Femenino , Fracturas Óseas/epidemiología , Humanos , Incidencia , Masculino , Maryland/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
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