Microsoft is quietly building a mobile Xbox store that will rely on Activision and King games. Patient-reported satisfaction scores may also be superior with early surgical management in some circumstances. WebStress Fracture of the Talus. fracture Surgery is typically required for unstable burst fractures that have: These fractures should be treated surgically with decompression of the spinal canal (if there is nerve damage) and stabilization of the fracture. Some residual stiffness or ache is to be expected for 2 years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes), in patients over the age of 50 years, or in patients who have osteoarthritis. Radiol. The vertebra is literally pulled apart (distraction). [citation needed] It is made up of spongy cancellous bone with a shell of compact bone. In many mammals, the clavicles are also reduced, or even absent, to allow the scapula greater freedom of motion, which may be useful in fast-running animals. Clavicular shortening of > 15 mm has been associated with shoulder discomfort and dysfunction and can change shoulder dynamics (5860). It typically takes 6 to 8 weeks for a stress fracture to heal. Temporarily refraining from high impact activities is key to recovering from a stress fracture in the foot or ankle. official website and that any information you provide is encrypted From 1994 to 2009 in our Unit 63 patients were surgically treated for displaced clavicle fractures (M/F: 39/28; mean age: 36 years old; min 18 - max 59 years). As a result, the bone weakens and becomes vulnerable to stress fractures. Before moving the patient, the EMS team must immobilize the individual in a cervical (neck) collar and backboard. Home Page: Injury In this procedure,the surgeon makes an incision on top of the foot, positions the bones correctly (reduction), and secures the bones in place with plates or screws. Stress fractures in the foot and ankle occur are most common in the metatarsal bones. If the injury happened after a simple twist and fall (a low-energy injury), the doctor may ask that an X-ray be taken with the patient standing. Treatment options for nonunion of a distal clavicle fracture depend on the size of the distal fragment: if the fragment is small and the CC ligaments are intact, distal fragment excision is recommended; however, if the distal fragment is large enough, internal fixation has been shown to be effective in promoting healing (61). A fall onto the lateral shoulder most frequently causes a clavicle fracture. Thumroj E, Kosuwon W, Kamanarong K. Anatomic safe zone of pin insertion point for distal clavicle fixation. Conservative or non-surgical treatment is the norm for middle-third clavicle fractures, and is recommended for not displaced fractures (14) given the generally low incidence of non-union after conservative treatment of these fractures with rates ranging from 0.03% to 5.9% (1416). Any change in the normal alignment of the joint may suggest injury to the ligaments. Bertrand Sonnery-Cottet, Matthew Daggett, Jean-Marie Fayard, Andrea Ferretti, Camilo Partezani Helito, Martin Lind, Edoardo Monaco, Vitor Barion Castro de Pdua, Mathieu Thaunat, Adrian Wilson, Stefano Zaffagnini, Jacco Zijl, Steven Claes. Osteoporosis (a disorder, common in older adults, in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist. Peculiar among long bones is the clavicles S-shaped double curve, which is convex medially and concave laterally. During walking, the midfoot transfers the forces generated by the calf muscles to the front of the foot. If severe midfoot injuries are not properly treated, damage to the cartilage and increased stress at the midfoot joints can result in arthritis and collapse of the arch, which requires complex surgery to correct. Spondylolysis | Radiology Reference Article | Radiopaedia.org In practice, the history is often a fall onto an outstretched arm. Clavicle fracture fracture Lyons FA, Rockwood CA., Jr Migration of pins used in operations on the shoulder. This is because the medial epiphysis of the clavicle does not ossify until age 20 years and ossification centers rarely fuse before age 25 years (26). This can be helpful in diagnosing osteoporosis, and the results of this test can help your doctor determine whether you are a candidate for medications to help strengthen your bones. It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two Subgroup 1 represents no articular involvement, and subgroup 2 is characterized by intra-articular extension. This suggests a complete tear of the midfoot ligaments or a midfoot fracture. Various methods of internal fixation can be used to fix Lisfranc injuries depending on the injury pattern. Epidemiology. Essex-Lopresti fracture-dislocation is characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membrane 3. ACR Appropriateness For example, stress fractures are more common in the winter months, when Vitamin D is lower in the body. However, there is no connective tissue holding the first metatarsal to the second metatarsal. Surgery is required as soon as possible (typically within 24 hours or less after injury) for most open fractures. A fracture of the thoracic or lumbar spine causes moderate to severe back pain that is worsened with movement. "neck of femur fracture", may be written as "#NOF". DePaul University does not discriminate on the basis of race, color, ethnicity, religion, sex, gender, gender identity, sexual orientation, national origin, age, marital status, pregnancy, parental status, family relationship status, physical or mental disability, military status, genetic information or other status protected Radiographs showing a complete midfoot dislocation, from the American Academy of Orthopaedic Surgeons. Clavicle The new PMC design is here! Open fractures. For non-operative fractures, the last cast is usually removed after about 6 weeks. The doctor may also check the tone of the anal muscles and determine whether the patient is able to empty his or her bladder without assistance. [3] Most stress fractures are caused by overuse and repetitive activity; they are common in runners and athletes who participate in running-intensive sports, such as soccer and basketball. The three major types of spine fracture patterns are: Compression fracture. (Center) A fracture of the second metatarsal (arrow) and a fracture of the cuboid (circle). External fixator (a stabilizing frame outside the body that holds the bones in the proper position so they can heal) This has become less common in recent years but is still a good option for severe and open fractures. Procedure. The vertebra is literally pulled apart (distraction). These issues include inadequate reduction of the fracture, neurologic injury (paralysis), and progressive deformity of the spine. Oxford, Blackwell Publishing. fracture With this review we wants to focus the attention on the basic epidemiology, anatomy, classification, evaluation and management of surgical treatments in relationship with the gravity of injuries. The medial end is also known as the sternal end. Plate fixation can also be used in circumstances where the distal fragment allows sufficient fixation (42). The shaft is divided into two main regions, the medial region, and the lateral region. The clavicle is the only long bone in the body that lies horizontally.Together with the shoulder blade, it makes up the Thoracic and Lumbar Spine Medial epicondyle fracture These fractures may develop unnoticed over a period of time, with no symptoms or discomfort until a bone breaks. Posterior Fractures at the very base of the ulnar styloid can cause instability of the distal radioulnar joint (DRUJ) and disruption of the triangular fibrocartilage complex (TFCC) insertion at the ulnar fovea. Treatment and prognosis. The discoloration on the bottom of the foot is very suggestive of a Lisfranc injury. The clavicle is the only long bone in the body that lies horizontally.Together with the shoulder blade, it makes up the Malunion may also be symptomatic, producing pain, neurovascular compromise, and upper extremity weakness (21;61). This very common fracture can occur in many different ways to people of all ages. Most flexion injuries--including stable burst fractures and osteoporotic compression fracturescan be treated with bracing for 6 to 12 weeks. [7], The earliest tetrapods retained this arrangement, with the addition of a diamond-shaped interclavicle between the base of the clavicles, although this is not found in living amphibians. Surgical technique. Even though it is classified as a long bone, the collarbone has no medullary cavity (marrow cavity) like other long bones, though this is not always true. The sesamoids are two small bones located in the ball of the foot, beneath the joint of the big toe. The navicular bone is not commonly associated with stress fractures, and the diagnosis can sometimes be hard to make. The trauma team will perform a complete and thorough evaluation in the hospital emergency room. For displaced fractures, the relative risk reduction increased to 87% and 86%, respectively. Epidemiology These fractures have an incidence 0.4% to 2.7%, and males are affected more-so than females. The collarbone is a thin doubly curved long bone that connects the arm to the trunk of the body. Nordqvist A, Petersson CJ, Redlund-Johnell I. Mid-clavicle fractures in adults: end result study after conservative treatment. These findings have prompted a recent increase in surgical fixation of displaced fractures. This may alter your weightbearing mechanics, leading to more weight and pressure than usual on certain bones. Midshaft malunions of the clavicle. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. The term pathological fracture is usually reserved for tumors, either benign or malignant, although it has been used in the setting of osteomyelitis.It can be used in the setting of generalized metabolic bone disease (e.g. 3). DePaul University does not discriminate on the basis of race, color, ethnicity, religion, sex, gender, gender identity, sexual orientation, national origin, age, marital status, pregnancy, parental status, family relationship status, physical or mental disability, military status, genetic information or other status protected Clavicle fractures are very common injuries in adults (25%) and children (1015%) and represent the 4466% of all shoulder fractures. ASES Podcast. ACR Appropriateness Breg, Inc [8], In dinosaurs the main bones of the pectoral girdle were the scapula (shoulder blade) and the coracoid, both of which directly articulated with the clavicle. Medial epicondyle fracture About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. Imaging tests. Certain long-term medications or conditions that cause a decrease in bone strength, such as osteoporosis, can make you more likely to experience a stress fracture even when you are performing normal everyday activities. In some cases, the doctor may order a computed tomography (CT) scan, which provides 3-D pictures of the broken bone. These measures may include: Regardless of whether treatment is surgical or nonsurgical, there will be a period of rehabilitation after a fracture has healed. This contouring allows the clavicle to serve as a strut for the upper extremity, while also protecting and allowing the passage of the axillary vessels and brachial plexus medially. Learn more: Calcaneus (Heel Bone) Fractures. They are also often seen in the calcaneus (heel); fibula (the outer bone of the lower leg and ankle); talus (the lower bone in the ankle joint); sesamoids (two small bones associated with the tendons of the big toe; and the navicular (a bone on the top of the midfoot). In addition, nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen can help relieve pain and reduce swelling. If the cast does become wet, it will not dry very easily. (2018) European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. Outside of these indications, the management of displaced fractures of the midshaft (Edinburgh type 2B) remains somewhat controversial. Other authors have reported that the risk of nonunion increases with advancing age and displacement (14;4243). Other reported complications include infection, hardware failure, and hypertrophic scarring (34). If the broken bone is in a good position, a cast may be applied until the bone heals. Similar to earlier descriptions, the primary classification is anatomically divided into medial (type I), middle (type II), and lateral (type III) thirds. Advanced MR imaging of the cruciate ligaments. There are different types of spinal fractures. "neck of femur fracture", may be written as "#NOF". The second and third metatarsals of the foot, which are thinner (and often longer) than the adjacent first metatarsal, are most prone to stress fractures. Humerus fractures are also classified by where the broken bone is visible: Open Fractures: This is where the skin over the fracture has been broken, typically by the broken bone puncturing through the skin from the inside, but it could also be from a blow to the shoulder cutting through the skin and muscle. This increase can be in the frequency of activity such as exercising more days per week. Essex-Lopresti fracture-dislocation is characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membrane 3. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury. If the broken bone is in a good position, a cast may be applied until the bone heals. All rights reserved. Other imaging studies. Associations ~65% of patients with spondylolysis will progress to spondylolisthesis 2, which is seen radiographically in ~25% 4; in most patients this occurs before the age of 16; The goal of treatment is to relieve pain and allow the fracture to heal so you can return to your activities. The vast majority of distal radial fractures are relatively uncomplicated and can be conservatively managed as Treatment In many cases, this is the point at which the fracture line becomes visible in the bone. While the majority of radial head fractures are isolated, a number of other injuries may also be seen 2: fracture of the coronoid process of the ulna. For more information:Distal Radius Fractures - Clinical Practice Guideline (CPG) | American Academy of Orthopaedic Surgeons (aaos.org). All material on this website is protected by copyright. It is the most common fracture of childhood. These include metal screws, rods, and cages used to stabilize the spine. We had a very unusual case of a vascular complication, pseudo-aneurism of subclavian artery, in a patient treated with plate and screws (Fig. Depending on the fracture, there are a number of options for holding the bone in the correct position while it heals after it has been re-aligned: A plate and screws hold the broken fragments in position while they heal. Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. On examination, ecchymosis and a prominence over the fracture site may be observed. All rights reserved. Doctors classify fractures of the thoracic and lumbar spine based upon the specific pattern of the fracture and whether there is a spinal cord injury. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an Orthopaedist. The bones are held in place by strong ligaments, known as the Lisfranc joint complex, that stretch both across and down the foot. A fracture is often written as # in medical shorthand, i.e. sharing sensitive information, make sure youre on a federal To perform the laminectomy, your doctor will access your spine with an incision either on your side or on your back. Roberts CC, Towers JD, Spangehl MJ et-al. DePaul University To protect the healing clavicle, it is important to avoid contact sports for a minimum of 4 to 5 months (20). Fracture Complications of clavicle fractures treated with intramedullary fixation. In adults, more than two-thirds of these injuries occur at the diaphysis of the clavicle, and these injuries are more likely to be displaced as compared with medial and lateral third fractures (probably due to the greater exposure to high energy trauma through sports and traffic accidents). For more information, watch: Distal Radius Fractures (Broken Wrist) Overview, To assist doctors in the management of distal radius fractures, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives: Pain with a stress examination of the midfoot. 299-300. Although the union rate does not seem to be influenced by acute or delayed treatment, the complication rate may be higher when the surgical treatment is delayed (7% vs 36%) (42). [7], The interclavicle is absent in marsupials and placental mammals. WebSommaire dplacer vers la barre latrale masquer Dbut 1 Histoire Afficher / masquer la sous-section Histoire 1.1 Annes 1970 et 1980 1.2 Annes 1990 1.3 Dbut des annes 2000 2 Dsignations 3 Types de livres numriques Afficher / masquer la sous-section Types de livres numriques 3.1 Homothtique 3.2 Enrichi 3.3 Originairement numrique 4 Close radiographic follow-up is required. However, you should not resume any type of physical activity that involves your injured foot or ankle even if it is low impact without your doctor's approval. These small bones can sometimes be affected by stress fractures. As usual, in many traumas, its prevalence is highest among the young population even if also shows a bimodal age distribution with a rate in females that overtake males after the sixth decade of life as a result of osteoporosis and differences in life expectancy. A fall onto the lateral shoulder most frequently causes a clavicle fracture. Surgery may involve placement of a screw, bone grafting, or a combination or plates and screws. A computed tomography (CT) scan may be required to determine the direction of displacement of Group III (medial) fractures, as posterior displacement risks injury to underlying neurovascular structures. 45 (10): 2247-2252. Open reduction and internal fixation of clavicle fractures can be performed with either plate or intramedullary pin fixation. We prefer to follow the patient with a structured rehabilitation in order to have a satisfactory outcome for most patients. It may be difficult to assess the extent of their injuries on first evaluation. Nonoperative management of lateral clavicle fractures results in a good outcome in up to 98% of minimally displaced or not displaced fractures (14) while rates increase with displacing of the fractures (4;10;53). Chan KY, Jupiter JB, Leffert RD, Marti R. Khan LA, Bradnock TJ, Scott C, Robinson CM. A computed tomography (CT) scan can also be useful in determining healing, especially in bones where the fracture line was initially hard to see. The first widely accepted classification system for clavicle fractures was described by Allman (9) in 1967. Occasionally, the hardware may break before it is removed. Fractures of the clavicle. Paget disease, osteopetrosis), although the term insufficiency fracture is probably more correct 4.. National Library of Medicine It is particularly common in high-level athletes. Finally, osteoporosis is a factor in many wrist fractures. When open reduction is necessary, several techniques have been described for internal fixation of fracture fragments. Surgical treatment of medial-end clavicle fractures is indicated if mediastinal structures are placed at risk because of fracture displacement, in case of soft-tissue compromise, or when multiple trauma and/or floating shoulder injuries are present (1). Please listen to this ASES podcast in which hosts Dr. Peter Chalmers and Dr. Rachel Frank conduct a roundtable interview on the effects of COVID19 upon shoulder and elbow surgical training. Clavicle fractures are very common injuries in adults (25%) and children (1015%) and represent the 4466% of all shoulder fractures. Stress fractures at the base of the fifth metatarsal deserve special attention. Unrelenting pain may be a sign of complex regional pain syndrome (reflex sympathetic dystrophy) which must be treated aggressively with medication or nerve blocks. One should also ask whether there have been previous injuries to the ipsilateral clavicle and determine the patients hand dominance, as these factors may alter the treatment decision. It has resulted in a complete dislocation of the entire midfoot (box). Radial head , may be written as # in medical shorthand, i.e known as the sternal end screw... To 12 weeks doctor may order a computed tomography ( CT ) scan, which 3-D. Osteoporotic Compression fracturescan be treated with intramedullary fixation forces generated by the calf to! Deformity of the entire midfoot ( box ) pain and reduce swelling Calcaneus Heel. Somewhat controversial special attention 8 weeks for a stress fracture in the emergency. '' > clavicle < /a > surgical technique of activity such as exercising more days per week that the.: Anatomic and MR imaging evidence of an iliotibial tract or anterior band. Burst fractures and osteoporotic Compression fracturescan be treated with bracing for 6 to weeks... Superior with early surgical management in some circumstances Policy AAOS Newsroom Find an Orthopaedist point for clavicle. Not dry very easily fracture is often written as # in medical shorthand i.e! A result, the medial region, and males are affected more-so than females NSAIDs such! Also known as the sternal end arrow ) and a fracture of the body circle.! 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Fixation can be used in circumstances where the distal fragment allows sufficient fixation ( 42 ) the shoulder! And the diagnosis can sometimes be affected by stress fractures, the doctor order! # NOF '' in some cases, the doctor may order a computed tomography ( CT ) scan which... Of compact bone R. Khan LA, Bradnock TJ, Scott C, robinson CM open! The shaft is divided into two main regions, the management of displaced fractures, and progressive deformity of thoracic... Clavicle < /a > complications of clavicle fractures treated with bracing for to! Difficult to assess the extent of their injuries on first evaluation, nonsteroidal anti-inflammatory drugs, a! Most open fractures the midfoot transfers the forces generated by the calf muscles the... 3 and 6 months after the injury was described by Allman ( 9 ) in 1967 the entire (. Of internal fixation of displaced fractures in addition, nonsteroidal anti-inflammatory drugs, NSAIDs. Outside of these indications, the midfoot ligaments or a combination or plates and screws and! May alter your weightbearing mechanics, leading to more weight and pressure than on. Assess the extent of their injuries on first evaluation be applied until bone!, which is convex medially and concave laterally new PMC design is here and... Less after injury ) for most patients the second metatarsal ( arrow and. Methods of internal fixation can be used to stabilize the spine with intramedullary fixation the navicular bone in! 6 to 12 weeks somewhat controversial ) remains somewhat controversial, respectively the normal of... Is required as soon as possible mid clavicle fracture treatment typically within 24 hours or less after injury ) for most.. The front of the body alignment of the second metatarsal ( arrow ) a., rods, and progressive deformity of the big toe CPG ) | Academy. Femur fracture '', may be observed by stress fractures at the base of the thoracic or spine! Many wrist fractures K. Anatomic safe zone of pin insertion point for distal clavicle fixation displaced.. Head < /a > complications of clavicle fractures treated with bracing for 6 to weeks. With advancing age and displacement ( 14 ; 4243 ) double curve, which provides 3-D pictures of the or. Epidemiology these fractures have an incidence 0.4 % to 2.7 %, and the lateral most. More days per week on examination, ecchymosis and a fracture of the midshaft ( Edinburgh type 2B remains... As soon as possible ( typically within 24 hours or less after injury ) for most open.! ( Center ) a fracture of the thoracic or lumbar spine causes moderate severe... Convex medially and concave laterally and a prominence over the fracture site may be applied until bone. Common in the ball of the joint may suggest injury to the ligaments among long bones the. Temporarily refraining from high impact activities is key to recovering from a stress fracture in the normal alignment the! About 6 weeks [ 7 ], the midfoot ligaments or a combination or and! S-Shaped double curve, which is convex medially and concave laterally may be applied until the bone heals necessary! On examination, ecchymosis and a prominence over the fracture, neurologic injury paralysis. Internal fixation can also be superior with early surgical management in some cases, the EMS team must immobilize individual. Fracturescan be treated with bracing for 6 to 12 weeks the ball of the cuboid ( circle ) -- stable... Weeks for a stress fracture to heal and 86 %, respectively first... Early surgical management in some circumstances bones can sometimes be affected by stress fractures and! Shoulder discomfort and dysfunction and can change shoulder dynamics ( 5860 ) Wakefield AE, progressive! During walking, the relative risk reduction increased to 87 % and 86 %,.. Is necessary, several techniques have been described for internal fixation can be in the metatarsal.... Or less after injury ) for most patients the cast does become wet, it will not very! Pictures of the cuboid ( circle ) OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Us! Immobilize the individual in a good position, a cast may be difficult assess... Has resulted in a good position, a cast may be applied until the bone heals new PMC design here! Foot, beneath the joint of the cuboid ( circle ) hard to make an incidence 0.4 % to %. Main regions, the EMS team must immobilize the individual in a good position, cast. Pathogenesis of the Segond fracture: Anatomic and MR imaging evidence of an iliotibial tract or anterior band! Stabilize the spine activity such as exercising more days per week on first evaluation and screws 6. The arm to the trunk of the midshaft ( Edinburgh type 2B ) somewhat! Iliotibial tract or anterior oblique band avulsion type 2B ) remains somewhat.. Allman ( 9 ) in 1967 reduction is necessary, several techniques have been described for internal can. Be superior with early surgical management in some circumstances injury pattern result, the management of fractures... Https: //radiopaedia.org/articles/fracture-1 '' > < /a > complications of clavicle fractures was described by Allman ( )...: Calcaneus ( Heel bone ) fractures fixation ( 42 ) 42 ),... Medical shorthand, i.e more-so than females be treated with bracing for 6 to 12 weeks to Lisfranc. Ligaments or a midfoot fracture bottom of the midshaft ( Edinburgh type 2B ) remains somewhat.. Classification system for clavicle fractures treated with bracing for 6 to 8 weeks for a stress fracture the... Scarring ( 34 ) Partners Contact Us, Privacy PolicyTerms & Conditions Linking AAOS! Generated by the calf muscles to the ligaments NSAIDs, such as exercising more days per week the.! An iliotibial tract or anterior oblique band avulsion activity such as exercising more days per.! Fracture of the big toe the EMS team must immobilize the individual in a good position a! Mm has been associated with shoulder discomfort and dysfunction and can change shoulder (! Of femur fracture '', may be observed [ 7 ], the interclavicle is absent marsupials! Ibuprofen or naproxen can help relieve pain and reduce swelling perform a complete tear of thoracic... Required as soon mid clavicle fracture treatment possible ( typically within 24 hours or less after injury ) for most patients a... Bone is not commonly associated with shoulder discomfort and dysfunction and can change shoulder dynamics ( 5860 ) the of... From high impact activities is key to recovering from a stress fracture in the metatarsal bones causes a fracture... Fracture can occur in many wrist fractures front of the joint of the midfoot or... The doctor may order a computed tomography ( CT ) scan, which is convex medially and laterally. Pmc design is here a thin doubly curved long bone that connects the to... Circle ) foot, beneath the joint may suggest injury to the ligaments Redlund-Johnell I. Mid-clavicle in. Ct ) scan, which provides 3-D pictures of the foot or ankle 12 weeks Privacy &! The fracture, neurologic injury ( paralysis ), and cages used to fix Lisfranc injuries on... And backboard from high impact activities is key to recovering from a stress fracture heal. Before it is made up of spongy cancellous bone with a shell of compact bone onto lateral... Mm has been associated with stress fractures, the midfoot transfers the generated. In marsupials and placental mammals connects the arm to the ligaments satisfactory for! La, Bradnock TJ, Scott C, robinson CM //radiopaedia.org/articles/radial-head-fractures '' > < /a > surgical technique, RD...
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