Skeletal Trauma: Basic Science, Management, and Reconstruction

2689 Pages·2003·130.418 MB·English

by  Jesse Jupiter, Alan Levine, Peter Trafton

SKELETAL TRAUMA
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MEDICAL ILLUSTRATORS
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Theeditorswouldliketorecognizetheworkofthemedicalillustrators
listedbelowwhocreatedthebeautifulartforthefirstedition,
muchofwhichhasbeenretainedforthisnewedition:
PhilipAshleyandDenisLee
inassociationwith
LeonaAllison
MarieChartrand
MeganCostello
CharlesCurro
GlennEdelmayer
TheodoreHuff
ChristineJones
JohnKlausmeyer
ValerieLoomis
LarryWard
TheeditorsespeciallywishtothankTheodoreHuff,
whocreatedallofthenewartworkforthisedition.
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T h i r d E d i t i o n
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SKELETAL
TRAUMA
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Basic Science, Management, and Reconstruction
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BRUCE D. BROWNER, M.D., F.A.C.S. ALAN M. LEVINE, M.D.
Gray-GosslingProfessorandChairman ProfessorofOrthopaedicSurgery
DepartmentofOrthopaedicSurgery UniversityofMarylandSchoolofMedicine
UniversityofConnecticutHealthSciencesCenter Director,AlvinandLoisLapidusCancerInstitute
Farmington,Connecticut SinaiHospital
Director,DepartmentofOrthopaedics Baltimore,Maryland
HartfordHospital
Hartford,Connecticut
PETER G. TRAFTON, M.D., F.A.C.S.
ProfessorandViceChairman
JESSE B. JUPITER, M.D.
DepartmentofOrthopaedicSurgery
ProfessorofOrthopaedicSurgery BrownUniversitySchoolofMedicine
HarvardMedicalSchool Surgeon-in-Charge,OrthopaedicTrauma
Director,OrthopaedicHandService RhodeIslandHospital
MassachusettsGeneralHospital Providence,RhodeIsland
Boston,Massachusetts
SAUNDERS
AnImprintofElsevierScience
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SAUNDERS
AnImprintofElsevierScience
TheCurtisCenter
IndependenceSquareWest
Philadelphia,Pennsylvania
Volume1:Partno.9997621123
Volume2:Partno.9997621131
SKELETALTRAUMA TwovolumesetISBN0-7216-9481-0
Copyright2003,ElsevierScience(USA).Allrightsreserved.
Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorby
anymeans,electronic,mechanical,photocopying,recording,orotherwise,withoutpriorpermissionofthe
publisher(Saunders,TheCurtisCenter,IndependenceSquareWest,Philadelphia,PA19106-3399).
Notice
Orthopaedicmedicineisanever-changingfield.Standardsafetyprecautionsmustbefollowed,butasnew
research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become
necessary or appropriate. Readers are advised to check the most current product information provided by the
manufacturerofeachdrugtobeadministeredtoverifytherecommendeddose,themethodanddurationof
administration, and the contraindications. It is the responsibility of the treating physician, relying on
experienceandknowledgeofthepatient,todeterminedosagesandthebesttreatmentforeachindividual
patient. Neither the Publisher nor the editor assumes any responsibility for any injury and/or damage to
personsorpropertyarisingfromthispublication.
THEPUBLISHER
FirstEdition1992.SecondEdition1998.
LibraryofCongressCataloging-in-PublicationData
Skeletaltrauma:basicscience,management,andreconstruction/BruceD.Browner...
[etal.].—3rded.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN0-7216-9481-0(set)—ISBN9997621123(v.1)—ISBN9997621131(v.2)
1.Musculoskeletalsystem—Woundsandinjuries.2.Fractures.I.Browner,BruceD.
[DNLM:1.Fractures.2.BoneandBones—injuries.3.Dislocations.4.
Ligaments—injuries.WE175S6272003]
RD731.S5642003
617.4′71044—dc21 2001042813
AcquisitionsEditor:RichardLampert
DevelopmentalEditor:FaithVoit
ProjectManager:LeeAnnDraud
GW/QWK
PrintedintheUnitedStatesofAmerica
Lastdigitistheprintnumber: 9 8 7 6 5 4 3 2 1
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TheEditorsDedicatetheThirdEditiontoTheirFamilies
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BarbaraTheaBrowner
JeremyToddBrowner
NicoleShannanBrowner
NinaBrowner
InmemoryofMonaAlexanderBrowner
Inappreciationofmyfather’ssupportandencouragement
IrwinEricBrowner
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BerylStephanieAbramsJupiter
StacyDeborahJupiter
BenjaminScottJupiter
InmemoryofMiriamandSamuelJupiter
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BarbaraPortnoyLevine
DanaAriLevine
AlissaLeighLevine
AndreaNaomiLevine
Inappreciationofmyparents’supportandencouragement
FeliceP.LevineandLeonLevine,M.D.
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FrancesConkeyTrafton
KatherineShaneTrafton
TheodoreGrierTrafton
ElizabethFairbankTrafton
InmemoryofVirginiaGrierTraftonandWillisA.Trafton,Jr.
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CONTRIBUTORS vii
BruceD.Browner,M.D.,F.A.C.S. LeoM.Cooney,Jr.,M.D.
Gray-Gossling Professor and Chairman, Department of Ortho- Humana Foundation Professor of Geriatric Medicine, Yale
paedic Surgery, University of Connecticut Health Sciences University School of Medicine; Chief, Section of Geriatrics, and
Center, Farmington; Director, Department of Orthopaedics, Chief, Section of General Internal Medicine, Yale–New Haven
HartfordHospital,Hartford,Connecticut Hospital,NewHaven,Connecticut
PrinciplesofInternalFixation;ChronicOsteomyelitis MedicalManagementofthePatientwithHipFracture
RichardA.Browning,M.D.
CharlesN.Cornell,M.D.
Clinical Professor, Brown University School of Medicine;
AssociateProfessor,OrthopaedicSurgery,CornellUniversityJoan
Anesthesiologist-in-Chief, Rhode Island Hospital, Providence,
and Sanford I. Weill Medical College and Graduate School of
RhodeIsland
Medical Sciences, New York; Chairman, Department of Ortho-
PainManagementfollowingTraumaInjury paedicSurgery,NewYorkHospitalMedicalCenterofQueensand
FlushingHospitalMedicalCenter,Flushing,NewYork
OsteoporoticFragilityFractures
FrederickW.Burgess,M.D.,Ph.D.
Clinical Associate Professor, Brown University School of Medi-
cine; Attending Anesthesiologist, Rhode Island Hospital, Provi-
JeromeM.Cotler,M.D.
dence,RhodeIsland
Professor,DepartmentofOrthopaedicSurgery,ThomasJefferson
PainManagementfollowingTraumaticInjury
UniversityHospital,Philadelphia,Pennsylvania
FracturesintheStiffandOsteoporoticSpine
AndrewE.Caputo,M.D.
ClinicalAssistantProfessor,DepartmentofOrthopaedicSurgery,
University of Connecticut Health Sciences Center, Farmington; CharlesM.Court-Brown,M.D.
Co-Director, Hand Surgery Service, Hartford Hospital and Professor of Orthopaedic Trauma, Edinburgh Orthopaedic
Connecticut Children’s Medical Center, Hartford, Connecticut TraumaUnit,RoyalInfirmaryofEdinburgh,Edinburgh,Scotland
PrinciplesofInternalFixation FemoralDiaphysealFractures
JamesB.Carr,M.D.
BradfordL.Currier,M.D.
Clinical Associate, Department of Orthopaedic Surgery, Univer-
sityofSouthCarolinaSchoolofMedicine;DirectorofOrthopae- AssociateProfessorandDirector,MayoClinicSpineFellowship,
dic Trauma, Palmetto-Richland Memorial Hospital, Columbia, MayoMedicalSchool,Rochester,Minnesota
SouthCarolina
MalleolarFracturesandSoftTissueInjuriesoftheAnkle
ChristopherW.DiGiovanni,M.D.
Assistant Professor, Department of Orthopaedic Surgery, Brown
CharlesCassidy,M.D. UniversitySchoolofMedicine;Director,FootandAnkleService,
Assistant Professor of Orthopaedic Surgery, Tufts University RhodeIslandHospital,Providence,RhodeIsland
School of Medicine; Chief, Hand and Upper Extremity Service, FootInjuries
NewEnglandMedicalCenter,Boston,Massachusetts
FracturesandDislocationsoftheCarpus
SridharM.Durbhakula,M.D.
AlbanyMedicalCenter,Latham,NewYork
DavidL.Ciraulo,D.O.,M.P.H.
ReconstructiveTotalHipReplacementafterProximalFemoral
AssistantProfessorofSurgery,UniversityofTennesseeCollegeof
Injuries
Medicine—Chattanooga Unit; Trauma/Critical Care Surgeon,
Chattanooga,TN
EvaluationandTreatmentoftheMultiple-TraumaPatient
ThomasA.Einhorn,M.D.
Professor and Chairman, Department of Orthopaedic Surgery,
MarkS.Cohen,M.D. Boston University School of Medicine; Chief of Orthopaedic
Surgery,BostonMedicalCenter,Boston,Massachusetts
Associate Professor and Director, Orthopaedic Education, and
Director,HandandElbowProgram,DepartmentofOrthopaedic EnhancementofSkeletalRepair
Surgery, Rush–Presbyterian–St. Luke’s Medical Center, Chicago,
Illinois
FracturesoftheDistalRadius FrankJ.Eismont,M.D.
Vice-Chairman and Professor, Department of Orthopaedic Sur-
gery,UniversityofMiamiSchoolofMedicine;Co-director,Acute
ChristopherL.Colton,M.D.,F.R.C.S.,F.R.C.S.Ed. Spinal Cord Injury Unit, Jackson Memorial Hospital, Miami,
Senior Consultant in Orthopaedic Trauma, Nottingham Univer- Florida
sityHospital,Nottingham,England ThoracicandUpperLumbarSpineInjuries;GunshotWounds
TheHistoryofFractureTreatment oftheSpine
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viii CONTRIBUTORS
DavidV.Feliciano,M.D. WilsonC.Hayes,Ph.D.
ProfessorofSurgery,EmoryUniversitySchoolofMedicine;Chief Professor of Exercise and Sport Science and Professor of
ofSurgery,GradyMemorialHospital,Atlanta,Georgia MechanicalEngineering,OregonStateUniversity;Presidentand
EvaluationandTreatmentofVascularInjuries Chief Executive Officer, Hayes & Associates, Inc., Corvallis,
Oregon
BiomechanicsofFractures
StevenR.Garfin,M.D.
ProfessorandChair,DepartmentofOrthopaedics,Universityof
California, San Diego, School of Medicine, La Jolla, California
AndrewC.Hecht,M.D.
ThoracicandUpperLumbarSpineInjuries
Associate Professor of Orthopaedics, Harvard Medical School;
Director of Massachusetts General Hospital Spine Surgery
HarrisGellman,M.D. Fellowship;DirectorofNewton-WellesleyHospitalSpineCenter,
Boston,Massachusetts
Professor and Co-Director, Hand and Upper Extremity Service,
DepartmentofOrthopaedicSurgery,UniversityofMiami,Miami, InjuriesoftheCervicocranium
Florida
GunshotWoundstotheMusculoskeletalSystem
DavidL.Helfet,M.D.
Professor of Orthopaedic Surgery, Cornell University Joan and
GregoryE.Gleis,M.D.
SanfordI.WeillMedicalCollegeandGraduateSchoolofMedical
AssociateClinicalProfessor,DepartmentofOrthopaedicSurgery, Sciences; Director, Combined Orthopaedic Trauma Service,
UniversityofLouisvilleSchoolofMedicine,Louisville,Kentucky HospitalforSpecialSurgeryandNewYork–PresbyterianHospi-
DiagnosisandTreatmentofComplications tal,NewYork,NewYork
FracturesoftheDistalFemur
JamesA.Goulet,M.D.
Professor, Department of Orthopaedic Surgery, University of
MichiganMedicalSchool;Director,OrthopaedicTraumaService, JohnA.Hipp,Ph.D.
UniversityofMichiganHospital,AnnArbor,Michigan Assistant Professor, Baylor College of Medicine; Chief Scientific
HipDislocations Officer,MedicalMetrics,Inc.,Houston,Texas
BiomechanicsofFractures
AndrewGreen,M.D.
Associate Professor, Department of Orthopaedic Surgery, Brown
LenworthM.Jacobs,M.D.,M.P.H.,F.A.C.S.
UniversitySchoolofMedicine,Providence,RhodeIsland
Professor of Surgery, University of Connecticut School of
ProximalHumeralFracturesandGlenohumeralDislocations
Medicine, Farmington; Director, Traumatology, Hartford Hospi-
tal,Hartford,Connecticut
StuartA.Green,M.D. EvaluationandTreatmentoftheMultiple-TraumaPatient
ClinicalProfessor,OrthopaedicSurgery,UniversityofCalifornia,
Irvine,SchoolofMedicine,Irvine,California
TheIlizarovMethod DavidJ.Jacofsky,M.D.
Instructor, Department of Orthopaedic Surgery, Mayo Clinic,
Rochester,Minnesota
ZbigniewGugala,M.D.
ComplicationsintheTreatmentofSpinalTrauma
The Joseph Barnhart Department of Orthopaedic Surgery,
Houston,Texas
ManagementTechniquesforSpinalInjuries
JesseB.Jupiter,M.D.
Professor of Orthopaedic Surgery, Harvard Medical School;
MunishC.Gupta,M.D. Director, Orthopaedic Hand Service, Massachusetts General
Associate Professor, Department of Orthopaedics, University Hospital,Boston,Massachusetts
of California, Davis, School of Medicine; Orthopaedic Surgeon,
FracturesandDislocationsoftheHand;FracturesoftheDistal
University of California, Davis, Medical Center, Sacramento,
Radius;DiaphysealFracturesoftheForearm;Traumatothe
California
AdultElbowandFracturesoftheDistalHumerus;Injuriesto
InitialEvaluationandEmergencyTreatmentoftheSpine-Injured theShoulderGirdle
Patient
SigvardT.Hansen,Jr.,M.D. TimothyL.Keenen,M.D.
Professor and Chairman Emeritus, Department of Orthopaedic Clinical Associate Professor of Orthopaedic Surgery, Oregon
Surgery,UniversityofWashingtonSchoolofMedicine;Director, HealthSciencesUniversitySchoolofMedicine,Portland,Oregon
Foot and Ankle Institute, Harborview Medical Center, Seattle, InitialEvaluationandEmergencyTreatmentoftheSpine-Injured
Washington Patient
FootInjuries;Post-traumaticReconstructionoftheFootand
Ankle
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CONTRIBUTORS ix
JamesF.Kellam,M.D.,F.R.C.S.(C.) RonaldW.Lindsey,M.D.
Director, Orthopedic Trauma Program, and Vice Chairman, Professor of Orthopaedic Surgery, The Joseph Barnhart Depart-
Department of Orthopedic Surgery, Carolinas Medical Center, mentofOrthopaedicSurgery,Houston,Texas
Charlotte, North Carolina; Adjunct Professor of Engineering, ManagementTechniquesforSpinalInjuries
ClemsonUniversity,Clemson,SouthCarolina
OrthopaedicManagementDecisionsintheMultiple-Trauma
Patient;PelvicRingDisruptions;DiaphysealFracturesofthe MargaretLobo,M.D.
Forearm Orthopaedic Resident, Thomas Jefferson University Hospital,
Philadelphia,Pennsylvania
OsteoporoticFragilityFractures
ChollW.Kim,M.D.,Ph.D.
Department of Orthopaedic Surgery, University of California,
SanDiego,SchoolofMedicine,LaJolla,California JayD.Mabrey,M.D.
ComplicationsintheTreatmentofSpinalTrauma Associate Professor of Orthopaedics, University of Texas Health
Science Center of San Antonio; Director, Total Joint Service,
UniversityHospital,SanAntonio,Texas
ChristianKrettek,M.D. PeriprostheticFracturesoftheLowerExtremities
Director, Trauma Department, Hannover Medical School,
Hannover,Germany
JeffreyW.Mast,M.D.
FracturesoftheDistalFemur
NorthernNevadaMedicalCenter,Sparks,Nevada
PrinciplesofInternalFixation
DavidKwon,M.S.
Medical Student, University of California, San Diego, School of
Medicine,LaJolla,California JoelM.Matta,M.D.
ClinicalProfessorofOrthopaedicSurgery,UniversityofSouthern
OsteoporoticFragilityFractures
California School of Medicine; John C. Wilson, Jr., Chair of
Orthopaedic Surgery, Good Samaritan Hospital, Los Angeles,
California
JosephM.Lane,M.D.
SurgicalTreatmentofAcetabularFractures
Professor of Orthopaedic Surgery and Assistant Dean, Cornell
University Joan and Sanford I. Weill Medical College and
Graduate School of Medical Sciences; Chief, Metabolic Bone
KeithMayo,M.D.
Disease,HospitalforSpecialSurgery,NewYork,NewYork
OrthopaedicCenter,Tacoma,Washington
OsteoporoticFragilityFractures
PelvicRingDisruptions
LorenL.Latta,P.E.,Ph.D.
AugustusD.Mazzocca,M.D.
ProfessorandDirectorofResearch,DepartmentofOrthopaedics
AssistantProfessor,DepartmentofOrthopaedicSurgery,Univer-
and Rehabilitation, University of Miami School of Medicine,
sity of Connecticut Health Sciences Center, Farmington,
Miami; Director of Orthopaedic Biomechanics Laboratory, Mt.
Connecticut
Sinai Medical Center/Miami Heart Institute, Miami Beach,
Florida PrinciplesofInternalFixation
PrinciplesofNonoperativeFractureTreatment
RobertA.McGuire,M.D.
ProfessorandChairman,DepartmentofOrthopedics,University
SebastianLattuga,M.D.
ofMississippiMedicalCenter,Jackson,Mississippi
Chief Spine Surgeon, Mercy Medical Center, Rockville Center,
ThoracicandUpperLumbarSpineInjuries
NewYork
GunshotWoundsoftheSpine
MichaelD.McKee,M.D.,F.R.C.S.(C.)
Associate Professor, Division of Orthopaedics, Department of
PaulE.Levin,M.D.
Surgery,UniversityofTorontoFacultyofMedicine;StaffSurgeon
Assistant Clinical Professor, Department of Orthopaedics, State and Assistant Medical Director, Trauma Program, St. Michael’s
UniversityofNewYorkatStonyBrook,StonyBrook,NewYork Hospital,Toronto,Ontario,Canada
HipDislocations TraumatotheAdultElbowandFracturesoftheDistalHumerus
AlanM.Levine,M.D. RobertY.McMurtry,M.D.
ProfessorofOrthopaedicSurgery,UniversityofMarylandSchool Professor of Surgery, Division of Orthopaedics, University of
of Medicine; Director, Alvin and Lois Lapidus Cancer Institute, WesternOntarioFacultyofMedicineandDentistry;Consultant,
SinaiHospital,Baltimore,Maryland Hand and Upper Limb Centre, St. Joseph’s Health Centre,
PathologicFractures;LowLumbarFractures;Fracturesofthe London,Ontario,Canada
Sacrum FracturesoftheDistalRadius
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x CONTRIBUTORS
DanaC.Mears,M.D.,Ph.D. DrorPaley,M.D.
Attending Orthopaedic Surgeon, University of Pittsburgh Medi- Professor, University of Maryland School of Medicine; Director,
calCenter—ShadysideHospital,Pittsburgh,Pennsylvania Rubin Institute for Advanced Orthopaedics, Sinai Hospital of
ReconstructiveTotalHipReplacementafterProximalFemoral Baltimore,Baltimore,Maryland
Injuries PrinciplesofDeformityCorrection
MichaelW.Mendes,M.D.
EdPesanti,M.D.,F.A.C.P.
AttendingPhysician,McLeodRegionalMedicalCenter,Florence,
Professor, Department of Medicine, University of Connecticut
SouthCarolina
School of Medicine; University of Connecticut Health Center,
PrinciplesofInternalFixation Farmington,Connecticut
ChronicOsteomyelitis
StuartE.Mirvis,M.D.,F.A.C.R.
Professor of Radiology, University of Maryland School of
MichaelS.Pinzur,M.D.
Medicine; Director, Trauma Radiology, University of Maryland
Professor of Orthopaedic Surgery and Rehabilitation, Loyola
R. Adams Cowley Shock-Trauma Center, Baltimore, Maryland
University of Chicago Stritch School of Medicine, Maywood,
SpinalImaging
Illinois
AmputationsinTrauma
SohailK.Mirza,M.D.
Assistant Professor, Department of Orthopaedics and Sports
Medicine,UniversityofWashingtonSchoolofMedicine;Harbor- SpirosG.Pneumaticos,M.D.
viewMedicalCenter,Seattle,Washington Assistant Professor, The Joseph Barnhart Department of Ortho-
InjuriesoftheLowerCervicalSpine paedicSurgery,Houston,Texas
ManagementTechniquesforSpinalInjuries
ToddD.Moldawer,M.D.
Co-Director, Spine Fellowship Program, Southern California AndrewN.Pollak,M.D.
OrthopedicInstitute,VanNuys,California
Associate Professor of Orthopaedic Surgery, University of Mary-
GunshotWoundstotheMusculoskeletalSystem landSchoolofMedicine;AttendingOrthopaedicTraumatologist,
R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
PrinciplesofExternalFixation
VictorA.Morris,M.D.
Assistant Professor of Medicine, General Medicine, Yale Univer-
sitySchoolofMedicine;Co-Director,MedicineConsultService,
MarkA.Pre´vost,M.D.
Yale University School of Medicine, New Haven, Connecticut
WalkerBaptistMedicalCenter,Jasper,Alabama
MedicalManagementofthePatientwithHipFracture
ThoracicandUpperLumbarSpineInjuries
CalinS.Moucha,M.D.
Chief Resident, Department of Orthopaedic Surgery, St. Luke’s– DavidRing,M.D.
Roosevelt Hospital Center and Columbia University College of Instructor, Department of Orthopaedics, Harvard Medical
PhysiciansandSurgeons,NewYork,NewYork School; Department of Orthopaedic Surgery, Massachusetts
GeneralHospital,Boston,Massachusetts
EnhancementofSkeletalRepair
InjuriestotheShoulderGirdle
MichaelL.Nerlich,M.D.,Ph.D.
Professor, Trauma Surgery, University of Regensburg Medical CraigS.Roberts,M.D.
School; Chairman, Department of Trauma Surgery, Regensburg Associate Professor and Residency Director, Department of
University Academic Medical Center, Regensburg, Bavaria, OrthopaedicSurgery,UniversityofLouisvilleSchoolofMedicine,
Germany Louisville,Kentucky
BiologyofSoftTissueInjuries DiagnosisandTreatmentofComplications
TomR.Norris,M.D.
C.M.Robinson,M.D.,F.R.C.S.
Department of Orthopaedic Surgery, California Pacific Medical
ConsultantOrthopaedicSurgeon,RoyalInfirmaryofEdinburgh,
Center,SanFrancisco,California
Edinburgh,Scotland
ProximalHumeralFracturesandGlenohumeralDislocations
FemoralDiaphysealFractures
WilliamT.Obremskey,M.D.,M.P.H.
AssistantProfessorofOrthopaedicsandRehabilitation,Division CraigM.Rodner,M.D.
of Orthopaedic Trauma, Vanderbilt University Medical Center, Department of Orthopaedic Surgery, University of Connecticut
Nashville,Tennessee HealthSystem,Farmington,Connecticut
EvaluationofOutcomesforMusculoskeletalInjury ChronicOsteomyelitis
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