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4. Biomechanical evaluation of a tool-less external fixator

Author

Carpanen, Diagarajen, Masouros, S D, and Stinner, D J

Abstract

IntroductionCurrent external fixator systems used by the US and UK military for stabilising extremity fractures require specialised tools to build a construct. The goal of obtaining and maintaining limb length and alignment is not achieved if these tools are misplaced. An alternative, tool-less system is currently available, namely the Dolphix Temporary Fixation System. The aim of this study was to compare the stiffness of the Dolphix system with the existing Hoffmann III system.MethodsThree Hoffmann III and three Dolphix constructs were assembled on a bone (tibia) surrogate. A 30 mm fracture gap was created to simulate a comminuted proximal tibia or distal femur fracture. The constructs were then tested in cyclic axial compression once daily for 3 consecutive days.ResultsThe length and alignment of the surrogate limb was restored following each testing cycle with both external fixation systems. The stiffness of the constructs was maintained throughout each sequential test, with the Dolphix exhibiting 54% the stiffness of the Hoffmann III construct.ConclusionGiven the Dolphix’s performance in mechanical testing and the unique advantage of having a tool-less manual locking clamp mechanism, this tool-less system should be considered for use in the mobile austere environment.

Published
2023
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9. Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Author

Sprague, S. (Sheila), Schemitsch, E.H. (Emil H.), Swiontkowski, M.F. (Marc ), Della Rocca, G.J. (Gregory J.), Jeray, K.J. (Kyle J.), Liew, S. (Susan), Slobogean, G.P. (Gerard P.), Bzovsky, S. (Sofia), Heels-Ansdell, D. (Diane), Zhou, Q. (Qi), Bhandari, M. (Mohit), Sprag, S. (Sheila), Devereaux, P.J., Guyatt, G.H. (Gordon), Heetveld, M.J. (Martin J.), Richardson, M. (Martin), Thabane, L. (Lehana), Tornetta III, P. (Paul), Walter, S.D. (Stephen D.), McKay, P. (Paula), Scott, T. (Taryn), Garibaldi, A. (Alisha), Viveiros, H. (Helena), Swinton, M. (Marilyn), Gichuru, M. (Mark), Buckingham, L. (Lisa), Duraikannan, A. (Aravin), Maddock, D. (Deborah), Simunovic, N. (Nicole), Agel, J. (Julie), Lieshout, E.M.M. (Esther) van, Zielinski, S.M. (Stephanie), Rangan, A. (Amar), Hanusch, B.C. (Birgit C.), Kottam, L. (Lucksy), Clarkson, R. (Rachel), Haverlag, R. (Robert), McCormack, R. (Robert), Apostle, K. (Kelly), Boyer, D. (Dory), Moola, F. (Farhad), Perey, B. (Bertrand), Stone, T. (Trevor), Viskontas, D. (Darius), Lemke, H.M. (H. Michael), Zomar, M. (Mauri), Moon, K. (Karyn), Moon, R. (Raely), Oatt, A. (Amber), Buckley, R.E. (Richard E.), Duffy, P. (Paul), Korley, R. (Robert), Puloski, S. (Shannon), Powell, J. (James), Johnston, K. (Kelly), Carcary, K. (Kimberly), Lorenzo, M. (Melissa), McKercher, R. (Ross), Sanders, D. (David), MacLeod, M. (Mark), Lawendy, A.-R. (Abdel-Rahman), Tieszer, C. (Christina), Stephen, D. (David), Kreder, H. (Hans), Jenkinson, R. (Richard), Nousiainen, M. (Markku), Axelrod, T. (Terry), Murnaghan, J. (John), Nam, D. (Diane), Wadey, V. (Veronica), Yee, A. (Albert), Milner, K. (Katrine), Kunz, M. (Monica), Ghent, W. (Wesley), McKee, M.D. (Michael D.), Hall, J.A. (Jeremy A.), Nauth, A. (Aaron), Ahn, H. (Henry), Whelan, D.B. (Daniel B.), Vicente, M.R. (Milena R.), Wild, L.M. (Lisa M.), Khan, R.M. (Ryan M.), Hidy, J.T. (Jennifer T.), Coles, C. (Chad), Leighton, R. (Ross), Biddulph, M. (Michael), Johnston, D. (David), Glazebrook, M. (Mark), Alexander, D. (David), Coady, C. (Catherine), Dunbar, M. (Michael), Amirault, J.D. (J. David), Gross, M. (Michael), Oxner, W. (William), Reardon, G. (Gerald), Richardson, C.G. (C. Glen), Trenholm, J.A. (J. Andrew), Wong, I. (Ivan), Trask, K. (Kelly), MacDonald, S. (Shelley), Dobbin, G. (Gwendolyn), Bicknell, R. (Ryan), Yach, J. (Jeff), Bardana, D. (Davide), Wood, G. (Gavin), Harrison, M. (Mark), Yen, D. (David), Lambert, S. (Sue), Howells, F. (Fiona), Ward, A. (Angela), Zalzal, P. (Paul), Brien, H. (Heather), Naumetz, V. (V.), Weening, B. (Brad), Wai, E.K. (Eugene K.), Papp, S. (Steve), Gofton, W.T. (Wade T.), Liew, A. (Allen), Kingwell, S.P. (Stephen P.), Johnson, G. (Garth), O'Neil, J. (Joseph), Roffey, D.M. (Darren M.), Borsella, V. (Vivian), Avram, V. (Victoria), Oliver, T.M. (Todd M.), Jones, V. (Vicki), Vogt, M. (Michelle), Jones, C.B. (Clifford B.), Ringler, J.R. (James R.), Endres, T.J. (Terrence J.), Sietsema, D.L. (Debra L.), Walker, J.E. (Jane E.), Broderick, J.S. (J. Scott), Goetz, D.R. (David R.), Pace, T.B. (Thomas B.), Schaller, T.M. (Thomas M.), Porter, S.E. (Scott E.), Beckish, M.L. (Michael L.), Adams, J.D. (John D.), Barden, B.B. (Benjamin B.), Creek, A.T. (Aaron T.), Finley, S.H. (Stephen H.), Foret, J.L. (Jonathan L.), Gudger, G.K. (Garland K.), Gurich, R.W. (Richard W.), Hill, A.D. (Austin D.), Hollenbeck, S.M. (Steven M.), Jackson, L.T. (Lyle T.), Kruse, K.K. (Kevin K.), Lackey, W.G. (Wesley G.), Langan, J.W. (Justin W.), Lee, J. (Julia), Leffler, L.C. (Lauren C.), Miller, T.J. (Timothy J.), Murphy, R.L. (R. Lee), O'Malley, L.K. (Lawrence K.), Peters, M.E. (Melissa E.), Price, D.M. (Dustin M.), Tanksley, J.A. (John A.), Torres, E.T. (Erick T.), Watson, D.J. (Dylan J.), Watson, S.T. (Scott T.), Tanner, S.L. (Stephanie L.), Snider, R.G. (Rebecca G.), Nastoff, L.A. (Lauren A.), Bielby, S.A. (Shea A.), Teasdall, R.J. (Robert J.), Switzer, J.A. (Julie A.), Cole, P.A. (Peter A.), Anderson, S.A. (Sarah A.), Lafferty, P.M. (Paul M.), Li, M. (Mengnai), Ly, T.V. (Thuan V.), Marston, S.B. (Scott B.), Foley, A.L. (Amy L.), Vang, S. (Sandy), Wright, D.M. (David M.), Marcantonio, A.J. (Andrew J.), Kain, M.S.H. (Michael S.H.), Iorio, R. (Richard), Specht, L.M. (Lawrence M.), Tilzey, J.F. (John F.), Lobo, M.J. (Margaret J.), Garfi, J.S. (John S.), Vallier, H.A. (Heather A.), Dolenc, A. (Andrea), Breslin, M. (Mary), Prayson, M.J. (Michael J.), Laughlin, R. (Richard), Rubino, L.J. (L. Joseph), May, J. (Jedediah), Rieser, G.R. (Geoffrey Ryan), Dulaney-Cripe, L. (Liz), Gayton, C. (Chris), Shaer, J. (James), Schrickel, T. (Tyson), Hileman, B. (Barbara), Gorczyca, J.T. (John T.), Gross, J.M. (Jonathan M.), Humphrey, C.A. (Catherine A.), Kates, S. (Stephen), Ketz, J.P. (John P.), Noble, K. (Krista), McIntyre, A.W. (Allison W.), Pecorella, K. (Kaili), Davis, C.A. (Craig A.), Weinerman, S. (Stuart), Weingarten, P. (Peter), Stull, P. (Philip), Lindenbaum, S. (Stephen), Hewitt, M. (Michael), Schwappach, J. (John), Baker, J.K. (Janell K.), Rutherford, T. (Tori), Newman, H. (Heike), Lieberman, S. (Shane), Finn, E. (Erin), Robbins, K. (Kristin), Hurley, M. (Meghan), Lyle, L. (Lindsey), Mitchell, K. (Khalis), Browner, K. (Kieran), Whatley, E. (Erica), Payton, K. (Krystal), Reeves, C. (Christina), Cannada, L.K. (Lisa K.), Karges, D.E. (David E.), Dawson, S.A. (Sarah A.), Mehta, S. (Samir), Esterhai, J. (John), Ahn, J. (Jaimo), Donegan, D. (Derek), Horan, A.D. (Annamarie D.), Hesketh, P.J. (Patrick J.), Bannister, E.R. (Evan R.), Keeve, J.P. (Jonathan P.), Anderson, C.G. (Christopher G.), McDonald, M.D. (Michael D.), Hoffman, J.M. (Jodi M.), Tarkin, I. (Ivan), Siska, P. (Peter), Gruen, G. (Gary), Evans, A. (Andrew), Farrell, D.J. (Dana J.), Irrgang, J. (James), Luther, A. (Arlene), Cross, W.W. (William W.), Cass, J.R. (Joseph R.), Sems, S.A. (Stephen A.), Torchia, M.E. (Michael E.), Scrabeck, T. (Tyson), Jenkins, M. (Mark), Dumais, J. (Jules), Romero, A.W. (Amanda W.), Sagebien, C.A. (Carlos A.), Butler, M.S. (Mark S.), Monica, J.T. (James T.), Seuffert, P. (Patricia), Hsu, J.R. (Joseph R.), Stinner, D. (Daniel), Ficke, J. (James), Charlton, M. (Michael), Napierala, M. (Matthew), Fan, M. (Mary), Tannoury, C. (Chadi), Carlisle, H. (Hope), Silva, H. (Heather), Archdeacon, M. (Michael), Finnan, R. (Ryan), Le, T. (Toan), Wyrick, J. (John), Hess, S. (Shelley), Brennan, M.L. (Michael L.), Probe, R. (Robert), Kile, E. (Evelyn), Mills, K. (Kelli), Clipper, L. (Lydia), Yu, M. (Michelle), Erwin, K. (Katie), Horwitz, D. (Daniel), Strohecker, K. (Kent), Swenson, T.K. (Teresa K.), Schmidt, A.H. (Andrew H.), Westberg, J.R. (Jerald R.), Aurang, K. (Kamran), Zohman, G. (Gary), Peterson, B. (Brett), Huff, R.B. (Roger B.), Baele, J. (Joseph), Weber, T. (Timothy), Edison, M. (Matt), McBeth, J.C. (Jessica Cooper), Shively, K. (Karl), Ertl, J.P. (Janos P.), Mullis, B. (Brian), Parr, J.A. (J. Andrew), Worman, R. (Ripley), Frizzell, V. (Valda), Moore, M.M. (Molly M.), DePaolo, C.J. (Charles J.), Alosky, R. (Rachel), Shell, L.E. (Leslie E.), Hampton, L. (Lynne), Shepard, S. (Stephanie), Nanney, T. (Tracy), Cuento, C. (Claudine), Cantu, R.V. (Robert V.), Henderson, E.R. (Eric R.), Eickhoff, L.S. (Linda S.), Hammerberg, E.M. (E. Mark), Stahel, P. (Philip), Hak, D. (David), Mauffrey, C. (Cyril), Henderson, C. (Corey), Gissel, H. (Hannah), Gibula, D. (Douglas), Zamorano, D.P. (David P.), Tynan, M.C. (Martin C.), Pourmand, D. (Deeba), Lawson, D. (Deanna), Crist, B.D. (Brett D.), Murtha, Y.M. (Yvonne M.), Anderson, L.K. (Linda K.), Linehan, C. (Colleen), Pilling, L. (Lindsey), Lewis, C.G. (Courtland G.), Caminiti, S. (Stephanie), Sullivan, R.J. (Raymond J.), Roper, E. (Elizabeth), Obremskey, W. (William), Kregor, P. (Philip), Richards, J.E. (Justin E.), Stringfellow, K. (Kenya), Dohm, M.P. (Michael P.), Zellar, A. (Abby), Segers, M.J.M. (Michiel), Zijl, J.A.C. (Jacco A.C.), Verhoeven, B. (Bart), Smits, A.B. (Anke B.), De Vries, J.P.P.M. (Jean Paul P.M.), Fioole, B. (Bram), Van Der Hoeven, H. (Henk), Theunissen, E.B.M. (Evert B.M.), De Vries Reilingh, T.S. (Tammo S.), Govaert, L. (Lonneke), Wittich, P. (Philippe), De Brauw, M. (Maurits), Wille, J.C. (Jan), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Ritchie, E.D. (Ewan D.), Wessel, R.N. (Ronald N.), Hammacher, E.R. (Eric), Visser, G.A. (Gijs A.), Stockmann, H. (Heyn), Silvis, R. (Rob), Snellen, J.P. (Jaap P.), Rijbroek, B. (Bram), Scheepers, J.J. (Joris J.), Vermeulen, E.G.J. (Erik G.J.), Siroen, M.P.C. (Michiel P.C.), Vuylsteke, R. (Ronald), Brom, H.L.F., Rijna, H., Rijcke, P.A.R. (Piet), Koppert, C.L. (Cees L.), Buijk, S.E. (Steven E.), Groenendijk, R.P.R. (Richard), Dawson, I. (Imro), Tetteroo, G.W.M. (Geert), Bruijninckx, M.M.M. (Milko), Doornebosch, P. (Pascal), Graaf, E.J.R. (Eelco) de, Elst, M. (Maarten) van der, Pol, C. (Carmen) van der, Riet, M. (Martijne) van 't, Karsten, T.M. (Thomas), Vries, M.R. (Mark) de, Stassen, L.P.S. (Laurents P.S.), Schep, N.W.L. (Niels), Ben Schmidt, G. (G.), Hoffman, W.H. (W. H.), Poolman, R.W. (Rudolf), Simons, M.P., Heijden, F.H.W.M. (Frank) van der, Willems, W.J. (Jaap), De Meulemeester, F.R.A.J. (Frank R.A.J.), Hart, C.P. (Cor P.) van der, Turckan, K. (Kahn), Festen, S. (Sebastiaan), Nies, F. (Frank) de, Out, N.J.M. (Nico J.M.), Bosma, J. (Jan), Kampen, A. (A.) van, Biert, J. (Jan), Van Vugt, A.B. (Arie B.), Edwards, M.J.R. (Michael J.R.), Blokhuis, T.J. (Taco J.), Frölke, J.P.M. (Jan Paul), Geeraedts, L.M.G. (Leo M.G.), Gardeniers, J.W.M. (Jean W.M.), Tan, E.C.T.H. (Edward C.T.H.), Poelhekke, L.M.S.J., De Waal Malefijt, M.C. (Maarten C.), Schreurs, B. (Bart), Roukema, G.R. (Gert), Josaputra, H.A. (Hong A.), Keller, P. (Paul), De Rooij, P.D. (Peter D.), Kuiken, H. (Hans), Boxma, H. (Han), Cleffken, B.I. (Berry), Liem, R. (Ronald), Rhemrev, S. (Steven), Bosman, C.H.R. (Coks H.R.), De Mol Van Otterloo, A. (Alexander), Hoogendoorn, J. (Jochem), Vries, A.C. (Alexander) de, Meylaerts, S.A.G. (Sven), Verhofstad, M.H.J. (Michiel), Meijer, J. (Joost), Van Egmond, T. (Teun), Van Der Brand, I. (Igor), Patka, P. (Peter), Eversdijk, M.G. (Martin), Peters, R. (Rolf), Hartog, D. (Dennis) den, Waes, O.J.F. (Oscar) van, Oprel, P.P. (Pim), Vis, H.M. (Harm) van der, Campo, M. (Martin), Verhagen, R. (Ronald), Albers, G.H.R. (G.H. Robert), Zurcher, A.W. (Arthur W.), Simmermacher, R.K.J., Van Mulken, J. (Jeroen), Wessem, K.J.P. van, Van Gaalen, S.M. (Steven M.), Leenen, L.P.H., Bronkhorst, M.W.G.A. (Maarten), Guicherit, O.R. (Onno R.), Goslings, J.C. (Carel), Ponsen, K.J. (Kees-jan), Bhatia, M. (Mahesh), Arora, V. (Vinod), Tyagi, V. (Vivek), Bedi, H. (Harvinder), Carr, A. (Ashley), Curry, H. (Hamish), Chia, A. (Andrew), Csongvay, S. (Steve), Donohue, C. (Craig), Doig, S. (Stephen), Edwards, E. (Elton), Etherington, G. (Greg), Esser, M. (Max), Gong, A. (Andrew), Jain, A. (Arvind), Li, D. (Doug), Miller, R. (Russell), Moaveni, A. (Ash), Russ, M. (Matthias), Ton, L. (Lu), Wang, O. (Otis), Dowrick, A. (Adam), Murdoch, Z. (Zoe), Sage, C. (Claire), Frihagen, F. (Frede), Clarke-Jenssen, J. (John), Hjorthaug, G. (Geir), Ianssen, T. (Torben), Amundsen, A. (Asgeir), Brattgjerd, J.E. (Jan Egil), Borch, T. (Tor), Bøe, B. (Berthe), Flatøy, B. (Bernhard), Hasselund, S. (Sondre), Haug, K.J. (Knut Jørgen), Hemlock, K. (Kim), Hoseth, T.M. (Tor Magne), Jomaas, G. (Geir), Kibsgård, T. (Thomas), Lona, T. (Tarjei), Moatshe, G. (Gilbert), Müller, O. (Oliver), Molund, M. (Marius), Nicolaisen, T. (Tor), Nilsen, F. (Fredrik), Rydinge, J. (Jonas), Smedsrud, M. (Morten), Stødle, A. (Are), Trommer, A. (Axel), Ugland, S. (Stein), Karlsten, A. (Anders), Ekås, G. (Guri), Vesterhus, E.B. (Elise Berg), Brekke, A.C. (Anne Christine), Gupta, A. (Ajay), Jain, N. (Neeraj), Khan, F. (Farah), Sharma, A. (Ateet), Sanghavi, A. (Amir), Trivedi, M. (Mittal), Rai, A. (Anil), Subash, (), Rai, K. (Kamal), Yadav, V. (Vineet), Singh, S. (Sanjay), Tetsworth, K. (Kevin), Donald, G. (Geoff), Weinrauch, P. (Patrick), Pincus, P. (Paul), Yang, S. (Steven), Halliday, B. (Brett), Gervais, T. (Trevor), Holt, M. (Michael), Flynn, A. (Annette), Prasad, A.S. (Amal Shankar), Mishra, V. (Vimlesh), Sundaresh, D.C. (D. C.), Khanna, A. (Angshuman), Cherian, J.J. (Joe Joseph), Olakkengil, D.J. (Davy J), Sharma, G. (Gaurav), Pirpiris, M. (Marinis), Love, D. (David), Bucknill, A. (Andrew), Farrugia, R.J. (Richard J), Pape, H.-C. (Hans-Christoph), Knobe, M. (Matthias), Pfeifer, R. (Roman), Hull, P. (Peter), Lewis, S. (Sophie), Evans, S. (Simone), Nanda, R. (Rajesh), Logishetty, R. (Rajanikanth), Anand, S. (Sanjeev), Bowler, C. (Carol), Dadi, A. (Akhil), Palla, N. (Naveen), Ganguly, U. (Utsav), Rai, B.S. (B. Sachidananda), Rajakumar, J. (Janakiraman), Jennings, A. (Andrew), Chuter, G. (Graham), Rose, G. (Glynis), Horner, G. (Gillian), Clark, C. (Callum), Eke, K. (Kate), Reed, M.R. (Mike), Inman, D. (Dominic), Herriott, C. (Chris), Dobb, C. (Christine), Sprague, S. (Sheila), Schemitsch, E.H. (Emil H.), Swiontkowski, M.F. (Marc ), Della Rocca, G.J. (Gregory J.), Jeray, K.J. (Kyle J.), Liew, S. (Susan), Slobogean, G.P. (Gerard P.), Bzovsky, S. (Sofia), Heels-Ansdell, D. (Diane), Zhou, Q. (Qi), Bhandari, M. (Mohit), Sprag, S. (Sheila), Devereaux, P.J., Guyatt, G.H. (Gordon), Heetveld, M.J. (Martin J.), Richardson, M. (Martin), Thabane, L. (Lehana), Tornetta III, P. (Paul), Walter, S.D. (Stephen D.), McKay, P. (Paula), Scott, T. (Taryn), Garibaldi, A. (Alisha), Viveiros, H. (Helena), Swinton, M. (Marilyn), Gichuru, M. (Mark), Buckingham, L. (Lisa), Duraikannan, A. (Aravin), Maddock, D. (Deborah), Simunovic, N. (Nicole), Agel, J. (Julie), Lieshout, E.M.M. (Esther) van, Zielinski, S.M. (Stephanie), Rangan, A. (Amar), Hanusch, B.C. (Birgit C.), Kottam, L. (Lucksy), Clarkson, R. (Rachel), Haverlag, R. (Robert), McCormack, R. (Robert), Apostle, K. (Kelly), Boyer, D. (Dory), Moola, F. (Farhad), Perey, B. (Bertrand), Stone, T. (Trevor), Viskontas, D. (Darius), Lemke, H.M. (H. Michael), Zomar, M. (Mauri), Moon, K. (Karyn), Moon, R. (Raely), Oatt, A. (Amber), Buckley, R.E. (Richard E.), Duffy, P. (Paul), Korley, R. (Robert), Puloski, S. (Shannon), Powell, J. (James), Johnston, K. (Kelly), Carcary, K. (Kimberly), Lorenzo, M. (Melissa), McKercher, R. (Ross), Sanders, D. (David), MacLeod, M. (Mark), Lawendy, A.-R. (Abdel-Rahman), Tieszer, C. (Christina), Stephen, D. (David), Kreder, H. (Hans), Jenkinson, R. (Richard), Nousiainen, M. (Markku), Axelrod, T. (Terry), Murnaghan, J. (John), Nam, D. (Diane), Wadey, V. (Veronica), Yee, A. (Albert), Milner, K. (Katrine), Kunz, M. (Monica), Ghent, W. (Wesley), McKee, M.D. (Michael D.), Hall, J.A. (Jeremy A.), Nauth, A. (Aaron), Ahn, H. (Henry), Whelan, D.B. (Daniel B.), Vicente, M.R. (Milena R.), Wild, L.M. (Lisa M.), Khan, R.M. (Ryan M.), Hidy, J.T. (Jennifer T.), Coles, C. (Chad), Leighton, R. (Ross), Biddulph, M. (Michael), Johnston, D. (David), Glazebrook, M. (Mark), Alexander, D. (David), Coady, C. (Catherine), Dunbar, M. (Michael), Amirault, J.D. (J. David), Gross, M. (Michael), Oxner, W. (William), Reardon, G. (Gerald), Richardson, C.G. (C. Glen), Trenholm, J.A. (J. Andrew), Wong, I. (Ivan), Trask, K. (Kelly), MacDonald, S. (Shelley), Dobbin, G. (Gwendolyn), Bicknell, R. (Ryan), Yach, J. (Jeff), Bardana, D. (Davide), Wood, G. (Gavin), Harrison, M. (Mark), Yen, D. (David), Lambert, S. (Sue), Howells, F. (Fiona), Ward, A. (Angela), Zalzal, P. (Paul), Brien, H. (Heather), Naumetz, V. (V.), Weening, B. (Brad), Wai, E.K. (Eugene K.), Papp, S. (Steve), Gofton, W.T. (Wade T.), Liew, A. (Allen), Kingwell, S.P. (Stephen P.), Johnson, G. (Garth), O'Neil, J. (Joseph), Roffey, D.M. (Darren M.), Borsella, V. (Vivian), Avram, V. (Victoria), Oliver, T.M. (Todd M.), Jones, V. (Vicki), Vogt, M. (Michelle), Jones, C.B. (Clifford B.), Ringler, J.R. (James R.), Endres, T.J. (Terrence J.), Sietsema, D.L. (Debra L.), Walker, J.E. (Jane E.), Broderick, J.S. (J. Scott), Goetz, D.R. (David R.), Pace, T.B. (Thomas B.), Schaller, T.M. (Thomas M.), Porter, S.E. (Scott E.), Beckish, M.L. (Michael L.), Adams, J.D. (John D.), Barden, B.B. (Benjamin B.), Creek, A.T. (Aaron T.), Finley, S.H. (Stephen H.), Foret, J.L. (Jonathan L.), Gudger, G.K. (Garland K.), Gurich, R.W. (Richard W.), Hill, A.D. (Austin D.), Hollenbeck, S.M. (Steven M.), Jackson, L.T. (Lyle T.), Kruse, K.K. (Kevin K.), Lackey, W.G. (Wesley G.), Langan, J.W. (Justin W.), Lee, J. (Julia), Leffler, L.C. (Lauren C.), Miller, T.J. (Timothy J.), Murphy, R.L. (R. Lee), O'Malley, L.K. (Lawrence K.), Peters, M.E. (Melissa E.), Price, D.M. (Dustin M.), Tanksley, J.A. (John A.), Torres, E.T. (Erick T.), Watson, D.J. (Dylan J.), Watson, S.T. (Scott T.), Tanner, S.L. (Stephanie L.), Snider, R.G. (Rebecca G.), Nastoff, L.A. (Lauren A.), Bielby, S.A. (Shea A.), Teasdall, R.J. (Robert J.), Switzer, J.A. (Julie A.), Cole, P.A. (Peter A.), Anderson, S.A. (Sarah A.), Lafferty, P.M. (Paul M.), Li, M. (Mengnai), Ly, T.V. (Thuan V.), Marston, S.B. (Scott B.), Foley, A.L. (Amy L.), Vang, S. (Sandy), Wright, D.M. (David M.), Marcantonio, A.J. (Andrew J.), Kain, M.S.H. (Michael S.H.), Iorio, R. (Richard), Specht, L.M. (Lawrence M.), Tilzey, J.F. (John F.), Lobo, M.J. (Margaret J.), Garfi, J.S. (John S.), Vallier, H.A. (Heather A.), Dolenc, A. (Andrea), Breslin, M. (Mary), Prayson, M.J. (Michael J.), Laughlin, R. (Richard), Rubino, L.J. (L. Joseph), May, J. (Jedediah), Rieser, G.R. (Geoffrey Ryan), Dulaney-Cripe, L. (Liz), Gayton, C. (Chris), Shaer, J. (James), Schrickel, T. (Tyson), Hileman, B. (Barbara), Gorczyca, J.T. (John T.), Gross, J.M. (Jonathan M.), Humphrey, C.A. (Catherine A.), Kates, S. (Stephen), Ketz, J.P. (John P.), Noble, K. (Krista), McIntyre, A.W. (Allison W.), Pecorella, K. (Kaili), Davis, C.A. (Craig A.), Weinerman, S. (Stuart), Weingarten, P. (Peter), Stull, P. (Philip), Lindenbaum, S. (Stephen), Hewitt, M. (Michael), Schwappach, J. (John), Baker, J.K. (Janell K.), Rutherford, T. (Tori), Newman, H. (Heike), Lieberman, S. (Shane), Finn, E. (Erin), Robbins, K. (Kristin), Hurley, M. (Meghan), Lyle, L. (Lindsey), Mitchell, K. (Khalis), Browner, K. (Kieran), Whatley, E. (Erica), Payton, K. (Krystal), Reeves, C. (Christina), Cannada, L.K. (Lisa K.), Karges, D.E. (David E.), Dawson, S.A. (Sarah A.), Mehta, S. (Samir), Esterhai, J. (John), Ahn, J. (Jaimo), Donegan, D. (Derek), Horan, A.D. (Annamarie D.), Hesketh, P.J. (Patrick J.), Bannister, E.R. (Evan R.), Keeve, J.P. (Jonathan P.), Anderson, C.G. (Christopher G.), McDonald, M.D. (Michael D.), Hoffman, J.M. (Jodi M.), Tarkin, I. (Ivan), Siska, P. (Peter), Gruen, G. (Gary), Evans, A. (Andrew), Farrell, D.J. (Dana J.), Irrgang, J. (James), Luther, A. (Arlene), Cross, W.W. (William W.), Cass, J.R. (Joseph R.), Sems, S.A. (Stephen A.), Torchia, M.E. (Michael E.), Scrabeck, T. (Tyson), Jenkins, M. (Mark), Dumais, J. (Jules), Romero, A.W. (Amanda W.), Sagebien, C.A. (Carlos A.), Butler, M.S. (Mark S.), Monica, J.T. (James T.), Seuffert, P. (Patricia), Hsu, J.R. (Joseph R.), Stinner, D. (Daniel), Ficke, J. (James), Charlton, M. (Michael), Napierala, M. (Matthew), Fan, M. (Mary), Tannoury, C. (Chadi), Carlisle, H. (Hope), Silva, H. (Heather), Archdeacon, M. (Michael), Finnan, R. (Ryan), Le, T. (Toan), Wyrick, J. (John), Hess, S. (Shelley), Brennan, M.L. (Michael L.), Probe, R. (Robert), Kile, E. (Evelyn), Mills, K. (Kelli), Clipper, L. (Lydia), Yu, M. (Michelle), Erwin, K. (Katie), Horwitz, D. (Daniel), Strohecker, K. (Kent), Swenson, T.K. (Teresa K.), Schmidt, A.H. (Andrew H.), Westberg, J.R. (Jerald R.), Aurang, K. (Kamran), Zohman, G. (Gary), Peterson, B. (Brett), Huff, R.B. (Roger B.), Baele, J. (Joseph), Weber, T. (Timothy), Edison, M. (Matt), McBeth, J.C. (Jessica Cooper), Shively, K. (Karl), Ertl, J.P. (Janos P.), Mullis, B. (Brian), Parr, J.A. (J. Andrew), Worman, R. (Ripley), Frizzell, V. (Valda), Moore, M.M. (Molly M.), DePaolo, C.J. (Charles J.), Alosky, R. (Rachel), Shell, L.E. (Leslie E.), Hampton, L. (Lynne), Shepard, S. (Stephanie), Nanney, T. (Tracy), Cuento, C. (Claudine), Cantu, R.V. (Robert V.), Henderson, E.R. (Eric R.), Eickhoff, L.S. (Linda S.), Hammerberg, E.M. (E. Mark), Stahel, P. (Philip), Hak, D. (David), Mauffrey, C. (Cyril), Henderson, C. (Corey), Gissel, H. (Hannah), Gibula, D. (Douglas), Zamorano, D.P. (David P.), Tynan, M.C. (Martin C.), Pourmand, D. (Deeba), Lawson, D. (Deanna), Crist, B.D. (Brett D.), Murtha, Y.M. (Yvonne M.), Anderson, L.K. (Linda K.), Linehan, C. (Colleen), Pilling, L. (Lindsey), Lewis, C.G. (Courtland G.), Caminiti, S. (Stephanie), Sullivan, R.J. (Raymond J.), Roper, E. (Elizabeth), Obremskey, W. (William), Kregor, P. (Philip), Richards, J.E. (Justin E.), Stringfellow, K. (Kenya), Dohm, M.P. (Michael P.), Zellar, A. (Abby), Segers, M.J.M. (Michiel), Zijl, J.A.C. (Jacco A.C.), Verhoeven, B. (Bart), Smits, A.B. (Anke B.), De Vries, J.P.P.M. (Jean Paul P.M.), Fioole, B. (Bram), Van Der Hoeven, H. (Henk), Theunissen, E.B.M. (Evert B.M.), De Vries Reilingh, T.S. (Tammo S.), Govaert, L. (Lonneke), Wittich, P. (Philippe), De Brauw, M. (Maurits), Wille, J.C. (Jan), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Ritchie, E.D. (Ewan D.), Wessel, R.N. (Ronald N.), Hammacher, E.R. (Eric), Visser, G.A. (Gijs A.), Stockmann, H. (Heyn), Silvis, R. (Rob), Snellen, J.P. (Jaap P.), Rijbroek, B. (Bram), Scheepers, J.J. (Joris J.), Vermeulen, E.G.J. (Erik G.J.), Siroen, M.P.C. (Michiel P.C.), Vuylsteke, R. (Ronald), Brom, H.L.F., Rijna, H., Rijcke, P.A.R. (Piet), Koppert, C.L. (Cees L.), Buijk, S.E. (Steven E.), Groenendijk, R.P.R. (Richard), Dawson, I. (Imro), Tetteroo, G.W.M. (Geert), Bruijninckx, M.M.M. (Milko), Doornebosch, P. (Pascal), Graaf, E.J.R. (Eelco) de, Elst, M. (Maarten) van der, Pol, C. (Carmen) van der, Riet, M. (Martijne) van 't, Karsten, T.M. (Thomas), Vries, M.R. (Mark) de, Stassen, L.P.S. (Laurents P.S.), Schep, N.W.L. (Niels), Ben Schmidt, G. (G.), Hoffman, W.H. (W. H.), Poolman, R.W. (Rudolf), Simons, M.P., Heijden, F.H.W.M. (Frank) van der, Willems, W.J. (Jaap), De Meulemeester, F.R.A.J. (Frank R.A.J.), Hart, C.P. (Cor P.) van der, Turckan, K. (Kahn), Festen, S. (Sebastiaan), Nies, F. (Frank) de, Out, N.J.M. (Nico J.M.), Bosma, J. (Jan), Kampen, A. (A.) van, Biert, J. (Jan), Van Vugt, A.B. (Arie B.), Edwards, M.J.R. (Michael J.R.), Blokhuis, T.J. (Taco J.), Frölke, J.P.M. (Jan Paul), Geeraedts, L.M.G. (Leo M.G.), Gardeniers, J.W.M. (Jean W.M.), Tan, E.C.T.H. (Edward C.T.H.), Poelhekke, L.M.S.J., De Waal Malefijt, M.C. (Maarten C.), Schreurs, B. (Bart), Roukema, G.R. (Gert), Josaputra, H.A. (Hong A.), Keller, P. (Paul), De Rooij, P.D. (Peter D.), Kuiken, H. (Hans), Boxma, H. (Han), Cleffken, B.I. (Berry), Liem, R. (Ronald), Rhemrev, S. (Steven), Bosman, C.H.R. (Coks H.R.), De Mol Van Otterloo, A. (Alexander), Hoogendoorn, J. (Jochem), Vries, A.C. (Alexander) de, Meylaerts, S.A.G. (Sven), Verhofstad, M.H.J. (Michiel), Meijer, J. (Joost), Van Egmond, T. (Teun), Van Der Brand, I. (Igor), Patka, P. (Peter), Eversdijk, M.G. (Martin), Peters, R. (Rolf), Hartog, D. (Dennis) den, Waes, O.J.F. (Oscar) van, Oprel, P.P. (Pim), Vis, H.M. (Harm) van der, Campo, M. (Martin), Verhagen, R. (Ronald), Albers, G.H.R. (G.H. Robert), Zurcher, A.W. (Arthur W.), Simmermacher, R.K.J., Van Mulken, J. (Jeroen), Wessem, K.J.P. van, Van Gaalen, S.M. (Steven M.), Leenen, L.P.H., Bronkhorst, M.W.G.A. (Maarten), Guicherit, O.R. (Onno R.), Goslings, J.C. (Carel), Ponsen, K.J. (Kees-jan), Bhatia, M. (Mahesh), Arora, V. (Vinod), Tyagi, V. (Vivek), Bedi, H. (Harvinder), Carr, A. (Ashley), Curry, H. (Hamish), Chia, A. (Andrew), Csongvay, S. (Steve), Donohue, C. (Craig), Doig, S. (Stephen), Edwards, E. (Elton), Etherington, G. (Greg), Esser, M. (Max), Gong, A. (Andrew), Jain, A. (Arvind), Li, D. (Doug), Miller, R. (Russell), Moaveni, A. (Ash), Russ, M. (Matthias), Ton, L. (Lu), Wang, O. (Otis), Dowrick, A. (Adam), Murdoch, Z. (Zoe), Sage, C. (Claire), Frihagen, F. (Frede), Clarke-Jenssen, J. (John), Hjorthaug, G. (Geir), Ianssen, T. (Torben), Amundsen, A. (Asgeir), Brattgjerd, J.E. (Jan Egil), Borch, T. (Tor), Bøe, B. (Berthe), Flatøy, B. (Bernhard), Hasselund, S. (Sondre), Haug, K.J. (Knut Jørgen), Hemlock, K. (Kim), Hoseth, T.M. (Tor Magne), Jomaas, G. (Geir), Kibsgård, T. (Thomas), Lona, T. (Tarjei), Moatshe, G. (Gilbert), Müller, O. (Oliver), Molund, M. (Marius), Nicolaisen, T. (Tor), Nilsen, F. (Fredrik), Rydinge, J. (Jonas), Smedsrud, M. (Morten), Stødle, A. (Are), Trommer, A. (Axel), Ugland, S. (Stein), Karlsten, A. (Anders), Ekås, G. (Guri), Vesterhus, E.B. (Elise Berg), Brekke, A.C. (Anne Christine), Gupta, A. (Ajay), Jain, N. (Neeraj), Khan, F. (Farah), Sharma, A. (Ateet), Sanghavi, A. (Amir), Trivedi, M. (Mittal), Rai, A. (Anil), Subash, (), Rai, K. (Kamal), Yadav, V. (Vineet), Singh, S. (Sanjay), Tetsworth, K. (Kevin), Donald, G. (Geoff), Weinrauch, P. (Patrick), Pincus, P. (Paul), Yang, S. (Steven), Halliday, B. (Brett), Gervais, T. (Trevor), Holt, M. (Michael), Flynn, A. (Annette), Prasad, A.S. (Amal Shankar), Mishra, V. (Vimlesh), Sundaresh, D.C. (D. C.), Khanna, A. (Angshuman), Cherian, J.J. (Joe Joseph), Olakkengil, D.J. (Davy J), Sharma, G. (Gaurav), Pirpiris, M. (Marinis), Love, D. (David), Bucknill, A. (Andrew), Farrugia, R.J. (Richard J), Pape, H.-C. (Hans-Christoph), Knobe, M. (Matthias), Pfeifer, R. (Roman), Hull, P. (Peter), Lewis, S. (Sophie), Evans, S. (Simone), Nanda, R. (Rajesh), Logishetty, R. (Rajanikanth), Anand, S. (Sanjeev), Bowler, C. (Carol), Dadi, A. (Akhil), Palla, N. (Naveen), Ganguly, U. (Utsav), Rai, B.S. (B. Sachidananda), Rajakumar, J. (Janakiraman), Jennings, A. (Andrew), Chuter, G. (Graham), Rose, G. (Glynis), Horner, G. (Gillian), Clark, C. (Callum), Eke, K. (Kate), Reed, M.R. (Mike), Inman, D. (Dominic), Herriott, C. (Chris), and Dobb, C. (Christine)

Abstract

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (for

Published
2018
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10. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Author

Nauth, A. (Aaron), Creek, A.T. (Aaron T.), Zellar, A. (Abby), Lawendy, A.-R. (Abdel-Rahman), Dowrick, A. (Adam), Gupta, A. (Ajay), Dadi, A. (Akhil), Kampen, A. (A.) van, Yee, A. (Albert), Vries, A.C. (Alexander) de, de Mol van Otterloo, A. (Alexander), Garibaldi, A. (Alisha), Liew, A. (Allen), McIntyre, A.W. (Allison W.), Prasad, A.S. (Amal Shankar), Romero, A.W. (Amanda W.), Rangan, A. (Amar), Oatt, A. (Amber), Sanghavi, A. (Amir), Foley, A.L. (Amy L.), Karlsten, A. (Anders), Dolenc, A. (Andrea), Bucknill, A. (Andrew), Chia, A. (Andrew), Evans, A. (Andrew), Gong, A. (Andrew), Schmidt, A.H. (Andrew H.), Marcantonio, A.J. (Andrew J.), Jennings, A. (Andrew), Ward, A. (Angela), Khanna, A. (Angshuman), Rai, A. (Anil), Smits, A.B. (Anke B.), Horan, A.D. (Annamarie D.), Brekke, A.C. (Anne Christine), Flynn, A. (Annette), Duraikannan, A. (Aravin), Stødle, A. (Are), van Vugt, A.B. (Arie B.), Luther, A. (Arlene), Zurcher, A.W. (Arthur W.), Jain, A. (Arvind), Amundsen, A. (Asgeir), Moaveni, A. (Ash), Carr, A. (Ashley), Sharma, A. (Ateet), Hill, A.D. (Austin D.), Trommer, A. (Axel), Rai, B.S. (B. Sachidananda), Hileman, B. (Barbara), Schreurs, B. (Bart), Verhoeven, B. (Bart), Barden, B.B. (Benjamin B.), Flatøy, B. (Bernhard), Cleffken, B.I. (Berry), Bøe, B. (Berthe), Perey, B. (Bertrand), Hanusch, B.C. (Birgit C.), Weening, B. (Brad), Fioole, B. (Bram), Rijbroek, B. (Bram), Crist, B.D. (Brett D.), Halliday, B. (Brett), Peterson, B. (Brett), Mullis, B. (Brian), Richardson, C.G. (C. Glen), Clark, C. (Callum), Sagebien, C.A. (Carlos A.), Pol, C. (Carmen) van der, Bowler, C. (Carol), Humphrey, C.A. (Catherine A.), Coady, C. (Catherine), Koppert, C.L. (Cees L.), Coles, C. (Chad), Tannoury, C. (Chadi), DePaolo, C.J. (Charles J.), Gayton, C. (Chris), Herriott, C. (Chris), Reeves, C. (Christina), Tieszer, C. (Christina), Dobb, C. (Christine), Anderson, C.G. (Christopher G.), Sage, C. (Claire), Cuento, C. (Claudine), Jones, C.B. (Clifford B.), Bosman, C.H.R. (Coks H.R.), Linehan, C. (Colleen), Hart, C.P. (Cor P.) van der, Henderson, C. (Corey), Lewis, C.G. (Courtland G.), Davis, C.A. (Craig A.), Donohue, C. (Craig), Mauffrey, C. (Cyril), Sundaresh, D.C. (D. C.), Farrell, D.J. (Dana J.), Whelan, D.B. (Daniel B.), Horwitz, D. (Daniel), Stinner, D. (Daniel), Viskontas, D. (Darius), Roffey, D.M. (Darren M.), Alexander, D. (David), Karges, D.E. (David E.), Hak, D. (David), Johnston, D. (David), Love, D. (David), Wright, D.M. (David M.), Zamorano, D.P. (David P.), Goetz, D.R. (David R.), Sanders, D. (David), Stephen, D. (David), Yen, D. (David), Bardana, D. (Davide), Olakkengil, D.J. (Davy J), Lawson, D. (Deanna), Maddock, D. (Deborah), Sietsema, D.L. (Debra L.), Pourmand, D. (Deeba), Hartog, D. (Dennis) den, Donegan, D. (Derek), Heels-Ansdell, D. (Diane), Nam, D. (Diane), Inman, D. (Dominic), Boyer, D. (Dory), Li, D. (Doug), Gibula, D. (Douglas), Price, D.M. (Dustin M.), Watson, D.J. (Dylan J.), Hammerberg, E.M. (E. Mark), Tan, E.T.C.H. (Edward T.C.H.), Graaf, E.J.R. (Eelco) de, Vesterhus, E.B. (Elise Berg), Roper, E. (Elizabeth), Edwards, E. (Elton), Schemitsch, E.H. (Emil), Hammacher, E.R. (Eric), Henderson, E.R. (Eric R.), Whatley, E. (Erica), Torres, E.T. (Erick T.), Vermeulen, E.G.J. (Erik G.J.), Finn, E. (Erin), Lieshout, E.M.M. (Esther) van, Wai, E.K. (Eugene K.), Bannister, E.R. (Evan R.), Kile, E. (Evelyn), Theunissen, E.B.M. (Evert B.M.), Ritchie, E.D. (Ewan D.), Khan, F. (Farah), Moola, F. (Farhad), Howells, F. (Fiona), Nies, F. (Frank) de, Heijden, F.H.W.M. (Frank) van der, de Meulemeester, F.R.A.J. (Frank R.A.J.), Frihagen, F. (Frede), Nilsen, F. (Fredrik), Schmidt, G.B. (G. Ben), Albers, G.H.R. (G.H. Robert), Gudger, G.K. (Garland K.), Johnson, G. (Garth), Gruen, G. (Gary), Zohman, G. (Gary), Sharma, G. (Gaurav), Wood, G. (Gavin), Tetteroo, G.W.M. (Geert), Hjorthaug, G. (Geir), Jomaas, G. (Geir), Donald, G. (Geoff), Rieser, G.R. (Geoffrey Ryan), Reardon, G. (Gerald), Slobogean, G.P. (Gerard P.), Roukema, G.R. (Gert), Visser, G.A. (Gijs A.), Moatshe, G. (Gilbert), Horner, G. (Gillian), Rose, G. (Glynis), Guyatt, G. (Gordon), Chuter, G. (Graham), Etherington, G. (Greg), Rocca, G.J.D. (Gregory J. Della), Ekås, G. (Guri), Dobbin, G. (Gwendolyn), Lemke, H.M. (H. Michael), Curry, H. (Hamish), Boxma, H. (Han), Gissel, H. (Hannah), Kreder, H. (Hans), Kuiken, H. (Hans), Brom, H.L.F., Pape, H.-C. (Hans-Christoph), Vis, H.M. (Harm) van der, Bedi, H. (Harvinder), Vallier, H.A. (Heather A.), Brien, H. (Heather), Silva, H. (Heather), Newman, H. (Heike), Viveiros, H. (Helena), van der Hoeven, H. (Henk), Ahn, H. (Henry), Johal, H. (Herman), Rijna, H., Stockmann, H. (Heyn), Josaputra, H.A. (Hong A.), Carlisle, H. (Hope), van der Brand, I. (Igor), Dawson, I. (Imro), Tarkin, I. (Ivan), Wong, I. (Ivan), Parr, J.A. (J. Andrew), Trenholm, J.A. (J. Andrew), Goslings, J.C. (Carel), Amirault, J.D. (J. David), Broderick, J.S. (J. Scott), Snellen, J.P. (Jaap P.), Zijl, J.A.C. (Jacco A.C.), Ahn, J. (Jaimo), Ficke, J. (James), Irrgang, J. (James), Powell, J. (James), Ringler, J.R. (James R.), Shaer, J. (James), Monica, J.T. (James T.), Biert, J. (Jan), Bosma, J. (Jan), Brattgjerd, J.E. (Jan Egil), Frölke, J.P.M. (Jan Paul), Wille, J.C. (Jan), Rajakumar, J. (Janakiraman), Walker, J.E. (Jane E.), Baker, J.K. (Janell K.), Ertl, J.P. (Janos P.), de Vries, J.P.P.M. (Jean Paul P.M.), Gardeniers, J.W.M. (Jean W.M.), May, J. (Jedediah), Yach, J. (Jeff), Hidy, J.T. (Jennifer T.), Westberg, J.R. (Jerald R.), Hall, J.A. (Jeremy A.), van Mulken, J. (Jeroen), McBeth, J.C. (Jessica Cooper), Hoogendoorn, J. (Jochem), Hoffman, J.M. (Jodi M.), Cherian, J.J. (Joe Joseph), Tanksley, J.A. (John A.), Clarke-Jenssen, J. (John), Adams, J.D. (John D.), Esterhai, J. (John), Tilzey, J.F. (John F.), Murnaghan, J. (John), Ketz, J.P. (John P.), Garfi, J.S. (John S.), Schwappach, J. (John), Gorczyca, J.T. (John T.), Wyrick, J. (John), Rydinge, J. (Jonas), Foret, J.L. (Jonathan L.), Gross, J.M. (Jonathan M.), Keeve, J.P. (Jonathan P.), Meijer, J. (Joost), Scheepers, J.J. (Joris J.), Baele, J. (Joseph), O'Neil, J. (Joseph), Cass, J.R. (Joseph R.), Hsu, J.R. (Joseph R.), Dumais, J. (Jules), Lee, J. (Julia), Switzer, J.A. (Julie A.), Agel, J. (Julie), Richards, J.E. (Justin E.), Langan, J.W. (Justin W.), Turckan, K. (Kahn), Pecorella, K. (Kaili), Rai, K. (Kamal), Aurang, K. (Kamran), Shively, K. (Karl), Wessem, K.J.P. van, Moon, K. (Karyn), Eke, K. (Kate), Erwin, K. (Katie), Milner, K. (Katrine), Ponsen, K.J. (Kees-jan), Mills, K. (Kelli), Apostle, K. (Kelly), Johnston, K. (Kelly), Trask, K. (Kelly), Strohecker, K. (Kent), Stringfellow, K. (Kenya), Kruse, K.K. (Kevin K.), Tetsworth, K. (Kevin), Mitchell, K. (Khalis), Browner, K. (Kieran), Hemlock, K. (Kim), Carcary, K. (Kimberly), Jørgen Haug, K. (Knut), Noble, K. (Krista), Robbins, K. (Kristin), Payton, K. (Krystal), Jeray, K.J. (Kyle J.), Rubino, L.J. (L. Joseph), Nastoff, L.A. (Lauren A.), Leffler, L.C. (Lauren C.), Stassen, L.P. (Laurents), O'Malley, L.K. (Lawrence K.), Specht, L.M. (Lawrence M.), Thabane, L. (Lehana), Geeraedts, L.M.G. (Leo M.G.), Shell, L.E. (Leslie E.), Anderson, L.K. (Linda K.), Eickhoff, L.S. (Linda S.), Lyle, L. (Lindsey), Pilling, L. (Lindsey), Buckingham, L. (Lisa), Cannada, L.K. (Lisa K.), Wild, L.M. (Lisa M.), Dulaney-Cripe, L. (Liz), Poelhekke, L.M.S.J., Govaert, L. (Lonneke), Ton, L. (Lu), Kottam, L. (Lucksy), Leenen, L.P.H. (Luke), Clipper, L. (Lydia), Jackson, L.T. (Lyle T.), Hampton, L. (Lynne), de Waal Malefijt, M.C. (Maarten C.), Simons, M.P., Elst, M. (Maarten) van der, Bronkhorst, M.W.G.A. (Maarten), Bhatia, M. (Mahesh), Swiontkowski, M.F. (Marc ), Lobo, M.J. (Margaret J.), Swinton, M. (Marilyn), Pirpiris, M. (Marinis), Molund, M. (Marius), Gichuru, M. (Mark), Glazebrook, M. (Mark), Harrison, M. (Mark), Jenkins, M. (Mark), MacLeod, M. (Mark), Vries, M.R. (Mark) de, Butler, M.S. (Mark S.), Nousiainen, M. (Markku), van ‘t Riet, M. (Martijne), Tynan, M.C. (Martin C.), Campo, M. (Martin), Eversdijk, M.G. (Martin), Heetveld, M.J. (Martin), Richardson, M. (Martin), Breslin, M. (Mary), Fan, M. (Mary), Edison, M. (Matt), Napierala, M. (Matthew), Knobe, M. (Matthias), Russ, M. (Matthias), Zomar, M. (Mauri), de Brauw, M. (Maurits), Esser, M. (Max), Hurley, M. (Meghan), Peters, M.E. (Melissa E.), Lorenzo, M. (Melissa), Li, M. (Mengnai), Archdeacon, M. (Michael), Biddulph, M. (Michael), Charlton, M. (Michael), McDonald, M.D. (Michael D.), McKee, M.D. (Michael D.), Dunbar, M. (Michael), Torchia, M.E. (Michael E.), Gross, M. (Michael), Hewitt, M. (Michael), Holt, M. (Michael), Prayson, M.J. (Michael J.), Edwards, M.J.R. (Michael), Beckish, M.L. (Michael L.), Brennan, M.L. (Michael L.), Dohm, M.P. (Michael P.), Kain, M.S.H. (Michael S.H.), Vogt, M. (Michelle), Yu, M. (Michelle), Verhofstad, M.H.J. (Michiel), Segers, M.J.M. (Michiel J.M.), Segers, M.J.M. (Michiel), Siroen, M.P.C. (Michiel P.C.), Reed, M.R. (Mike), Vicente, M.R. (Milena R.), Bruijninckx, M.M.M. (Milko), Trivedi, M. (Mittal), Bhandari, M. (Mohit), Moore, M.M. (Molly M.), Kunz, M. (Monica), Smedsrud, M. (Morten), Palla, N. (Naveen), Jain, N. (Neeraj), Out, N.J.M. (Nico J.M.), Simunovic, N. (Nicole), Schep, N.W.L. (Niels), Müller, O. (Oliver), Guicherit, O.R. (Onno R.), Waes, O.J.F. (Oscar) van, Wang, O. (Otis), Doornebosch, P. (Pascal), Seuffert, P. (Patricia), Hesketh, P.J. (Patrick J.), Weinrauch, P. (Patrick), Duffy, P. (Paul), Keller, P. (Paul), Lafferty, P.M. (Paul M.), Pincus, P. (Paul), Tornetta III, P. (Paul), Zalzal, P. (Paul), McKay, P. (Paula), Cole, P.A. (Peter A.), de Rooij, P.D. (Peter D.), Hull, P. (Peter), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Patka, P. (Peter), Siska, P. (Peter), Weingarten, P. (Peter), Kregor, P. (Philip), Stahel, P. (Philip), Stull, P. (Philip), Wittich, P. (Philippe), Rijcke, P.A.R. (Piet), Oprel, P.P. (Pim), Devereaux, P.J. (P. J.), Zhou, Q. (Qi), Lee Murphy, R. (R.), Alosky, R. (Rachel), Clarkson, R. (Rachel), Moon, R. (Raely), Logishetty, R. (Rajanikanth), Nanda, R. (Rajesh), Sullivan, R.J. (Raymond J.), Snider, R.G. (Rebecca G.), Buckley, R.E. (Richard E.), Iorio, R. (Richard), Farrugia, R.J. (Richard J), Jenkinson, R. (Richard), Laughlin, R. (Richard), Groenendijk, R.P.R. (Richard), Gurich, R.W. (Richard W.), Worman, R. (Ripley), Silvis, R. (Rob), Haverlag, R. (Robert), Teasdall, R.J. (Robert J.), Korley, R. (Robert), McCormack, R. (Robert), Probe, R. (Robert), Cantu, R.V. (Robert V.), Huff, R.B. (Roger B.), Simmermacher, R.K.J., Peters, R. (Rolf), Pfeifer, R. (Roman), Liem, R. (Ronald), Wessel, R.N. (Ronald N.), Verhagen, R. (Ronald), Vuylsteke, R. (Ronald), Leighton, R. (Ross), McKercher, R. (Ross), Poolman, R.W. (Rudolf), Miller, R. (Russell), Bicknell, R. (Ryan), Finnan, R. (Ryan), Khan, R.M. (Ryan M.), Mehta, S. (Samir), Vang, S. (Sandy), Singh, S. (Sanjay), Anand, S. (Sanjeev), Anderson, S.A. (Sarah A.), Dawson, S.A. (Sarah A.), Marston, S.B. (Scott B.), Porter, S.E. (Scott E.), Watson, S.T. (Scott T.), Festen, S. (Sebastiaan), Lieberman, S. (Shane), Puloski, S. (Shannon), Bielby, S.A. (Shea A.), Sprague, S. (Sheila), Hess, S. (Shelley), MacDonald, S. (Shelley), Evans, S. (Simone), Bzovsky, S. (Sofia), Hasselund, S. (Sondre), Lewis, S. (Sophie), Ugland, S. (Stein), Caminiti, S. (Stephanie), Tanner, S.L. (Stephanie L.), Zielinski, S.M. (Stephanie), Shepard, S. (Stephanie), Sems, S.A. (Stephen A.), Walter, S.D. (Stephen D.), Doig, S. (Stephen), Finley, S.H. (Stephen H.), Kates, S. (Stephen), Lindenbaum, S. (Stephen), Kingwell, S.P. (Stephen P.), Csongvay, S. (Steve), Papp, S. (Steve), Buijk, S.E. (Steven E.), Rhemrev, S. (Steven), Hollenbeck, S.M. (Steven M.), van Gaalen, S.M. (Steven M.), Yang, S. (Steven), Weinerman, S. (Stuart), Subash, (), Lambert, S. (Sue), Liew, S. (Susan), Meylaerts, S.A.G. (Sven), Blokhuis, T.J. (Taco J.), de Vries Reilingh, T.S. (Tammo S.), Lona, T. (Tarjei), Scott, T. (Taryn), Swenson, T.K. (Teresa K.), Endres, T.J. (Terrence J.), Axelrod, T. (Terry), van Egmond, T. (Teun), Pace, T.B. (Thomas B.), Kibsgård, T. (Thomas), Schaller, T.M. (Thomas M.), Ly, T.V. (Thuan V.), Miller, T.J. (Timothy J.), Weber, T. (Timothy), Le, T. (Toan), Oliver, T.M. (Todd M.), Karsten, T.M. (Thomas), Borch, T. (Tor), Hoseth, T.M. (Tor Magne), Nicolaisen, T. (Tor), Ianssen, T. (Torben), Rutherford, T. (Tori), Nanney, T. (Tracy), Gervais, T. (Trevor), Stone, T. (Trevor), Schrickel, T. (Tyson), Scrabeck, T. (Tyson), Ganguly, U. (Utsav), Naumetz, V. (V.), Frizzell, V. (Valda), Wadey, V. (Veronica), Jones, V. (Vicki), Avram, V. (Victoria), Mishra, V. (Vimlesh), Yadav, V. (Vineet), Arora, V. (Vinod), Tyagi, V. (Vivek), Borsella, V. (Vivian), Willems, W.J. (Jaap), Hoffman, W.H. (W. H.), Gofton, W.T. (Wade T.), Lackey, W.G. (Wesley G.), Ghent, W. (Wesley), Obremskey, W. (William), Oxner, W. (William), Cross, W.W. (William W.), Murtha, Y.M. (Yvonne M.), Murdoch, Z. (Zoe), Nauth, A. (Aaron), Creek, A.T. (Aaron T.), Zellar, A. (Abby), Lawendy, A.-R. (Abdel-Rahman), Dowrick, A. (Adam), Gupta, A. (Ajay), Dadi, A. (Akhil), Kampen, A. (A.) van, Yee, A. (Albert), Vries, A.C. (Alexander) de, de Mol van Otterloo, A. (Alexander), Garibaldi, A. (Alisha), Liew, A. (Allen), McIntyre, A.W. (Allison W.), Prasad, A.S. (Amal Shankar), Romero, A.W. (Amanda W.), Rangan, A. (Amar), Oatt, A. (Amber), Sanghavi, A. (Amir), Foley, A.L. (Amy L.), Karlsten, A. (Anders), Dolenc, A. (Andrea), Bucknill, A. (Andrew), Chia, A. (Andrew), Evans, A. (Andrew), Gong, A. (Andrew), Schmidt, A.H. (Andrew H.), Marcantonio, A.J. (Andrew J.), Jennings, A. (Andrew), Ward, A. (Angela), Khanna, A. (Angshuman), Rai, A. (Anil), Smits, A.B. (Anke B.), Horan, A.D. (Annamarie D.), Brekke, A.C. (Anne Christine), Flynn, A. (Annette), Duraikannan, A. (Aravin), Stødle, A. (Are), van Vugt, A.B. (Arie B.), Luther, A. (Arlene), Zurcher, A.W. (Arthur W.), Jain, A. (Arvind), Amundsen, A. (Asgeir), Moaveni, A. (Ash), Carr, A. (Ashley), Sharma, A. (Ateet), Hill, A.D. (Austin D.), Trommer, A. (Axel), Rai, B.S. (B. Sachidananda), Hileman, B. (Barbara), Schreurs, B. (Bart), Verhoeven, B. (Bart), Barden, B.B. (Benjamin B.), Flatøy, B. (Bernhard), Cleffken, B.I. (Berry), Bøe, B. (Berthe), Perey, B. (Bertrand), Hanusch, B.C. (Birgit C.), Weening, B. (Brad), Fioole, B. (Bram), Rijbroek, B. (Bram), Crist, B.D. (Brett D.), Halliday, B. (Brett), Peterson, B. (Brett), Mullis, B. (Brian), Richardson, C.G. (C. Glen), Clark, C. (Callum), Sagebien, C.A. (Carlos A.), Pol, C. (Carmen) van der, Bowler, C. (Carol), Humphrey, C.A. (Catherine A.), Coady, C. (Catherine), Koppert, C.L. (Cees L.), Coles, C. (Chad), Tannoury, C. (Chadi), DePaolo, C.J. (Charles J.), Gayton, C. (Chris), Herriott, C. (Chris), Reeves, C. (Christina), Tieszer, C. (Christina), Dobb, C. (Christine), Anderson, C.G. (Christopher G.), Sage, C. (Claire), Cuento, C. (Claudine), Jones, C.B. (Clifford B.), Bosman, C.H.R. (Coks H.R.), Linehan, C. (Colleen), Hart, C.P. (Cor P.) van der, Henderson, C. (Corey), Lewis, C.G. (Courtland G.), Davis, C.A. (Craig A.), Donohue, C. (Craig), Mauffrey, C. (Cyril), Sundaresh, D.C. (D. C.), Farrell, D.J. (Dana J.), Whelan, D.B. (Daniel B.), Horwitz, D. (Daniel), Stinner, D. (Daniel), Viskontas, D. (Darius), Roffey, D.M. (Darren M.), Alexander, D. (David), Karges, D.E. (David E.), Hak, D. (David), Johnston, D. (David), Love, D. (David), Wright, D.M. (David M.), Zamorano, D.P. (David P.), Goetz, D.R. (David R.), Sanders, D. (David), Stephen, D. (David), Yen, D. (David), Bardana, D. (Davide), Olakkengil, D.J. (Davy J), Lawson, D. (Deanna), Maddock, D. (Deborah), Sietsema, D.L. (Debra L.), Pourmand, D. (Deeba), Hartog, D. (Dennis) den, Donegan, D. (Derek), Heels-Ansdell, D. (Diane), Nam, D. (Diane), Inman, D. (Dominic), Boyer, D. (Dory), Li, D. (Doug), Gibula, D. (Douglas), Price, D.M. (Dustin M.), Watson, D.J. (Dylan J.), Hammerberg, E.M. (E. Mark), Tan, E.T.C.H. (Edward T.C.H.), Graaf, E.J.R. (Eelco) de, Vesterhus, E.B. (Elise Berg), Roper, E. (Elizabeth), Edwards, E. (Elton), Schemitsch, E.H. (Emil), Hammacher, E.R. (Eric), Henderson, E.R. (Eric R.), Whatley, E. (Erica), Torres, E.T. (Erick T.), Vermeulen, E.G.J. (Erik G.J.), Finn, E. (Erin), Lieshout, E.M.M. (Esther) van, Wai, E.K. (Eugene K.), Bannister, E.R. (Evan R.), Kile, E. (Evelyn), Theunissen, E.B.M. (Evert B.M.), Ritchie, E.D. (Ewan D.), Khan, F. (Farah), Moola, F. (Farhad), Howells, F. (Fiona), Nies, F. (Frank) de, Heijden, F.H.W.M. (Frank) van der, de Meulemeester, F.R.A.J. (Frank R.A.J.), Frihagen, F. (Frede), Nilsen, F. (Fredrik), Schmidt, G.B. (G. Ben), Albers, G.H.R. (G.H. Robert), Gudger, G.K. (Garland K.), Johnson, G. (Garth), Gruen, G. (Gary), Zohman, G. (Gary), Sharma, G. (Gaurav), Wood, G. (Gavin), Tetteroo, G.W.M. (Geert), Hjorthaug, G. (Geir), Jomaas, G. (Geir), Donald, G. (Geoff), Rieser, G.R. (Geoffrey Ryan), Reardon, G. (Gerald), Slobogean, G.P. (Gerard P.), Roukema, G.R. (Gert), Visser, G.A. (Gijs A.), Moatshe, G. (Gilbert), Horner, G. (Gillian), Rose, G. (Glynis), Guyatt, G. (Gordon), Chuter, G. (Graham), Etherington, G. (Greg), Rocca, G.J.D. (Gregory J. Della), Ekås, G. (Guri), Dobbin, G. (Gwendolyn), Lemke, H.M. (H. Michael), Curry, H. (Hamish), Boxma, H. (Han), Gissel, H. (Hannah), Kreder, H. (Hans), Kuiken, H. (Hans), Brom, H.L.F., Pape, H.-C. (Hans-Christoph), Vis, H.M. (Harm) van der, Bedi, H. (Harvinder), Vallier, H.A. (Heather A.), Brien, H. (Heather), Silva, H. (Heather), Newman, H. (Heike), Viveiros, H. (Helena), van der Hoeven, H. (Henk), Ahn, H. (Henry), Johal, H. (Herman), Rijna, H., Stockmann, H. (Heyn), Josaputra, H.A. (Hong A.), Carlisle, H. (Hope), van der Brand, I. (Igor), Dawson, I. (Imro), Tarkin, I. (Ivan), Wong, I. (Ivan), Parr, J.A. (J. Andrew), Trenholm, J.A. (J. Andrew), Goslings, J.C. (Carel), Amirault, J.D. (J. David), Broderick, J.S. (J. Scott), Snellen, J.P. (Jaap P.), Zijl, J.A.C. (Jacco A.C.), Ahn, J. (Jaimo), Ficke, J. (James), Irrgang, J. (James), Powell, J. (James), Ringler, J.R. (James R.), Shaer, J. (James), Monica, J.T. (James T.), Biert, J. (Jan), Bosma, J. (Jan), Brattgjerd, J.E. (Jan Egil), Frölke, J.P.M. (Jan Paul), Wille, J.C. (Jan), Rajakumar, J. (Janakiraman), Walker, J.E. (Jane E.), Baker, J.K. (Janell K.), Ertl, J.P. (Janos P.), de Vries, J.P.P.M. (Jean Paul P.M.), Gardeniers, J.W.M. (Jean W.M.), May, J. (Jedediah), Yach, J. (Jeff), Hidy, J.T. (Jennifer T.), Westberg, J.R. (Jerald R.), Hall, J.A. (Jeremy A.), van Mulken, J. (Jeroen), McBeth, J.C. (Jessica Cooper), Hoogendoorn, J. (Jochem), Hoffman, J.M. (Jodi M.), Cherian, J.J. (Joe Joseph), Tanksley, J.A. (John A.), Clarke-Jenssen, J. (John), Adams, J.D. (John D.), Esterhai, J. (John), Tilzey, J.F. (John F.), Murnaghan, J. (John), Ketz, J.P. (John P.), Garfi, J.S. (John S.), Schwappach, J. (John), Gorczyca, J.T. (John T.), Wyrick, J. (John), Rydinge, J. (Jonas), Foret, J.L. (Jonathan L.), Gross, J.M. (Jonathan M.), Keeve, J.P. (Jonathan P.), Meijer, J. (Joost), Scheepers, J.J. (Joris J.), Baele, J. (Joseph), O'Neil, J. (Joseph), Cass, J.R. (Joseph R.), Hsu, J.R. (Joseph R.), Dumais, J. (Jules), Lee, J. (Julia), Switzer, J.A. (Julie A.), Agel, J. (Julie), Richards, J.E. (Justin E.), Langan, J.W. (Justin W.), Turckan, K. (Kahn), Pecorella, K. (Kaili), Rai, K. (Kamal), Aurang, K. (Kamran), Shively, K. (Karl), Wessem, K.J.P. van, Moon, K. (Karyn), Eke, K. (Kate), Erwin, K. (Katie), Milner, K. (Katrine), Ponsen, K.J. (Kees-jan), Mills, K. (Kelli), Apostle, K. (Kelly), Johnston, K. (Kelly), Trask, K. (Kelly), Strohecker, K. (Kent), Stringfellow, K. (Kenya), Kruse, K.K. (Kevin K.), Tetsworth, K. (Kevin), Mitchell, K. (Khalis), Browner, K. (Kieran), Hemlock, K. (Kim), Carcary, K. (Kimberly), Jørgen Haug, K. (Knut), Noble, K. (Krista), Robbins, K. (Kristin), Payton, K. (Krystal), Jeray, K.J. (Kyle J.), Rubino, L.J. (L. Joseph), Nastoff, L.A. (Lauren A.), Leffler, L.C. (Lauren C.), Stassen, L.P. (Laurents), O'Malley, L.K. (Lawrence K.), Specht, L.M. (Lawrence M.), Thabane, L. (Lehana), Geeraedts, L.M.G. (Leo M.G.), Shell, L.E. (Leslie E.), Anderson, L.K. (Linda K.), Eickhoff, L.S. (Linda S.), Lyle, L. (Lindsey), Pilling, L. (Lindsey), Buckingham, L. (Lisa), Cannada, L.K. (Lisa K.), Wild, L.M. (Lisa M.), Dulaney-Cripe, L. (Liz), Poelhekke, L.M.S.J., Govaert, L. (Lonneke), Ton, L. (Lu), Kottam, L. (Lucksy), Leenen, L.P.H. (Luke), Clipper, L. (Lydia), Jackson, L.T. (Lyle T.), Hampton, L. (Lynne), de Waal Malefijt, M.C. (Maarten C.), Simons, M.P., Elst, M. (Maarten) van der, Bronkhorst, M.W.G.A. (Maarten), Bhatia, M. (Mahesh), Swiontkowski, M.F. (Marc ), Lobo, M.J. (Margaret J.), Swinton, M. (Marilyn), Pirpiris, M. (Marinis), Molund, M. (Marius), Gichuru, M. (Mark), Glazebrook, M. (Mark), Harrison, M. (Mark), Jenkins, M. (Mark), MacLeod, M. (Mark), Vries, M.R. (Mark) de, Butler, M.S. (Mark S.), Nousiainen, M. (Markku), van ‘t Riet, M. (Martijne), Tynan, M.C. (Martin C.), Campo, M. (Martin), Eversdijk, M.G. (Martin), Heetveld, M.J. (Martin), Richardson, M. (Martin), Breslin, M. (Mary), Fan, M. (Mary), Edison, M. (Matt), Napierala, M. (Matthew), Knobe, M. (Matthias), Russ, M. (Matthias), Zomar, M. (Mauri), de Brauw, M. (Maurits), Esser, M. (Max), Hurley, M. (Meghan), Peters, M.E. (Melissa E.), Lorenzo, M. (Melissa), Li, M. (Mengnai), Archdeacon, M. (Michael), Biddulph, M. (Michael), Charlton, M. (Michael), McDonald, M.D. (Michael D.), McKee, M.D. (Michael D.), Dunbar, M. (Michael), Torchia, M.E. (Michael E.), Gross, M. (Michael), Hewitt, M. (Michael), Holt, M. (Michael), Prayson, M.J. (Michael J.), Edwards, M.J.R. (Michael), Beckish, M.L. (Michael L.), Brennan, M.L. (Michael L.), Dohm, M.P. (Michael P.), Kain, M.S.H. (Michael S.H.), Vogt, M. (Michelle), Yu, M. (Michelle), Verhofstad, M.H.J. (Michiel), Segers, M.J.M. (Michiel J.M.), Segers, M.J.M. (Michiel), Siroen, M.P.C. (Michiel P.C.), Reed, M.R. (Mike), Vicente, M.R. (Milena R.), Bruijninckx, M.M.M. (Milko), Trivedi, M. (Mittal), Bhandari, M. (Mohit), Moore, M.M. (Molly M.), Kunz, M. (Monica), Smedsrud, M. (Morten), Palla, N. (Naveen), Jain, N. (Neeraj), Out, N.J.M. (Nico J.M.), Simunovic, N. (Nicole), Schep, N.W.L. (Niels), Müller, O. (Oliver), Guicherit, O.R. (Onno R.), Waes, O.J.F. (Oscar) van, Wang, O. (Otis), Doornebosch, P. (Pascal), Seuffert, P. (Patricia), Hesketh, P.J. (Patrick J.), Weinrauch, P. (Patrick), Duffy, P. (Paul), Keller, P. (Paul), Lafferty, P.M. (Paul M.), Pincus, P. (Paul), Tornetta III, P. (Paul), Zalzal, P. (Paul), McKay, P. (Paula), Cole, P.A. (Peter A.), de Rooij, P.D. (Peter D.), Hull, P. (Peter), Go, P.M.N.Y.M. (Peter M.N.Y.M.), Patka, P. (Peter), Siska, P. (Peter), Weingarten, P. (Peter), Kregor, P. (Philip), Stahel, P. (Philip), Stull, P. (Philip), Wittich, P. (Philippe), Rijcke, P.A.R. (Piet), Oprel, P.P. (Pim), Devereaux, P.J. (P. J.), Zhou, Q. (Qi), Lee Murphy, R. (R.), Alosky, R. (Rachel), Clarkson, R. (Rachel), Moon, R. (Raely), Logishetty, R. (Rajanikanth), Nanda, R. (Rajesh), Sullivan, R.J. (Raymond J.), Snider, R.G. (Rebecca G.), Buckley, R.E. (Richard E.), Iorio, R. (Richard), Farrugia, R.J. (Richard J), Jenkinson, R. (Richard), Laughlin, R. (Richard), Groenendijk, R.P.R. (Richard), Gurich, R.W. (Richard W.), Worman, R. (Ripley), Silvis, R. (Rob), Haverlag, R. (Robert), Teasdall, R.J. (Robert J.), Korley, R. (Robert), McCormack, R. (Robert), Probe, R. (Robert), Cantu, R.V. (Robert V.), Huff, R.B. (Roger B.), Simmermacher, R.K.J., Peters, R. (Rolf), Pfeifer, R. (Roman), Liem, R. (Ronald), Wessel, R.N. (Ronald N.), Verhagen, R. (Ronald), Vuylsteke, R. (Ronald), Leighton, R. (Ross), McKercher, R. (Ross), Poolman, R.W. (Rudolf), Miller, R. (Russell), Bicknell, R. (Ryan), Finnan, R. (Ryan), Khan, R.M. (Ryan M.), Mehta, S. (Samir), Vang, S. (Sandy), Singh, S. (Sanjay), Anand, S. (Sanjeev), Anderson, S.A. (Sarah A.), Dawson, S.A. (Sarah A.), Marston, S.B. (Scott B.), Porter, S.E. (Scott E.), Watson, S.T. (Scott T.), Festen, S. (Sebastiaan), Lieberman, S. (Shane), Puloski, S. (Shannon), Bielby, S.A. (Shea A.), Sprague, S. (Sheila), Hess, S. (Shelley), MacDonald, S. (Shelley), Evans, S. (Simone), Bzovsky, S. (Sofia), Hasselund, S. (Sondre), Lewis, S. (Sophie), Ugland, S. (Stein), Caminiti, S. (Stephanie), Tanner, S.L. (Stephanie L.), Zielinski, S.M. (Stephanie), Shepard, S. (Stephanie), Sems, S.A. (Stephen A.), Walter, S.D. (Stephen D.), Doig, S. (Stephen), Finley, S.H. (Stephen H.), Kates, S. (Stephen), Lindenbaum, S. (Stephen), Kingwell, S.P. (Stephen P.), Csongvay, S. (Steve), Papp, S. (Steve), Buijk, S.E. (Steven E.), Rhemrev, S. (Steven), Hollenbeck, S.M. (Steven M.), van Gaalen, S.M. (Steven M.), Yang, S. (Steven), Weinerman, S. (Stuart), Subash, (), Lambert, S. (Sue), Liew, S. (Susan), Meylaerts, S.A.G. (Sven), Blokhuis, T.J. (Taco J.), de Vries Reilingh, T.S. (Tammo S.), Lona, T. (Tarjei), Scott, T. (Taryn), Swenson, T.K. (Teresa K.), Endres, T.J. (Terrence J.), Axelrod, T. (Terry), van Egmond, T. (Teun), Pace, T.B. (Thomas B.), Kibsgård, T. (Thomas), Schaller, T.M. (Thomas M.), Ly, T.V. (Thuan V.), Miller, T.J. (Timothy J.), Weber, T. (Timothy), Le, T. (Toan), Oliver, T.M. (Todd M.), Karsten, T.M. (Thomas), Borch, T. (Tor), Hoseth, T.M. (Tor Magne), Nicolaisen, T. (Tor), Ianssen, T. (Torben), Rutherford, T. (Tori), Nanney, T. (Tracy), Gervais, T. (Trevor), Stone, T. (Trevor), Schrickel, T. (Tyson), Scrabeck, T. (Tyson), Ganguly, U. (Utsav), Naumetz, V. (V.), Frizzell, V. (Valda), Wadey, V. (Veronica), Jones, V. (Vicki), Avram, V. (Victoria), Mishra, V. (Vimlesh), Yadav, V. (Vineet), Arora, V. (Vinod), Tyagi, V. (Vivek), Borsella, V. (Vivian), Willems, W.J. (Jaap), Hoffman, W.H. (W. H.), Gofton, W.T. (Wade T.), Lackey, W.G. (Wesley G.), Ghent, W. (Wesley), Obremskey, W. (William), Oxner, W. (William), Cross, W.W. (William W.), Murtha, Y.M. (Yvonne M.), and Murdoch, Z. (Zoe)

Abstract

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Marc

Published
2017
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11. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial.

Author

Nauth, A., Creek, A.T., Zellar, A., Lawendy, A.R., Dowrick, A., Gupta, A., Dadi, A., Kampen, A. van, Yee, A., Vries, A.C. de, Mol van Otterloo, A., Garibaldi, A., Liew, A., McIntyre, A.W., Prasad, A.S., Romero, A.W., Rangan, A., Oatt, A., Sanghavi, A., Foley, A.L., Karlsten, A., Dolenc, A., Bucknill, A., Chia, A., Gong, A., Schmidt, A.H., Marcantonio, A.J., Jennings, A., Khanna, A., Rai, A., Horan, A.D., Brekke, A.C., Flynn, A., Duraikannan, A., Stodle, A., Vugt, A.B. van, Luther, A., Zurcher, A.W., Jain, A., Amundsen, A., Moaveni, A., Carr, A., Sharma, A., Hill, A.D., Trommer, A., Rai, B.S., Hileman, B., Schreurs, B.W., Verhoeven, B., Barden, B.B., Flatoy, B., Cleffken, B.I., Boe, B., Perey, B., Hanusch, B.C., Weening, B., Fioole, B., Rijbroek, B., Crist, B.D., Halliday, B., Peterson, B., Mullis, B., Richardson, C.G., Clark, C., Sagebien, C.A., Pol, C.C. van der, Bowler, C., Humphrey, C.A., Coady, C., Koppert, C.L., Tannoury, C., Paolo, C.J. de, Gayton, C., Herriott, C., Reeves, C., Tieszer, C., Dobb, C., Anderson, C.G., Sage, C, Cuento, C., Jones, C.B., Bosman, C.H.R., Linehan, C., Hart, C.P. van der, Henderson, C., Lewis, C.G., Davis, C.A., Donohue, C., Mauffrey, C., Sundaresh, D.C., Farrell, D.J., Whelan, D.B., Horwitz, D., Stinner, D., Viskontas, D., Roffey, D.M., Alexander, D., Karges, D.E., Love, D., Wright, D.M., Zamorano, D.P., Goetz, D.R., Sanders, D., Yen, D., Bardana, D., Olakkengil, D.J., Lawson, D., Maddock, D., Sietsema, D.L., Pourmand, D., Hartog, D. Den, Donegan, D., Heels-Ansdell, D., Nam, D., Inman, D., Boyer, D., Li, D., Gibula, D., Price, D.M., Hammerberg, E.M., Tan, E.C.T.H., Graaf, E.J. de, Vesterhus, E.B., Roper, E., Edwards, E., Schemitsch, E.H., Hammacher, E.R., Henderson, E.R., Whatley, E., Torres, E.T., Vermeulen, E.G.J., Finn, E., Lieshout, E.M. van, Wai, E.K., Bannister, E.R., Kile, E., Theunissen, E.B.M., Ritchie, E.D., Moola, F., Howells, F., Nies, F. de, Heijden, F.H. van der, Meulemeester, F.R. de, Frihagen, F., Nilsen, F., Schmidt, G.B., Albers, G.H.R., Gudger, G.K., Johnson, G., Gruen, G., Zohman, G., Wood, G, Tetteroo, G.W., Hjorthaug, G., Jomaas, G., Donald, G., Rieser, G.R., Reardon, G., Slobogean, G.P., Roukema, G.R., Visser, G., Moatshe, G., Horner, G., Gardeniers, J.W.M., Waal Malefijt, M.C. de, et al., Nauth, A., Creek, A.T., Zellar, A., Lawendy, A.R., Dowrick, A., Gupta, A., Dadi, A., Kampen, A. van, Yee, A., Vries, A.C. de, Mol van Otterloo, A., Garibaldi, A., Liew, A., McIntyre, A.W., Prasad, A.S., Romero, A.W., Rangan, A., Oatt, A., Sanghavi, A., Foley, A.L., Karlsten, A., Dolenc, A., Bucknill, A., Chia, A., Gong, A., Schmidt, A.H., Marcantonio, A.J., Jennings, A., Khanna, A., Rai, A., Horan, A.D., Brekke, A.C., Flynn, A., Duraikannan, A., Stodle, A., Vugt, A.B. van, Luther, A., Zurcher, A.W., Jain, A., Amundsen, A., Moaveni, A., Carr, A., Sharma, A., Hill, A.D., Trommer, A., Rai, B.S., Hileman, B., Schreurs, B.W., Verhoeven, B., Barden, B.B., Flatoy, B., Cleffken, B.I., Boe, B., Perey, B., Hanusch, B.C., Weening, B., Fioole, B., Rijbroek, B., Crist, B.D., Halliday, B., Peterson, B., Mullis, B., Richardson, C.G., Clark, C., Sagebien, C.A., Pol, C.C. van der, Bowler, C., Humphrey, C.A., Coady, C., Koppert, C.L., Tannoury, C., Paolo, C.J. de, Gayton, C., Herriott, C., Reeves, C., Tieszer, C., Dobb, C., Anderson, C.G., Sage, C, Cuento, C., Jones, C.B., Bosman, C.H.R., Linehan, C., Hart, C.P. van der, Henderson, C., Lewis, C.G., Davis, C.A., Donohue, C., Mauffrey, C., Sundaresh, D.C., Farrell, D.J., Whelan, D.B., Horwitz, D., Stinner, D., Viskontas, D., Roffey, D.M., Alexander, D., Karges, D.E., Love, D., Wright, D.M., Zamorano, D.P., Goetz, D.R., Sanders, D., Yen, D., Bardana, D., Olakkengil, D.J., Lawson, D., Maddock, D., Sietsema, D.L., Pourmand, D., Hartog, D. Den, Donegan, D., Heels-Ansdell, D., Nam, D., Inman, D., Boyer, D., Li, D., Gibula, D., Price, D.M., Hammerberg, E.M., Tan, E.C.T.H., Graaf, E.J. de, Vesterhus, E.B., Roper, E., Edwards, E., Schemitsch, E.H., Hammacher, E.R., Henderson, E.R., Whatley, E., Torres, E.T., Vermeulen, E.G.J., Finn, E., Lieshout, E.M. van, Wai, E.K., Bannister, E.R., Kile, E., Theunissen, E.B.M., Ritchie, E.D., Moola, F., Howells, F., Nies, F. de, Heijden, F.H. van der, Meulemeester, F.R. de, Frihagen, F., Nilsen, F., Schmidt, G.B., Albers, G.H.R., Gudger, G.K., Johnson, G., Gruen, G., Zohman, G., Wood, G, Tetteroo, G.W., Hjorthaug, G., Jomaas, G., Donald, G., Rieser, G.R., Reardon, G., Slobogean, G.P., Roukema, G.R., Visser, G., Moatshe, G., Horner, G., Gardeniers, J.W.M., Waal Malefijt, M.C. de, and et al.

Abstract

Item does not contain fulltext

Published
2017

12. Center for the Intrepid: Providing Patients POWER

Author

Amorelli, C. R., Baumann, M. L., Yancosek, K. E., Keizer, B. M., Stinner, D. J., and Jason Wilken

Subjects
Patient Care Team, Warfare, Military Personnel, Amputees, Humans, Artificial Limbs, Program Development, Military Medicine, Rehabilitation Centers, Texas
Published
2016

16. A pilot study of surgical telementoring for leg fasciotomy

Author

Talbot, Max, Harvey, E J, Berry, G K, Reindl, R, Tien, H, Stinner, D J, and Slobogean, G

Abstract

IntroductionAcute extremity compartment syndrome requires rapid decompression. In remote locations, distance, weather and logistics may delay the evacuation of patients with extremity trauma beyond the desired timeline for compartment release. The aim of this study was to establish the feasibility of performing telementored surgery for leg compartment release and to identify methodological issues relevant for future research.MethodsThree anaethetists and one critical care physician were recruited as operators. They were directed to perform a two-incision leg fasciotomy on a Thiel-embalmed cadaver under the guidance of a remotely located orthopaedic surgeon. The operating physician and the surgeon (mentor) were connected through software that allows for real-time supervision and the use of a virtual pointer overlaid onto the surgical field. Two experienced orthopaedic traumatologists independently assessed the adequacy of compartment decompression and the presence of iatrogenic complications.Results14 of 16 compartments (in four leg specimens) were felt to have been completely released. The first evaluator considered that the deep posterior compartment was incompletely released in two specimens. The second evaluator considered that the superficial posterior compartment was incompletely released in two specimens. The only complication was a large laceration of the soleus muscle that occurred during a period of blurred video signal attributed to a drop in bandwidth.ConclusionsThis study suggests that surgical telementoring may enable physicians to safely perform two-incision leg fasciotomy in remote environments. This could improve the chances of limb salvage when compartment syndrome occurs far from surgical care. We found interobserver variation in the assessment of compartment release, which should be considered in the design of future research protocols.

Published
2018
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27. Perioperative nutritional status thought to be important, but poorly understood.

Author

Firoozabadi R, Taylor TJ, Fernando N, Hsu JR, Stinner D, Obremskey W, and Castillo RC

Subjects
Humans, Practice Patterns, Physicians' statistics & numerical data, Surveys and Questionnaires, Attitude of Health Personnel, Biomarkers blood, United States, Orthopedic Procedures, Serum Albumin analysis, Wounds and Injuries surgery, Wounds and Injuries complications, C-Reactive Protein analysis, Nutritional Status, Nutrition Assessment, Malnutrition diagnosis, Malnutrition etiology
Abstract

Objectives: Malnutrition has been shown to increase complications and leads to poor outcomes in surgical patients, but it has not been studied extensively in orthopedic trauma. This study's purpose is to determine the perspective and assessment of nutrition by orthopedic traumatologists., Methods: A survey was created and distributed via REDCap to orthopedic traumatologists at 60 U.S. trauma centers. Out of 183 distributed surveys, 130 surgeons completed the survey (71%). The survey focused on the importance of nutrition and practice patterns in orthopedic trauma., Results: Seventy-five percent of surgeons thought that nutritional status was "very important" to the final outcome of patients with orthopedic trauma injuries, 24% responded "somewhat important" and 1% responded "not important." Furthermore, 88% perform nutritional assessments; most surgeons (77%) utilize nutritional laboratory markers, with the most common markers being albumin, pre-albumin, transferrin and CRP. Additionally, 42% think trending the laboratory markers is important, and 50% are not sure if nutrition markers should be tested at multiple time points. Despite 75% of surgeons believing that nutrition is very important, only 8% discuss it with patients routinely. When asked what is more important for outcomes, nutrition or Vitamin D, almost three times as many surgeons thought nutrition was more important (29% vs 11%, respectively)., Conclusions: While orthopedic traumatologists believe nutrition is an important determinant of patient outcomes, this study shows a clear lack of consensus and variability in practice regarding nutrition among surgeons. Orthopedic trauma surgeons need specific guidelines on how to assess and treat malnutrition in trauma patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Published
2024
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28. Biomechanical evaluation of a tool-less external fixator.

Author

Carpanen D, Masouros SD, and Stinner DJ

Subjects
Humans, External Fixators, Extremities, Biomechanical Phenomena, Bone Plates, Fractures, Bone
Abstract

Introduction: Current external fixator systems used by the US and UK military for stabilising extremity fractures require specialised tools to build a construct. The goal of obtaining and maintaining limb length and alignment is not achieved if these tools are misplaced. An alternative, tool-less system is currently available, namely the Dolphix Temporary Fixation System. The aim of this study was to compare the stiffness of the Dolphix system with the existing Hoffmann III system., Methods: Three Hoffmann III and three Dolphix constructs were assembled on a bone (tibia) surrogate. A 30 mm fracture gap was created to simulate a comminuted proximal tibia or distal femur fracture. The constructs were then tested in cyclic axial compression once daily for 3 consecutive days., Results: The length and alignment of the surrogate limb was restored following each testing cycle with both external fixation systems. The stiffness of the constructs was maintained throughout each sequential test, with the Dolphix exhibiting 54% the stiffness of the Hoffmann III construct., Conclusion: Given the Dolphix's performance in mechanical testing and the unique advantage of having a tool-less manual locking clamp mechanism, this tool-less system should be considered for use in the mobile austere environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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30. Trauma System Support to Facilitate Recovery.

Author

Stinner D, Hendrickson SB, and Vallier HA

Subjects
Humans, Mass Screening, Orthopedic Surgeons, Trauma Centers
Abstract

Summary: Trauma is a major public health issue. Orthopaedic trauma surgeons are skilled in the acute management of musculoskeletal injury; however, formal training and resources have not been devoted to optimizing recovery after trauma. Recovery entails addressing the biomedical aspects of injury, as well as the psychological and social factors. The purposes of this study were to describe existing programs and resources within trauma centers, developed to promote psychosocial recovery. Supporting research data will be referenced, and potential barriers to program implementation will be discussed. The American College of Surgeons has mandated screening and treatment for mental illness after trauma, which will raise the bar to highlight the importance of these social issues, likely enabling providers to develop new programs and other resources within their systems. Provider education will promote the informing of patients and families, with the intent of enhancing the efficiency and scope of recovery., Competing Interests: The authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2022
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31. Adaptation of the Centers for Disease Control Surgical Wound Classification System for Orthopaedic Trauma Surgery.

Author

Scolaro JA, Agel J, Marmor M, Dumpe J, Karam M, Kellam J, Meinberg E, Munz J, Nguyen M, Soles G, Stinner D, and Marecek GS

Subjects
Centers for Disease Control and Prevention, U.S., Humans, Reproducibility of Results, United States, Orthopedic Procedures, Orthopedics, Surgical Wound
Abstract

Objectives: To evaluate a proposed orthopaedic-specific surgical wound classification system (SWCS) and the current Centers for Disease Control (CDC) system in a series of detailed clinical vignettes and to identify the degree of satisfaction with CDC SWCS and desire for institution of an orthopaedic-specific SWCS., Methods: Forty-five clinical vignettes and a 5-question survey were distributed to current and past members of the Orthopaedic Trauma Association's Classification Committee. Respondents were asked to provide wound class for each vignette using the CDC system and orthopaedic-specific SWCS., Results: The orthopaedic-specific and CDC SWCS had interclass correlations of 0.95 and 0.91, respectively. When the systems were compared, in 34% of cases, there was no grade change; in 63% of cases, the wound was graded higher using the orthopaedic-specific SWCS. When only the procedure was changed between vignettes, wound classification was infrequently affected. There was near universal dissatisfaction with the CDC SWCS and desire for an orthopaedic-specific system., Conclusions: Both the CDC SWCS and orthopaedic-specific SWCS have excellent interobserver reliability. Incorporation of orthopaedic-specific language affects wound classification. There is low satisfaction with the current CDC SWCS and a desire exists for further development and validation of an orthopaedic-specific SWCS., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2022
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32. The risk of fracture to the tibia from a fragment simulating projectile.

Author

Nguyen TN, Carpanen D, Stinner D, Rankin IA, Ramasamy A, Breeze J, Proud WG, Clasper JC, and Masouros SD

Subjects
Animals, Bone and Bones, Humans, Sheep, Tibia, Fractures, Bone, Tibial Fractures
Abstract

Penetrating injuries due to fragments energised by an explosive event are life threatening and are associated with poor clinical and functional outcomes. The tibia is the long bone most affected in survivors of explosive events, yet the risk of penetrating injury to it has not been quantified. In this study, an injury-risk assessment of penetrating injury to the tibia was conducted using a gas-gun system with a 0.78-g cylindrical fragment simulating projectile. An ovine tibia model was used to generate the injury-risk curves and human cadaveric tests were conducted to validate and scale the results of the ovine model. The impact velocity at 50% risk (±95% confidence intervals) for EF1+, EF2+, EF3+, and EF4+ fractures to the human tibia - using the modified Winquist-Hansen classification - was 271 ± 30, 363 ± 46, 459 ± 102, and 936 ± 182 m/s, respectively. The scaling factor for the impact velocity from cadaveric ovine to human was 2.5. These findings define the protection thresholds to improve the injury outcomes for fragment penetrating injury to the tibia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Published
2020
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33. Multisite Evaluation of a Custom Energy-Storing Carbon Fiber Orthosis for Patients with Residual Disability After Lower-Limb Trauma.

Author

Potter BK, Sheu RG, Stinner D, Fergason J, Hsu JR, Kuhn K, Owens JG, Rivera J, Shawen SB, Wilken JM, DeSanto J, Huang Y, Scharfstein DO, and MacKenzie EJ

Subjects
Adult, Equipment Design, Female, Humans, Male, Middle Aged, Military Personnel, Physical Phenomena, Young Adult, Carbon Fiber, Leg Injuries rehabilitation, Orthotic Devices
Abstract

Background: The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom energy-storing carbon fiber ankle-foot orthosis developed for lower-extremity trauma patients. Studies conducted at the military treatment facility where the IDEO was developed demonstrated benefits of the IDEO when used with the Return to Run Physical Therapy (RTR PT) program. The current study was designed to determine if results could be replicated at other military treatment facilities and to examine whether early performance gains in patient-reported functional outcomes remained at 12 months., Methods: Study participants included service members who had functional deficits that interfered with daily activities at least 1 year after a traumatic unilateral lower-extremity injury at or below the knee. Participants were evaluated before receiving the IDEO, immediately following completion of RTR PT, and at 6 and 12 months. Agility, strength/power, and speed were assessed using well-established performance tests. Self-reported function was measured using the Short Musculoskeletal Function Assessment (SMFA). The Orthotics and Prosthetics Users' Survey was administered to assess satisfaction with the IDEO. Of 87 participants with complete baseline data, 6 did not complete any physical therapy and were excluded from the analysis. Follow-up rates immediately following completion of the RTR PT and at 6 and 12 months were 88%, 75%, and 79%, respectively., Results: Compared with baseline, improvement at completion of RTR PT was observed in all but 1 performance test. SMFA scores for all domains except hand and arm function were lower (improved function) at 6 and 12 months. Satisfaction with the IDEO was high following completion of RTR PT, with some attenuation at the time of follow-up., Conclusions: This study adds to the evidence supporting the efficacy of the IDEO coupled with RTR PT. However, despite improvement in both performance and self-reported functioning, deficits persist compared with population norms., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Published
2018
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34. Orthopedic Trauma: Extremity Fractures.

Author

Osier C, Smith C, Stinner D, Rivera J, Possley D, Finnan R, Bode K, and Stockinger Z

Subjects
Compartment Syndromes prevention & control, Compartment Syndromes surgery, Debridement methods, Fracture Fixation methods, Humans, Military Personnel statistics & numerical data, Warfare, Extremities injuries, Fractures, Bone therapy
Abstract

Fractures continue to account for a large proportion of combat-related injuries. The basic tenets of irrigation, debridement, soft tissue care, and vigilant monitoring/fasciotomy for acute compartment syndrome persist. Closed management of fractures with splinting or casting is acceptable. If time and facility allow, external fixation of fractures offer many advantages over closed treatment but require knowledge, experience and skill in the safe placement of pins. The care of host nationals presents unique challenges and deployed surgeons must be flexible and resourceful in these situations.

Published
2018
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35. Early Complications and Outcomes in Combat Injury-Related Invasive Fungal Wound Infections: A Case-Control Analysis.

Author

Lewandowski LR, Weintrob AC, Tribble DR, Rodriguez CJ, Petfield J, Lloyd BA, Murray CK, Stinner D, Aggarwal D, Shaikh F, and Potter BK

Subjects
Adult, Afghan Campaign 2001-, Case-Control Studies, Causality, Comorbidity, Female, Humans, Male, Mycoses, Prevalence, Treatment Outcome, Young Adult, Amputation, Surgical statistics & numerical data, Military Personnel statistics & numerical data, Surgical Wound Infection epidemiology, Surgical Wound Infection therapy, Wounds and Injuries epidemiology, Wounds and Injuries therapy
Abstract

Objective: Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures before initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure., Design: Retrospective review and case-control analysis., Setting: Military hospitals., Patients/participants: US military personnel injured during combat operations (2009-2011). The IFI cases were identified based on the presence of recurrent, necrotic extremity wounds with mold growth in culture, and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury., Intervention: None., Main Outcome Measurements: Amputation revision rate and loss of functional levels., Results: Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (P < 0.001). Additionally, significantly (P < 0.001) higher number of operative procedures and longer duration to initial wound closure were associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% confidence interval, 1.17-2.01). The supplemental matching analysis found similar results., Conclusions: Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2016
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36. Blood flow restriction rehabilitation for extremity weakness: a case series.

Author

Hylden C, Burns T, Stinner D, and Owens J

Subjects
Adult, Humans, Intermittent Pneumatic Compression Devices, Leg Injuries complications, Male, Middle Aged, Muscle, Skeletal physiopathology, Quadriceps Muscle physiopathology, Regional Blood Flow physiology, Young Adult, Exercise Therapy methods, Muscle Weakness etiology, Muscle Weakness physiopathology, Muscle Weakness rehabilitation, Muscle Weakness therapy, Muscle, Skeletal blood supply, Quadriceps Muscle blood supply
Abstract

Background: Blood flow restricted (BFR) training, the brief and partial restriction of venous outflow of an extremity during low load resistance exercises, is a safe and effective method of improving strength in healthy, active individuals. A relatively unexplored potential of this adjunctive modality lies in treating patients with severe musculoskeletal trauma, persistent chronic quadriceps and hamstring weakness despite traditional therapy, and low improvement during early postoperative strengthening., Methods: This case series describes patients with chronic quadriceps and hamstring weakness who received an intervention of BFR at low loads, 20% of 1 repetition max (1RM), to restore strength. A case series was conducted of seven patients, all located at one hospital and all with traumatic lower extremity injuries. The seven patients were treated at the same medical center and with the same BFR protocol. All seven patients had isokinetic dynamometer testing that showed persistent thigh muscle weakness despite previous rehabilitation with traditional therapy and 35% to 75% peak torque deficit in either knee extension or flexion compared with the contralateral lower extremity. Patients underwent 2 weeks of BFR training therapy using a pneumatic tourniquet set at 110mmHg while performing leg extensions, leg presses, and reverse leg presses. All affected extremities were retested after 2 weeks (six treatment sessions). Dynamometer measurements were done with flexion and extension at two speeds: 90° and 300°/sec. The data recorded included peak torque normalized for body weight, average power, and total work., Results: All seven patients demonstrated improvements in peak torque, average power, and total work for both knee flexion and extension, with power being the most improved overall. Peak torque improved an average of 13% to 37%, depending on contraction direction and speed. Average power improved an average of 42% to 81%, and total work improved an average of 35% to 55%., Conclusion: BFR therapy at low loads can affect improvement in muscle strength in patients who are unable to perform high-resistance exercise or patients who have persistent extremity weakness despite traditional therapy., (2015.)

Published
2015

37. Quadriceps and patellar tendon ruptures.

Author

Lee D, Stinner D, and Mir H

Subjects
Arthroplasty, Replacement, Knee, Biomechanical Phenomena, Diagnostic Imaging, Humans, Patellar Ligament pathology, Patellar Ligament physiology, Postoperative Complications surgery, Rupture diagnosis, Rupture surgery, Suture Anchors, Suture Techniques, Tendon Injuries diagnosis, Tendons pathology, Tendons physiology, Patellar Ligament injuries, Patellar Ligament surgery, Tendon Injuries surgery, Tendons surgery
Abstract

The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Published
2013
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38. Military orthopedic residency: the good, the challenging, and the different.

Author

Krueger CA and Stinner DJ

Subjects
Attitude of Health Personnel, Education, Medical, Graduate organization & administration, Female, Humans, Internship and Residency organization & administration, Job Satisfaction, Male, Military Medicine organization & administration, Program Evaluation, Texas, Career Choice, Clinical Competence, Military Medicine education, Orthopedics education
Published
2012

39. Time-dependent effect of chlorhexidine surgical prep.

Author

Stinner DJ, Krueger CA, Masini BD, and Wenke JC

Subjects
Bacterial Load methods, Culture Media chemistry, Dose-Response Relationship, Drug, Drug Stability, Staphylococcus aureus drug effects, Time Factors, Anti-Infective Agents, Local pharmacology, Chlorhexidine pharmacology
Abstract

Despite continued advances in preoperative preventive measures and aseptic technique, surgical site infections remain a problem. The purpose of this study was to evaluate the time-dependent effectiveness of chlorhexidine, a common surgical preparation solution, at various concentrations. Agar plates containing a Mueller-Hinton medium were inoculated with Staphylococcus aureus (lux) bacteria. The bacteria are genetically engineered to emit photons, allowing for quantification with a photon-counting camera system. Standardized amounts of aqueous chlorhexidine at three different concentrations (group 1:4%; group 2:2%; group 3:0.4%) were applied to the agar plates and comparisons in bacterial reduction were made. After 2 min of contact time, groups 1 and 2 had similar reductions in bacterial load with 30% bacterial load remaining in each group (P=0.512), whereas group 3 had a significantly higher bacterial load (33%) when compared to both groups 1 and 2 (1 vs 3, P<0.0001; 2 vs 3, P=0.0002). The bacterial load in all three groups continued to decrease out to the final time point (1h) with group 1 having the least amount of bacterial load remaining, 9% (P<0.0001) and group 3 with the highest bacterial load remaining, 19% (P<0.0001). This study demonstrates two key results: first, dilution of chlorhexidine correlates directly with its bactericidal activity; second, its effectiveness is directly related to its contact time. Based on the results of this study, the authors recommend using 4% chlorhexidine for surgical site preparation and allowing a minimum of 2 min of contact time prior to making the skin incision., (Published by Elsevier Ltd.)

Published
2011
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41. [Haematological data relating to phenol excretion in urine with chronic benzene exposure. I. Epidemiological studies of adults (author's transl)].

Author

Eikmann T, Stinner D, and Prajsnar D

Subjects
Aged, Benzene blood, Body Burden, Environmental Exposure, Epidemiologic Methods, Erythrocytes drug effects, Female, Germany, West, Hematocrit, Hemoglobins metabolism, Humans, Male, Middle Aged, Reticulocytes drug effects, Benzene metabolism, Blood Cells drug effects, Phenols urine
Abstract

The phenol excretion in 24-h-urine has proved in epidemiological studies of normal population as a parameter, which can be measured very well and is sufficient exact as a parameter for a benzene burden. For an exact assessment of healthy impairment of the investigated collectives only the height of the phenol level is not sufficient. Therefore in the presented study the parameters little blood picture, differential blood picture, thrombocytes and reticulocytes were measured relating to the phenol excretion. 60-65 years old male and female adults from six districts of a large city in the strong industrialized North-West of the Ruhr-Area were investigated. The districts were differently exposed (i.e. 55 t/a benzene) to emissions. Adults at the same age from a little residential town (approx. 16 km apart) were investigated as a comparative collective. In the nearer environs there are no industrial emittents existing. - The different exposure situation is reflected well in the mean values of the collective exposure parameters. In the residential town you can find a lower phenol excretion, statistically guarded, corresponding with higher values of thrombocytes and leukocytes. Corresponding with phenol levels in urine the exposed districts presents the more adverse blood parameters. - The reticulocytes and MCHC values, like the MCV and MCH values show a similar trend corresponding with phenol values, statistically guarded. The other parameters, especially the differential blood picture, show no or little relation to the phenol values and give no indication of the exposure situation. - The combination of lower thrombocytes and leucocytes values, the trend to lower erythrocytes values (only females) and to higher MCH values in the industrial districts indicate a pancytopenic influence on the bone marrow as a characteristic for a benzene burden. - The higher reticulocytes count and its influence on the MCHC and MCV values suggest a reactive activity of the bone marrow. The absence of left displacement in the white blood picture let us suppose a compensated reaction. An acute healthy impairment of the population is not provable; therefore benzene is a certain carcinogen, it is not possible to estimate the potential hazard of the population for a longer period. For better registration of the real endangering of the population further more investigations are proposed.

Published
1981

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