A Clinical Overview of Management of First Time Anterior Shoulder Dislocation

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 47-52 | Abhay Narvekar, Nikhil Iyer, Nagraj Shetty, Shreya Joshi


Author: Abhay Narvekar [1], Nikhil Iyer [2], Nagraj Shetty [3], Shreya Joshi [4]

[1] Department of Orthopaedic and Arthroscopy surgeon, P D Hinduja National Hospital and Research Center, Mahim 400016, Global Hospital, Parel, Mumbai 400012, India
[2] Department of Orthopaedic and Arthroscopic Surgeon, Zen Multi-speciality Hospital, Chembur, Global Hospital, Parel, Reliance Hospital, Navi. Mumbai, India
[3] Department of Arthroscopy, Complex Knee and Shoulder Surgeon, Lilavati Hospital and Medical Research Centre, P D Hinduja, Khar, Max Nanavati Super-Speciality
hospital, Mumbai, India
[4] Department Orthopaedic and Arthroscopic Surgeon, Shushrusha Citizens Co-operative Hospital, Dadar, LifeCare Hospital, Sion, Mumbai, India


Address of Correspondence
Dr. Nikhil Iyer,
Consultant Orthopaedic and Arthroscopic Surgeon, Director ArthroSports Medical Service LLP.
OrthoCare Clinic, 603 Centerpoint, Opp. State Bank of India, Near Ambedkar garden, Chembur, Mumbai 400071, India.
E-mail: iyernikhil@yahoo.com


Background: Instability following a traumatic shoulder dislocation is known to cause significant morbidity especially as ost-traumatic dislocations occur in young active patients. The management of this injury is still controversial. There is always a debate between those that recommend surgical stabilization following a 1st time dislocation (FTD) and those that prefer treating them conservatively. The aim of treatment following a dislocation is to manage the episode such that there is no threat of recurrence, there is a full functional recovery with no apprehension, and an ability to get back to the same level of sporting activity.

Purpose: The purpose of the study is to review the current literature and provide recommendations regarding management following FTD.

Design: Clinical overview, Perspective.

Methods: Review of literature using PUBMED, MEDLINE.

Results: The present thought process is towards Arthroscopic primary stabilization following 1st time post-traumatic dislocation in young active individuals with projected significant overhead activities.

Conclusion: Management of a patient following a FTD/subluxation has been the subject of debate for a long time. A number of factors have been studied and published such as age, sports participation, sex, pathological findings after the dislocation to enable the surgeon to decide on the management of this condition. Recurrence comes at a cost of increasing the instability with every episode of dislocation. More the instability before the surgical stabilization, more are the chances of either failure or the requirement of a salvage procedure like a Latarjet with its inherent high complication rate. But not every patient with FTD should warrant a surgical stabilization. A personalized approach is recommended and not a one size fits all approach.

Keywords: First time dislocator, microinstability, Bankart lesion, Latarjet


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How to Cite this article: Narvekar A, Iyer N, Shetty N, Joshi S. A Clinical Overview of Management of First Time Anterior Shoulder Dislocation. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):47-52.

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Management of Chronic Palmar Distal Radio-ulnar Joint Dislocation of Wrist: A Case Report on Young Gymnast with 1-Year Follow-up

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 64-66 | Parag Lad, Pankaj Ahire


Author: Parag Lad [1], Pankaj Ahire [2]

[1] Department of Orthopaedics, Pinnacle Orthocentre & Jupiter Hospital, Thane, Maharashtra, India

[2] Department of Orthopaedics, P D Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India


Address of Correspondence
Dr. Parag Lad,
Department of Orthopaedic, Pinnacle Orthocentre, Chandanwadi-Charai Junction, Thane (401602), Maharashtra, India.
E-mail: orthodoc_p@yahoo.com


Background: A palmar dislocation of distal radio-ulnar joint (DRUJ) is rare and causes gross functional restriction of pronation. It is certainly major cosmetic concern for the patient as keeps the forearm supinated because of dislocation. Usually, such injuries are caused due to high velocity trauma and fall on supinated hand. The literature is sparse on the management of palmar dislocation of DRUJ.

Materials and Methods: We present a case report on the management of chronic palmar dislocation in a 27-year-old professional gymnast trainer with 1-year follow-up. We describe the surgical technique of open reduction by palmar approach and reconstruction of triangular fibrocartilage complex ligament by suture anchor. The post-operative rehabilitation protocol is also mentioned in detail.

Results: The patient has 80° pronation and painless wrist range of movements at 1-year follow-up. She is able to perform all activities of daily living though not confident in weight bearing on affected wrist.

Conclusion: As per our knowledge, this is described for the 1st time about the management of chronic palmar DRUJ case in young gymnast. The restricted pronation is important sign of palmar DRUJ dislocation. The return of pronation gives immense satisfaction to the patient.

Keywords: Case report, palmar, chronic, DRUJ, dislocation, wrist, gymnast


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How to Cite this article: Lad P, Ahire P. Management of Chronic Palmar Distal Radio-ulnar Joint Dislocation of Wrist: A Case Report on Young Gymnast with 1-Year Follow-up. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):64-66.

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Vertebral Fragility Fractures in Osteoporosis – A Comprehensive Review on its Management

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 67-76 | Vibhu Krishnan Viswanathan, Rishi M Kanna, Ajoy Prasad Shetty


Author: Vibhu Krishnan Viswanathan [1], Rishi M Kanna [1], Ajoy Prasad Shetty [1]

[1] Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India


Address of Correspondence
Dr. Rishi M Khana,
Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
E-mail: rishiortho@gmail.com


Introduction: Approximately 20% of individuals older than 50 years of age have been reported to present with vertebral fragility fractures (VFF) – a prevalence which is anticipated to steadily increase in future. VFF is associated with disabling pain, significant impairment of quality of life, reduced ambulatory capacity, impaired social interactions, and poor quality of sleep. Early detection, appropriate management, evaluation of osteoporosis, and prevention of future fragility fractures would form the crux of treatment. Nevertheless, there is no consensus on what constitutes the ideal management protocol for symptomatic VFF.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to prepare this review. A detailed review of the literature was performed using PubMed, EMBASE, MEDLINE, and Cochrane Database of Systematic Reviews, which were searched for eligible studies with terms “treatment of VEF,” “osteoporotic vertebral fracture (OVF),” “management of osteoporotic compression fracture,” “imaging in OVF,” “percutaneous vertebral augmentation,” and “conservative treatment of OVF” from inception to November 2021. Duplicate studies, case reports, and letters to the editor were excluded from the study.

Results: A total of 286 studies were identified using our search criteria. Of these, 142 were duplicates and 107 did not meet inclusion criteria. After removal of these articles through various stages of screening, a total of 37 studies were finally included in the review. Plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are helpful in the diagnosis, evaluation, and management of these fractures. Radiologically, unstable VFFs need to be identified based on the following criteria (>50% vertebral height loss, kyphosis ≥25–35°, substantial retropulsion of bony fragments, significant bony, or ligamentous posterior column injuries). Conservative treatment (which includes analgesics, orthoses, and early mobilization) has remained the traditional way of treating these fractures. More recent systematic reviews have demonstrated a significant improvement in early pain control, vertebral height restoration, and ambulation with percutaneous augmentation (PKP or PVP) procedures. These studies have recommended cement augmentation in patients with intractable pain, not responding to medications. Surgical stabilization is recommended in elderly patients with pseudoarthrosis, substantial intervertebral instability, intractable pain with vertebral collapse, neurological deficit, and kyphosis. The need for long-term medical therapy to improve the bone density cannot be understated.

Conclusion: A high index of suspicion is necessary to diagnose VFFs in elderly patients with back pain. Conservative treatment has remained the traditional way of treating these fractures. Recent evidence shows early pain control and better vertebral height restoration with cement augmentation procedures (PKP or PVP). Open surgical stabilization can be helpful in a subset of patients with substantial intervertebral instability, deformity, and neuro-deficit.

Keywords: Osteoporosis, vertebral fragility fractures, cement augmentation, kyphosis


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How to Cite this article: Krishnan V, Kanna RM, Shetty AP. Vertebral Fragility Fractures in Osteoporosis – A Comprehensive Review on its Management. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):67-76.

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Potpourri – Recent and Relevant Literature in Distal Femur Fractures

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 56-59 | Clevio Desouza , Nicholas Antao


Author: Clevio Desouza [1], Nicholas Antao [1]

[1] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, India


Address of Correspondence
Dr. Clevio Desouza,
Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, India.
E-mail: ceviod@gmail.com


Distal femur fractures include fractures of the supracondylar and intercondylar region and are relatively common injuries. The goals of treatment follow AO principles of anatomic reduction of the articular surface, restoration of limb alignment, length, and rotation. Despite improvements in implant design, management of distal femur fractures remains a challenge; fractures are often comminuted, intra-articular, and involve osteoporotic bone, making fixation challenging to achieve. In the geriatric trauma population, the incidence of co-morbidities is high and may impact the therapeutic options. We have aimed to bring together all the recent advances and literature in the management of distal femur fractures through this article.

Keywords: Distal femur, Plating, Nailing, Prosthesis


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How to Cite this article: Desouza C, Antao N. Potpourri – Recent and Relevant Literature in Distal Femur Fractures. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):56-59.

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Functional Outcome of Unilateral Biportal Endoscopic Ligamentum Flavum Preserving Discectomy

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 104-109 | Nicholas Antao, Clevio Desouza, Malcolm Pestonji, Jehangir Pestonji, Maulik Langal

DOI: 10.13107/jcorth.2022.v07i01.487

Author: Nicholas Antao [1], Clevio Desouza [1], Malcolm Pestonji [1], Jehangir Pestonji [1], Maulik Langal [1]

[1] Department of Orthopaedics, Holy Spirit Hospital, Mumbai, Maharashtra, India.


Address of Correspondence
Dr. Clevio Desouza,
Department of Orthopaedics, Holy Spirit Hospital, Mumbai, Maharashtra, India.
E-mail: ceviod@gmail.com


Introduction: Low back pain affects roughly 70–80% of people at some point in their lives. Lumbar disc prolapse is one of the major reasons of low back pain that causes severe morbidity around the world, affecting primarily the working-class young population. We conducted this study to describe the unilateral biportal endoscopic (UBE) discectomy technique for lumbar herniated disc with the aim on how to perform theses procedure safely while also preserving the structures like the facet joints through the posterior interlaminar approach.

Materials and Methods: This was a retrospective study conducted between July 2019 and July 2021. The total number of patients included in the study was 41. A total of 54 levels of discectomy were done. The visual analog scale was used to assess back pain and lower leg symptoms, the Oswestry Disability Index was used to assess degrees of disability, and modified Macnab criteria were used to assess overall outcomes of treatment.

Results: Following the procedure, there was a significant improvement. The ultimate outcomes were excellent in 24 patients (58.53%), good in 15 (36.58%), fair in 2 (4.8%), and poor in 0 patients, according to the modified Macnab criteria. That is, 95.11% of patients had excellent or good results.

Conclusion: The UBE discectomy approach for lumbar disc herniation is a minimally invasive procedure that is both safe and successful. There is no soft-tissue degradation or facet joint destruction.

Keywords: Unilateral biportal endoscopy, ligamentum flavum, discectomy, visual analog scale, Oswestry Disability Index, Macnab criteria


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How to Cite this article: Antao N, Desouza C, Pestonji M, Pestonji J, Langaliya M. Functional Outcome of Unilateral Biportal Endoscopic Ligamentum Flavum Preserving Discectomy. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):104-109.

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Ultrasonic Bone Scalpel and Its Role In Spine Surgeries : An Article Review

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 20-27| TausifAhmed Shikalgar, Priyank Patel, Abhay Nene, Shubhanshu Bhaladhare, Sanjay Puri, Manojkumar Gaddiker


Author: TausifAhmed Shikalgar [1], Priyank Patel [1], Abhay Nene [1], Shubhanshu Bhaladhare [1], Sanjay Puri [1], Manojkumar Gaddiker [1]

[1] Department of Orthopaedics, Lilavati Hospital and Research Centre, Bandra (W), Mumbai 400050, India


Address of Correspondence
Dr. Tausif Ahmed Shikalgar,
Fellow Spine Surgery, Under Dr. Abhay Nene, Lilavati Hospital and Research Centre, Bandra (W), Mumbai – 400 050, Maharashtra, India.
E-mail: Dr.tausifahmedshikalgar@gmail.com


The past few decades have seen tremendous improvement in the field of spine surgery. Spine surgery involves a number of procedures from simple laminectomy to deformity correction. This requires high surgical skills and care, which is achieved by a number of instruments, which, in turn, protect surgeons from committing complications. Recent advancements in spine surgery include ultrasonic bone scalpel, which cut bone accurately and precisely. It is a unique surgical device which offers a controlled osteotomy which slices the hard bone while the soft tissues remain largely unaffected. The major benefits of using this modern instrument are the soft-tissue sparing, controlled cutting, reduced bleeding, and thereby increasing the effectiveness. The aim of this article is to summarize its uses in current practice of spine surgeons and to focus on its advantages and complications associated with uses of this device.

Keywords: Ultrasonic bone scalpel, spine surgery, complications, safety, osteotomy


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How to Cite this article: Shikalgar TA, Patel P, Nene A, Bhaladhare S, Puri S, Gaddikeri M. Ultrasonic Bone Scalpel and its Role in Spine Surgeries: An Article Review. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):20-27.

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Arthroscopic Latarjet – Retrospective Study of 74 Patients – Technique, Indications, and Results

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 94-99 | Sameer Shaikh, Farzana Shaikh, Santosh Takale, Amol Gowaikar, Manohar Kachare, Vijaykumar Rukde, Mahadev Mali


Author: Sameer Shaikh [1], Farzana Shaikh [1], Santosh Takale [1], Amol Gowaikar [1], Manohar Kachare [1], Vijaykumar Rukde [1], Mahadev Mali [1] 

[1] Department of Sports Injuries & Joint Replacement, Shaikh Institute of Orthopaedics & Trauma, Miraj – 416410, Maharashtra, India


Address of Correspondence
Dr. Sameer Salim Shaikh,
Department of Sports Injuries & Joint Replacement, Shaikh Institute of Orthopaedics & Trauma, Miraj – 416410, Maharashtra, India.
E-mail: drsameerphysio@rediffmail.com


Objective: The all arthroscopic latarjet procedure was performed to manage anterior recurrent shoulder instability with bone loss. The aim of present study was to briefly describe the technique and to evaluate the results and complications following procedure.

Materials and Methods: Retrospective study of 74 patients with anterior shoulder instability since 2010–2019 conducted in a single center. Out of 74 patients, 32 patients were sportsperson who were involved in at least district level games, 14 were manual laborers and remaining were non-sportsmen. Fifty-five patients were males and 19 were females. Arthrolatarjet was done using DePuy Synthes double barrel cannula system and fixation of coracoid with 4.00 mm titanium cannulated cancellous screws with Top Hat. No capsular repair done in our cases..

Results: Out of 74 cases, two-screw fixation was possible in 98% of patients. No neurological complications seen in our series. Two patients had graft resorption and non-union. Osteolysis of the graft around upper screw is seen in eight patients post-operative computed tomography scans but clinically no complaints. Technically challenging in first 25 cases.

Conclusion: Arthrolatarjet is a safe and reproducible procedure which gives good results, better visualization of anatomy, more precise graft positioning, concomitant abnormalities that can be treated. Cadaveric workshops needed. Technically demanding.

Keywords: Arthroscopic latarjet, glenoid bone loss, humeral boneless, double barrel cannula, depuy synthes


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How to Cite this article: Shaikh S, Shaikh F, Takale S, Gowaikar A, Kachare M, Rukde V, Mali M. Arthroscopic Latarjet – Retrospective Study of 74 Patients – Technique, Indications, and Results. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):94-99.

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Management of Periprosthetic Femoral Fractures following Total Hip Replacement: A Case Series

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 100-103 | Lokesh Kumar Yogi, Vijay Chandrakant Shinde, Moti Janardhan Naik, Vikash Kumar


Author: Lokesh Kumar Yogi [1], Vijay Chandrakant Shinde [1], Moti Janardhan Naik [1], Vikash Kumar [2]

[1] Department of Orthopaedic Surgery, Government Medical College, Aurangabad, Maharashtra, India.

[2] Department of Orthopaedic Surgery, Deen Dayal Upadhyaya Hospital, New Delhi, India.

Address of Correspondence
Dr. Lokesh Kumar Yogi,
Department of Orthopaedic Surgery, Government Medical College, Aurangabad, Maharashtra, India.
E-mail: lokesh.k.yogi@gmail.com


Background: Periprosthetic femoral fractures following total hip arthroplasty (THA) are not very uncommon. At present the Vancouver classification provides management algorithm for deciding treatment options but treatment options may vary between surgeons, where as in this study most patients managed were according to Vancouver classification management algorithm. The most common treatment modality for treating periprosthetic femoral fractures around a well-fixed stem is with osteosynthesis, but fracture with loose stem requires revision arthroplasty and fracture with poor bone requires bone graft augmentation.

Methods: We reviewed 21 consecutive cases with periprosthetic femoral fractures in association with THA between June 2018 and December 2020. Locking and non locking compression plates, wires, cables system were used for osteosynthesis. Most of fractures were managed according to Vancouver classification management algorithm but modified in some cases according to the surgeon’s skills and judgment.

Results: According to Vancouver classification, two patients had AL fractures, two patients had AG fractures, twelve Patients had B1, five patients had B2, two patients had B3 and one patient had type C fracture. Of these two cases were treated by conservatively, sixteen cases were treated by osteosynthesis, three cases by revision arthroplasty.

Conclusion: The careful analysis of implant stability and fracture patterns is crucial for the optimal treatment of Periprosthetic femoral fractures. Expert Surgeon’s skills are needed to deal with periprosthetic femoral fractures.

Keywords: Locking compression plate, periprosthetic fractures, total hip arthroplasty, Vancouver classification


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How to Cite this article: Yogi LK, Shinde VC, Naik MJ, Kumar V. Management of periprosthetic femoral fractures following total hip replacement: A case series. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):100-103.

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Massive Tophaceous Gout at Right Elbow Region Sin 55 Years Old Male: A Case Report

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 122-125 | Ida Bagus Anom Krishna Caitanya, Made Agus Maharjana

DOI: 10.13107/jcorth.2022.v07i01.493

Author: Ida Bagus Anom Krishna Caitanya [1], Made Agus Maharjana [2]

[1] Department of Orthopaedics and Traumatology, Sanglah Hospital, Udayansa University, Bali, Indonesia.

[2] Pediatric consult of Department of Orthopaedics and Traumatology, Sanglah Hospital, Udayansa University, Bali, Indonesia


Address of Correspondence
Dr. Ida Bagus Anom Krishna Caitanya,
Department of Orthopaedics and Traumatology, Sanglah Hospital, Udayansa University, Bali, Indonesia.
E-mail: krishnacaitanya2112@gmail.com


Gouty arthritis is one of the most common inflammatory joint diseases, characterized by monosodium urate crystals in or around the joints that comes from purine metabolism. Risk factors of gout are age, excessive intake of purine, alcohol, obesity, lack of physical activity, hypertension and heart disease, certain drugs, and impaired kidney function. This case presented a 55-year-old male patient with lumps and pain in the right elbow. Uric acid laboratory test results with a level of 9.20 mg/dL. Surgical excision could be the only solution to solve minimally decreased range of motion and aesthetic problems. Metabolic problems should be considered a priority with the patients who have unilateral joints problems.

Keywords: Chronic gout, tophaceous, elbow, pseudotumor


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How to Cite this article: Caitanya IBAK, Maharjana MA. Massive Tophaceous Gout at Right Elbow Region Sin 55 Years Old Male: A Case Report. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):122-125.

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Classification of Thoracolumbar Fractures: A Narrative Review

Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 77-84 | Harvinder Singh Chhabra, Jitesh Manghwani


Author: Harvinder Singh Chhabra [1], Jitesh Manghwani [1]

[1] Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India


Address of Correspondence
Dr. Harvinder Singh Chhabra,
Medical Director and Chief of Spine service, Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
E-mail: drhschhabra@isiconline.org


Thoracolumbar fractures constitute 75% of the cases of spine trauma. Thoracolumbar classification systems are important to diagnose, stage, determine the management of vertebral lesions, and predict the results of the different treatment options. This narrative review describes how the classification systems evolved over time with the unique features of each historically. Radiographs are the initial step of investigation. Magnetic resonance imaging and computed tomography help in delineating the injury better. This article narrates diagnosing instability and the role of each classification system in aiding to make a decision of a particular thoracolumbar fracture with merits and demerits of each.

Keywords: Thoracolumbar, classification, review, AOSpine, TLICS, SCS


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How to Cite this article: Chhabra HS, Manghwani J. Classification of Thoracolumbar Fractures: A Narrative Review. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):77-84.

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