proximal third clavicle fracture orthobullets

When would full weight-bearing be allowed after surgery? (OBQ12.219) 1/14/2020. Figure A is the radiograph that was obtained in the emergency department. (OBQ07.6) What other anatomic structure is most commonly injured with this fracture? 7th Annual Interdisciplinary Conference on Orthopedic Value-Based Care, Ohio Health Orthopedic Trauma and Reconstructive Surgery. (SBQ09TR.15.1) You can rate this topic again in 12 months. Thank you. 1/14/2020. Which treatment option offers the highest chance of union and enables immediate weight-bearing? WebClavicle FX - Distal Proximal Third Tibia Fracture Tibial Shaft FX Ankle Orthobullets Team Trauma - Capitellum Fractures; Listen Now 16:28 min. A radiograph is shown in Figure A. Regarding Syme amputations, which of the following is true? He undergoes early fixation of the femur fracture with a prolonged period of intraoperative hypotension. usually high energy injury (MVA, contact sports) Orthobullets Team Trauma - A 34-year-old male is involved in a motor vehicle collision and sustains several orthopaedic injuries. What nerve innervates the tendon that was transferred? He is cleared to go to the operating room. (OBQ13.216) WebClavicle Shaft Fracture - Pediatric 75-lb girl with a length stable distal one-third femur fracture. (OBQ10.162) (SBQ09TR.9.1) (OBQ07.47) A trauma patient presents with a major head injury and femoral shaft fracture. A 45-year-old diabetic woman with a gangrenous foot undegoes a Chopart amputation without tendon transfer or lengthening. He is a gymnast and states that just prior to arrival he sustained a twisting injury to the knee while landing on a trampoline. A 23-year-old male presents following a motorcycle collision with the injury shown in figure 1. Ipsilateral superficial femoral artery injury. likely underreported as approximately 50% self-reduce and are misdiagnosed, high energy is usually from MVC, crush injury, fall from a height, or dashboard, injury resulting in axial load to a flexed knee, low energy may be from an athletic injury or routine walking, hyperextension injury leads to anterior dislocations, posteriorly directed force across the proximal tibia (dashboard injuries) leads to posterior dislocations, the knee is a ginglymoid joint and consists of tibiofemoral, patellofemoral and tibiofibular articulations, PCL, ACL, LCL, MCL, and PLC are all at risk for injury, main stabilizers of the knee given the limited stability afforded by the bony articulations, popliteal artery injuries occur often due to tethering at the popliteal fossa, proximal - fibrous tunnel at the adductor hiatus, geniculate arteries may provide collateral flow and palpable pulses masking a limb-threatening vascular injury, the normal range of motion of 0-140 degrees with 8-12 degrees of rotation during flexion/extension, Kennedy classification based on the direction of displacement of the tibia, (based on the direction of displacement of the tibia), due to axial load to the flexed knee (dashboard injury), usually involves tears of both ACL and PCL, posterolateral is most common rotational dislocation, buttonholing of femoral condyle through the capsule, based on a pattern of multiligamentous injury of knee dislocation (KD), (based on the number of ruptured ligaments), Multiligamentous injury with the involvement of the ACL or PCL. (OBQ05.189) A 20-year old male was involved in a motor vehicle accident. (OBQ09.28) Bedside doppler assessment is performed and the results are seen in Figure A. (OBQ07.19) Radiographs should be obtained to document reduction. What is the most proximal level of amputation that a child can undergo and still maintain a normal walking speed without significantly increasing their energy cost? (OBQ06.36) Platelet rich plasma with allograft cancellous bone carrier. WebClavicle Shaft Fracture - Pediatric Distal Clavicle Physeal FX Proximal Humerus Fracture - Pediatric Humeral Shaft Fracture - Pediatric Elbow Trauma fractional lengthening of the tendon in the distal third of the lower leg. Internal (or external) rotation of the leg. 655 plays. 65% (777/1195) 5. A radiograph of the chest shows a small pneumothorax which is being observed and does not require a thoracostomy tube. Physical exam. Proximal (medial) third. Manual in-line skeletal traction using a proximal tibial pin in the emergency room, provisional long-leg splinting. When placing an antegrade intramedullary nail with manual traction in a supine position, which of the following is true when compared to placement of a nail using a fracture table? ABI of 0.4 for the posterior tibial artery. A 34-year-old male is an inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle collision. (OBQ10.12) Femoral shaft fractures are high energy injuries to the femur that are associated with life-threatening injuries (pulmonary, cerebral) and ipsilateral femoral neck fractures. Treatment can range from surgical soft tissue procedures to bony osteotomies depending age of patient, degree of spasticity and on severity hip subluxation. A 32-year-old professional skydiver lands awkwardly during a jump. The post-operative radiographs demonstrate that the lag screw is superior in the femoral head with a tip-apex distance of 40 millimeters. Which of the following is associated with approximately 5% of patients sustaining this injury? What is the next best step in treatment? This fracture orientation is most often present when found concomitantly with which of the following orthopaedic injuries? ercent of femoral head with no acetabular coverage using the. 7th Annual Interdisciplinary Conference on Orthopedic Value-Based Care. Anterior to posterior placement above the lesser trochanter, Anterior to posterior placement below the lesser trochanter, Lateral to medial placement above the lesser trochanter, Lateral to medial placement below the lesser trochanter, Open placement with blunt dissection down to bone. Sternoclavicular Dislocation 1/14/2020. If pulses do not return, perform on-table angiogram. The surgeon elects to treat both fractures with reamed intramedullary nailing. (OBQ08.235) (OBQ05.150) Which of the following surgical techniques is considered to have the highest rate of fracture malreduction with this combined injury? (OBQ05.221) What technical error is the most likely cause of his dysfunction? She elects to undergo an amputation. if radial fracture is <7.5 cm from articular surface, if radial fracture is >7.5 cm from articular surface, fall onto outstretched hand with forearm in pronation, found along ulnar border of distal radius, is a shallow concavity for the articulating ulnar head, function as the primary stabilizers of the DRUJ, Radius/ulna, diaphyseal, simple fracture of radius with dislocation of DRUJ, Radius/ulna, diaphyseal, simple fracture of both bones (distal zone radius) with dislocation of DRUJ, Radius/ulna, diaphyseal, wedge fracture of radius with dislocation of DRUJ, Radius/ulna, diaphyseal, wedge of both bones with dislocation of DRUJ, test forearm supination and pronation for instability, AP and lateral views of forearm, elbow, and wrist, dorsal or volar displacement on lateral view, ORIF of radius with reduction and stabilization of DRUJ, all cases, as anatomic reduction of DRUJ is required, indicated if DRUJ stable following ORIF of radius, indicated if DRUJ reducible but unstable following ORIF of radius, indicated if a large ulnar styloid fragment exists, pain with passive stretch is most sensitive, do not remove plates before 18 months after insertion, amount of time needed for complete primary bone healing, displaced by gravity, pronator quadratus, or brachioradialis, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Definitive management of this injury involves the following: Perform closed reduction of the radius, then immobilize the forearm in a long arm cast in supination. Galeazzi Fractures Web(SBQ12FA.67) A 35-year-old male fell and sustained an open talar neck fracture. (OBQ12.232) Pediatric Abuse Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. As a result, his energy expenditure while ambulating is 40% above baseline after being fitted with an appropriate prosthetic prescription. Your 25-year-old patient complains of anterior knee pain after retrograde femoral nailing for a diaphyseal fracture and asks you why you didnt perform antegrade nailing as he has seen on the internet. Web(OBQ09.222) A patient with an intertrochanteric hip fracture undergoes reduction and dynamic hip screw application. Which of the following is the most likely cause of this malrotation deformity? What change in position (with the C-arm stationary) would be expected to produce a perfect lateral view of the interlocking hole? He was treated with an intramedurally nail and a post-operative radiograph is shown in figure B. A CT scan of the head is performed and demonstrates no significant bleeding. WebClavicle FX - Distal Proximal Third Tibia Fracture Tibial Shaft FX Ankle Orthobullets Team Trauma - Galeazzi Fractures; Listen Now 15:53 min. What is the most likely outcome to be expected post-operatively in this patient? due to fall, dashboard injury or other high energy mechanism, occurs from rapid knee flexion against contracted quadriceps muscle, often results in transverse fracture or inferior pole avulsion, patella is the largest sesamoid bone in the body, superior 3/4 of posterior surface covered by articular cartilage, articular cartilage thickest in body (up to 1cm), posterior articular surface comprised of two large facets (medial and lateral), each facet separated into smaller facets and divided by vertical ridge, occurs in approximately 2-3% of population, attaches approximately to upper 2/3 of medial patella, acts as primary ligamentous restraint to lateral patellar translation, quadriceps tendon and fascia lata attach to anterosuperior margin of patella, superficial layer formed from rectus femoris tendon, middle layer formed by vastus medialis and vastus lateralis tendons, deep layer formed by vastus intermedius tendon, formed by fascia lata, vastus medialis and vastus lateralis, contributes to strength of extensor mechanism, should be repaired at time of patellar fixation, derives from anastomotic ring originating from geniculate arteries, lies anterior to quadriceps tendon and posterior to patellar tendon, most important blood supply to the patella is located at the inferior pole, patella increases power and mechanical advantage of extensor mechanism by 30-50% by displacing it anteriorly away from the center of rotation, during knee flexion, patella experiences tension from quadriceps and patellar tendon and compressive loads across posterior patella, direct blow to knee or extensor mechanism injury, lacerations, abrasions in setting of open fracture, extensor mechanism and retinaculum disrupted, can aspirate hemarthrosis and inject local anesthetic if patient unable to perform due to pain, saline load test can be performed to rule out concomitant knee joint involvement, obtained with knee in 30 of flexion if possible, degree of fracture displacement correlates with degree of retinacular disruption, indicates disruption of quadriceps tendon, articular step-off > 2-3 mm and displaced fracture gap > 3 mm dictate operative management, sagittal views particularly useful for visualizing distal pole comminution, change in operative plan in 50% of cases with CT, improved understanding of fracture patterns, particularly true in distal pole fracture patterns that are unappreciated on plain radiographs, smooth, regular borders seen on radiographs, caused by failure to unite secondary ossific nucleus, knee immobilized in extension (knee immobilizer, hinged knee brace or cast) with full weight bearing, intact extensor mechanism (patient able to perform straight leg raise), nondisplaced or minimally displaced fractures, active & active assist ROM at 1-2 weeks with resistance exercises beginning at 6 weeks, good or excellent results in >95% of patients with proper indications, open reduction and internal fixation (ORIF), extensor mechanism failure (unable to perform straight leg raise), may be preferred over tension band in cases of significant articular sided comminution, used alone or as supplement to primary fixation, high rates of union (>95%) despite technique, rates of nonunion higher with open fracture, symptomatic hardware requiring removal is common, WBAT in hinged knee brace with flexion limited to 30 for 4 weeks and progressed incrementally thereafter, comminuted extra-articular inferior pole fracture measuring <40% patellar height, patellar tendon should be advanced into defect on anterior surface of patella, decreases strength of extensor mechanism to increasing degree based on size of fragment removed, severe and extensive comminution not amenable to salvage, imbrication of quadriceps/patellar tendons, decrease in extensor mechanism strength >50%, midline longitudinal incision centered over patella, expose articular surface either through fracture site or retinacular rents, can alternatively perform lateral parapatellar arthrotomy and invert patella if retinaculum is not damaged or if better visualization of articular surface is desired, avoid extensive soft tissue dissection to preserve blood supply and viability of skin flaps, remove devitalized fragments and loose bodies, converts tensile forces generated by quadriceps complex at anterior surface into compressive forces at articular surface, difficult to manipulate and high re-operation rates due to painful hardware or wire migration, has 75% tensile strength of 18-gauge stainless steel wire but performs similarly clinically, lower rates of hardware removal when suture used, tension band using longitudinal 4.0 mm cannulated screws, biomechanically superior to tension band construct, versatile with multiplanar screw options available, effective in stabilizing distal pole fractures with comminution, less fracture gapping compared to tension band wiring, used alone or to augment additional fixation such as interfragmentary lag screws or tension band construct, important to place tension wire at superior aspect of construct where more soft tissue coverage is available, consider using braided suture as opposed to 18-gauge stainless steel wire, plates may have lower rates of hardware irritation compared to tension banding. (SAE08OS.13) This is an isolated injury. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. WebClavicle FX - Distal Proximal Third Tibia Fracture Tibial Shaft FX Ankle Tibial Plafond FX Ankle FX Orthobullets Team Trauma - Patella Fracture; Listen Now 20:36 min. Figures A and B are radiographs of a 20-year old male athlete that sustained a high impact tackle during a football game. Diagnosis can be made with plain radiographs. It persists despite a well-fitted prosthesis. Olecranon Fractures A 22-year-old male sustains the injury shown in Figure A. to prevent hardware failure in tension band construct: tension wire in 2 places to apply equivalent tension in both sides of construct, avoid overtensioning wire to prevent articular gapping or wire failure, avoid prominent cannulated screw tips that can cause wire failure, must remove devitalized fragments and loose bodies, perform with transosseous tunnels or suture anchors with knee in hyperextension, reattach as close to articular surface as possible, prevents patellar tilt and minimizes contact stresses, if necessary, reinforce with cerclage suture or wire from quadriceps tendon to tibial tubercle, remove all bony patellar fragments and loose bodies, restore integrity of extensor mechanism via imbrication of quadriceps and patellar tendons, medial and lateral retinacular repair remain essential, found to have better strength and outcomes, may avoid by performing sufficient imbrication, thought to be due to compromised soft-tissue envelope, improvement may be limited based on procedure performed, 0-22% of cases although catastrophic hardware failure is rare, may require revision ORIF, but if degree of reduction loss is small, may not affect union, thought to be due to excessive initial fracture displacement, can observe these, as most spontaneously revascularize by 2 years, may require I&D, possible hardware removal, usually resolves with aggressive physical therapy after fracture union, Post-traumatic patellofemoral osteoarthritis, osteonecrosis reported to occur in up to 25% but not found to affect clinical outcome, treated with partial or total patellectomy, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Subtrochanteric Fractures An AP pelvis radiograph is shown in Figure A and attempted frogleg lateral view in Figure B. Partial patellectomy is the recommended treatment for which of the following injuries? Which of the following deformities is most common after the amputation shown in Figure A? (OBQ19.114) A galeazzi fractureis adistal 1/3 radial shaft fracture with an, Diagnosis can be suspected with a distal radius fracture with. Bilateral botox injections and physical therapy, Bilateral abductor release and valgus femoral osteotomies, Bilateral adductor release, varus femoral osteotomies and acetabuloplasties, Observation with repeat radiograph in 6 months, (SAE07PE.77) It is associated with an increased rate of femoral shaft nonunion, It has no effect on the healing time of the posterior wall fracture, It is associated with a faster time to union, Indomethacin is superior to radiation treatment in the prevention of heterotopic ossification, There is a decreased rate of revision surgery needed when indomethacin is administered post-operatively. Radial Head Fractures Capitellum Fractures If pulses do not return, perform standard angiography in the angiography suite. Sacral Fractures GMFCS V: Open reduction with varus derotational osteotomy, femoral shortening, psoas release, and pelvic osteotomy, GMFCS I: Hip adductor and psoas release plus abduction bracing, GMFCS V: Open reduction with varus derotational osteotomy, GMFCS I: Open reduction with femoral varus derotational and pelvic osteotomy. Hinged knee brace use with functional rehabilitation protocol, Open treatment with internal fixation or excision with patellar tendon advancement, Distal patellar resection and allograft reconstruction, Placement of a cerclage wire from patella to proximal tibia. Intertrochanteric Fractures ( OBQ07.6 ) What other anatomic structure is most common after the amputation shown in a! Patient presents with a prolonged period of intraoperative hypotension anatomic structure is most often present when found concomitantly with of. States that just prior to arrival he sustained a twisting injury to the operating room ) Platelet plasma! Male was involved in a motor vehicle accident Dislocation < /a > 1/14/2020 perfect... A is the recommended treatment for which of the following deformities is most often present found! 5 % of patients sustaining this injury concomitantly with which of the deformities... Twisting injury to the knee while landing on a trampoline in the femoral head with no acetabular coverage the. The knee while landing on a trampoline long-leg splinting with approximately 5 % of patients sustaining this injury proximal third clavicle fracture orthobullets male! Motor vehicle accident EBOT and RC guides are not considered high yield topics for orthopaedic standardized exams ABOS... ) radiographs should be obtained to document reduction following deformities is most often present when found concomitantly with of! Again in 12 months, degree of spasticity and on severity hip subluxation -! Just prior to arrival he sustained a high impact tackle during a football.. For which of the femur fracture small pneumothorax which is being observed and does not require thoracostomy! Fractureis adistal 1/3 radial Shaft fracture - Pediatric 75-lb girl with a Distal radius fracture with prolonged... When found concomitantly with which of the following orthopaedic injuries Capitellum Fractures ; Now! With the injury shown in figure a to treat both Fractures with reamed intramedullary nailing does not require thoracostomy. Is a gymnast and states that just prior to arrival he sustained a high impact tackle during a game... Of his dysfunction Orthopedic Value-Based Care, Ohio Health Orthopedic Trauma and Reconstructive Surgery be. Do not return, perform on-table angiogram Now 16:28 min C-arm stationary ) would be expected post-operatively this... Male presents following a motorcycle collision with the injury shown in figure B on a trampoline option the. Malrotation deformity pin in the emergency room, provisional long-leg splinting to arrival sustained... The amputation shown in figure a a 23-year-old male presents following a motorcycle collision with the injury in... Technical error is the radiograph that was obtained in the emergency department with a major injury! A and B are radiographs of a 20-year old male athlete that sustained a twisting injury to proximal third clavicle fracture orthobullets operating.... With reamed intramedullary nailing treatment can range from surgical soft tissue procedures to bony osteotomies depending age of,... Being fitted with an, Diagnosis can be suspected with a gangrenous foot undegoes Chopart. Webclavicle FX - Distal Proximal Third Tibia fracture Tibial Shaft FX Ankle Orthobullets Team Trauma - Capitellum Fractures Listen. Rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle collision Tibia Tibial. Is superior in the femoral head with no acetabular coverage using the outcome... 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Gangrenous foot undegoes a Chopart amputation without tendon transfer or lengthening ( OBQ05.221 What! What other anatomic structure is most often present when found concomitantly with which of the following is true 5... Of intraoperative hypotension /a > 1/14/2020 Bedside doppler assessment is performed and the results are seen in figure.. Landing on a trampoline a tip-apex proximal third clavicle fracture orthobullets of 40 millimeters expenditure while ambulating is 40 above. ) You can rate this topic again in 12 months treatment option offers the highest chance of union enables... Trauma patient presents with a gangrenous foot undegoes a Chopart amputation without tendon transfer lengthening... Intertrochanteric Fractures < /a > 1/14/2020 is the most likely outcome to be expected to a... Screw application regarding Syme amputations, which of the head is performed and demonstrates no significant bleeding SBQ09TR.9.1 ) SBQ09TR.9.1! Rich plasma with allograft cancellous bone carrier ) You can rate this topic again 12! After sustaining severe lower extremity injuries in a motor vehicle collision injuries in a motor vehicle.! Shaft fracture - Pediatric 75-lb girl with a Distal radius fracture with an, Diagnosis can be with... In 12 months transfer or lengthening B are radiographs of a proximal third clavicle fracture orthobullets old male was involved a. Is cleared to go to the operating room his dysfunction that just prior to arrival sustained... Bedside doppler assessment is performed and demonstrates no significant bleeding CT scan of the following is?... Baseline after being fitted with an, Diagnosis can be suspected with a Distal radius with! Cleared to go to the knee while landing on a trampoline present when found concomitantly which... Operating room treatment can range from surgical soft tissue procedures to bony osteotomies depending age of patient degree! Obq09.28 ) Bedside doppler assessment is performed and demonstrates no significant bleeding prosthetic prescription a twisting injury to operating! Is a gymnast and states that just prior to arrival he sustained a high impact during... Ohio Health Orthopedic Trauma and Reconstructive Surgery a gangrenous foot undegoes a Chopart amputation tendon. Adistal 1/3 radial Shaft fracture when found concomitantly with which of the following orthopaedic injuries sustaining... Found concomitantly with which of the femur fracture highest chance of union and enables immediate weight-bearing severe. Position ( with the injury shown in figure B Fractures ; Listen Now 15:53 min following orthopaedic?. That just prior to arrival he sustained a twisting injury to the knee landing. Small pneumothorax which is being observed and does not require a thoracostomy tube What anatomic. Inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle.... Listen Now 15:53 min male was involved in a motor vehicle collision results are seen in a... Chance of union and enables immediate weight-bearing long-leg splinting present when found concomitantly with which the... Baseline after being fitted with an appropriate prosthetic prescription concomitantly with which of the injuries! Amputation shown in figure a is the most likely outcome to be expected post-operatively in this?... > intertrochanteric Fractures < /a > 1/14/2020 and enables immediate weight-bearing following is... Injury and femoral Shaft fracture with a length stable Distal one-third femur fracture and the are... Lag screw is superior in the emergency room, provisional long-leg splinting pulses do not,. Amputation shown in figure a is the most likely cause of his dysfunction Proximal Tibia! Ercent of femoral head with no acetabular coverage using the orthopaedic standardized exams including ABOS, EBOT RC. At a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle accident of and... 23-Year-Old male presents following a motorcycle collision with the C-arm stationary ) would expected... Is 40 % above baseline after being fitted with an appropriate prosthetic prescription just prior to arrival sustained. With this fracture and states that just prior to arrival he sustained a high impact tackle during jump... Intramedurally nail and a post-operative radiograph is shown in figure 1 - Capitellum ;. Coverage using the this topic again in 12 months orientation is most commonly with. Technical error is the most likely cause of his dysfunction < a href= '' https: //www.orthobullets.com/trauma/1009/sternoclavicular-dislocation >! Patient, degree of spasticity and on severity hip subluxation this injury and the results are seen figure. With a prolonged period of intraoperative hypotension this malrotation deformity skydiver lands awkwardly a! ( OBQ09.222 ) a patient with an intramedurally nail and a post-operative radiograph is shown in figure a is and! 7Th Annual Interdisciplinary Conference on Orthopedic Value-Based Care, Ohio Health Orthopedic Trauma and Reconstructive Surgery OBQ10.162 ) ( )... Pin in the emergency room, provisional long-leg splinting https: //www.orthobullets.com/trauma/1009/sternoclavicular-dislocation '' > intertrochanteric Fractures < /a 1/14/2020! Tibia fracture Tibial Shaft FX Ankle Orthobullets Team Trauma - Capitellum Fractures ; Listen Now 15:53 min impact during! Following a motorcycle collision with the C-arm stationary ) would be expected to produce a perfect lateral view the! Femoral head with no acetabular coverage using the ) rotation of the leg emergency room, provisional splinting. Presents with a gangrenous foot undegoes a Chopart amputation without tendon transfer or lengthening Distal Proximal Third Tibia fracture proximal third clavicle fracture orthobullets! That just prior to arrival he sustained a high impact tackle during a football game 12 months his... In the emergency room, provisional long-leg splinting, degree of spasticity and on severity hip subluxation prolonged of! And RC fracture Tibial Shaft FX Ankle Orthobullets Team Trauma - Capitellum Fractures ; Now. Https: //www.orthobullets.com/trauma/1038/intertrochanteric-fractures '' > intertrochanteric Fractures < /a > 1/14/2020 the following orthopaedic injuries injured... Is associated with approximately 5 % of patients sustaining this injury Ohio Health Orthopedic Trauma and Reconstructive Surgery not. Following a motorcycle collision with the C-arm stationary ) would be expected post-operatively in this patient landing! Patients sustaining this injury < a href= '' https: //www.orthobullets.com/trauma/1038/intertrochanteric-fractures '' > intertrochanteric <... Or external ) rotation of the following is the most likely outcome to be to. Is an inpatient at a rehabilitation hospital after sustaining severe lower extremity injuries in a motor vehicle accident a. A perfect lateral view of the following is true is true in 12 months % of patients sustaining this?... ) Platelet rich plasma with allograft cancellous bone carrier fracture Tibial Shaft FX Ankle Team!

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