605:
available evidence suggests that if the child has a median nerve palsy, their neurological recovery is faster, more complete and more probable if an open reduction and exploration of the nerve is performed. If the operating surgeons chooses to perform a closed reduction & percutaneous k-wiring in the presence of a neurological (and/or vascular) deficit and the pulse does not return immediately or the neurological deficit recover, then urgent surgical exploration is indicated. In patients with a "pink but pulseless hand" (absent radial pulse but demonstrable perfusion at extremities) after successful reduction and percutaneous pinning, there is uncertainty about the ideal management and imaging or surgical exploration should be considered given the risk of
Volkmann's contracture.
556:
applying traction along the long axis of the humerus with elbow in slight flexion. Full extension of the elbow is not recommended because the neurovascular structures can hook around the proximal fragment of the humerus. If the proximal humerus is suspected to have pierced the brachialis muscle, gradual traction over the proximal humerus should be given instead. After that, reduction can be done through hyperflexion of the elbow can be done with the olecranon pushing anteriorly. If the distal fragment is internally rotated, reduction maneuver can be applied with extra stress applied over medial elbow with pronation of the forearm at the same time.
361:
349:
373:
192:
fracture may result in an effusion in the elbow joint. With severe displacement, there may be an anterior dimple from the proximal bone end trapped within the biceps muscle. The skin is usually intact. If there is a laceration that communicates with the fracture site, it is an open fracture, which increases infection risk. For fractures with significant displacement, the bone end can be trapped within the biceps muscle with resulting tension producing an indentation to the skin, which is called a "pucker sign".
67:. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
395:
259:
103:
the weakness of the hand with a weak "OK" sign on physical examination (Unable to do an "OK" sign; instead a pincer grasp is performed). Radial nerve would be injured if the distal humerus is displaced postero-medially. This is because the proximal fragment will be displaced antero-laterally. Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus.
29:
183:) are located at the supracondylar area and can give rise to complications if these structures are injured. Most vulnerable structure to get damaged is median nerve. Meanwhile, the flexion-type of supracondylar humerus fracture is less common. It occurs by falling on the point of the elbow, or falling with the arm twisted behind the back. This causes anterior dislocation of the proximal fragment of the humerus.
322:- A non-displaced fracture can be difficult to identify and a fracture line may not be visible on the X-rays. However, the presence of a joint effusion is helpful in identifying a non-displaced fracture. Bleeding from the fracture expands the joint capsule and is visualized on the lateral view as a darker area anteriorly and posteriorly, and is known as the
222:. Antero-posterior (AP) and lateral view of the elbow joint should be obtained. Any other sites of pain, deformity, or tenderness should warrant an X-ray for that area too. X-ray of the forearm (AP and lateral) should also be obtained for because of the common association of supracondylar fractures with the fractures of the forearm. Ideally,
614:
commonly due to fall on an outstretch hand. Extension type of injury (70% of all elbow fractures) is more common than the flexion type of injury (1% to 11% of all elbow injuries). Injury often occurs on the non-dominant part of the limb. Flexion type of injury is more commonly found in older children.
595:
For routine displaced supracondylar fractures requiring percutaneous pinning, radiographic evaluation and clinical assessment can be delayed until the pin removal. Pins are only removed when there is no tenderness over the elbow region at 3 to 4 weeks. After pin removal, mobilisation of the elbow can
586:
should be performed to prevent any infection into the elbow joint. All Type II and III fractures requiring elbow flexion of more than 90° to maintain the reduction needs to be fixed by percutaneous pinning. All Type IV fractures of supracondylar humerus are unstable; therefore, requires percutaneous
573:
Percutaneous pinning are usually inserted over the medial or lateral sides of the elbow under X-ray image intensifier guidance. There is 1.8 times higher risk of getting nerve injury when inserting both medial and lateral pins compared to lateral pin insertion alone. However, medial and lateral pins
102:
should be performed to ascertain blood flow of the affected limb if the distal pulses are not palpable. Anterior interosseus branch of the median nerve most often injured in postero-lateral displacement of the distal humerus as the proximal fragment is displaced antero-medially. This is evidenced by
613:
Supracondylar humerus fractures is commonly found in children between 5 and 7 years (90% of the cases), after the clavicle and forearm fractures. It is more often occurs in males, accounting of 16% of all pediatric fractures and 60% of all paediatric elbow fractures. The mechanism of injury is most
564:
Gartland III and IV are unstable and prone to neurovascular injury. Therefore, closed or open reduction together with percutaneous pinning within 24 hours is the preferred method of management with low complication rates. Straight arm lateral traction can be a safe method to deal with
Gartland Type
226:
should be used to immobilise the elbow at 20 to 30 degrees flexion in order to prevent further injury of the blood vessels and nerves while doing X-rays. Splinting of fracture site with full flexion or extension of the elbow is not recommended as it can stretch the blood vessels and nerves over the
209:
The neurologic status must be assessed including the sensory and motor function of the radial, ulnar, and median nerves (see "neurovascular complications" below). Neurologic deficits are found in 10-20% of patients. The mostly commonly injured nerve is the median nerve (specifically, the anterior
604:
Absence of radial pulse is reported in 6–20% of the supracondylar fracture cases. This is because brachial artery is frequently injured in
Gartland Type II and Type III fractures, especially when the distal fragment is displaced postero-laterally (proximal fragment displaced antero-medially). The
577:
Percutaneous pinning should be done when close manipulation fails to achieve the reduction, unstable fracture after closed reduction, neurological deficits occurs during or after the manipulation of fracture, and surgical exploration is required to determine the integrity of the blood vessels and
191:
A supracondylar humerus facture is diagnosed by x-ray and the injured limb will be examined to assess the surrounding soft tissue, neurovascular status, and to identify any other injuries to the affected area. Pain, swelling, and deformity near the elbow or arm area is common and a bleed near the
200:
The vascular status must be assessed, including the warmth and perfusion of the hand, the time for capillary refill, and the presence of a palpable radial pulse. Limb vascular status is categorized as "normal," "pulseless with a (warm, pink) perfused hand," or "pulseless–pale (nonperfused)" (see
555:
Gartland Type II fractures requires closed reduction and casting at 90 degrees flexion. Percutaneous pinning is required if more than 90 degrees flexion is required to maintain the reduction. Closed reduction with percutaneous pinning has low complication rates. Closed reduction can be done by
166:
acts as a fulcrum which focuses the stress on distal humerus (supracondylar area), predisposing the distal humerus to fracture. The supracondylar area undergoes remodeling at the age of 6 to 7, making this area thin and prone to fractures. Important arteries and nerves
565:
III fractures. Although
Gartland Type III fractures with posteromedial displacement of distal fragment can be reduced with closed reduction and casting, those with posterolateral displacement should preferably be fixed by percutaneous pinning.
372:
145:
The distal humerus grows slowly post fracture (only contributes 10 to 20% of the longitudinal growth of the humerus), therefore, there is a high rate of malunion if the supracondylar fracture is not corrected appropriately. Such
1143:
De
Pellegrin, M.; Fracassetti, D; Moharamzadeh, D; Origo, C; Catena, N (2018). "Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review".
360:
299:
On lateral view of the elbow, there are five radiological features should be looked for: tear drop sign, anterior humeral line, coronoid line, fish-tail sign, and fat pad sign/sail sign (anterior and posterior).
1203:
574:
insertions are able to stabilise the fractures more properly than lateral pins alone. Therefore, medial and lateral pins insertion should be done with care to prevent nerve injuries around elbow region.
75:
A child will complain of pain and swelling over the elbow immediately post trauma with loss of function of affected upper limb. Late onset of pain (hours after injury) could be due to muscle
547:
has earlier resumption of activity when compared to immobilisation using collar and cuff sling. Both methods gives similar pain scores and activity level at two weeks of treatment.
336:
should touch the anterior part of the lateral condyle of the humerus. If lateral condyle appears posterior to this line, it indicates the posterior displacement of lateral condyle.
106:
A puckered, dimple, or an ecchymosis of the skin just anterior to the distal humerus is a sign of difficult reduction because the proximal fragment may have already penetrated the
893:. Azar, Frederick M.,, Canale, S. T. (S. Terry),, Beaty, James H.,, Preceded by: Campbell, Willis C. (Willis Cohoon), 1880-1941. (Thirteenth ed.). Philadelphia, PA.
272:
The first definition of
Baumann's angle is an angle between a line parallel to the longitudinal axis of the humeral shaft and a line drawn along the lateral epicondyle.
162:
Extension type of supracondylar humerus fractures typically result from a fall on to an outstretched hand, usually leading to a forced hyperextension of the elbow. The
133:
which leads to long-term complication of
Volkmann's contracture (fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the
503:
Treatment options for supracondylar humerus fractures vary depending if the bone is displaced (out of position) or not displaced (see classification section above).
348:
587:
pinning. Besides, any polytrauma with multiple fractures of the same side requiring surgical intervention is another indication for percutaneous pinning.
82:
It is important to check for viability of the affected limb post trauma. Clinical parameters such as temperature of the limb extremities (warm or cold),
1100:"The Pink Pulseless Hand: A Review of the Literature Regarding Management of Vascular Complications of Supracondylar Humeral Fractures in Children"
342:- The distal fragment is rotated away from the proximal fragment, thus the sharp ends of the proximal fragment looks like a shape of a fish-tail.
922:
1883:
230:
Depending on the child's age, parts of the bone will still be developing and if not yet calcified, will not show up on the X-rays. The
378:
The anterior humeral line is not reliable in children with sparse ossification of the capitulum, such as in this 6 months old child.
366:
Anterior humeral line (black line), with normal area passed on the capitulum of the humerus colored in green in a 4 year old child.
543:
is recommended. In one study, for those children who was done percutaneous pinning, immobilisation using a posterior splint and an
312:- It is a line drawn down along the front of the humerus on the lateral view and it should pass through the middle third of the
269:
can be evaluated through AP view of the elbow by looking at the
Baumann's angle. There are two definitions of Bowmann's angle:
57:
1365:
291:. Reported normal values for Baumann's angle range between 9 and 26°. An angle of more than 10° is regarded as acceptable.
1270:
638:
Marson, Ben A.; Ikram, Adeel; Craxford, Simon; Lewis, Sharon R.; Price, Kathryn R.; Ollivere, Benjamin J. (2022-06-09).
316:. If it passes through the anterior third of the capitulum, it indicates the posterior displacement of distal fragment.
63:
just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and
1758:
898:
990:
952:
239:
1061:"Median Nerve Palsy in Pediatric Supracondylar Humerus Fractures Recovers Faster With Open Than Closed Reduction"
1433:
1059:
Wilks, Daniel J.; Ye, Xuan; Biggins, Rose; Wang, Kemble K.; Wade, Ryckie G.; McCombe, David (August 2023).
333:
1519:
250:
of the ulna at 8 to 9 years of age, and lateral epicondyle of the humerus to ossify at 10 years of age.
1408:
1283:
1743:
1509:
1413:
1360:
808:
Eira, Kuoppala; Roope, Parvianien; Tytti, Pokka; Minna, Serlo; Juha-Jaakko, Sinikumpu (11 May 2016).
134:
124:
210:
interosseous portion of the median nerve). Injuries to the ulnar and radial nerves are less common.
313:
288:
276:
231:
219:
1888:
1589:
1574:
1263:
536:
389:
99:
1559:
1403:
1340:
938:
323:
980:
810:"Low incidence of flexion-type supracondylar humerus fractures but high rate of complications"
1767:
1702:
1623:
1418:
306:- Tear drop sign is seen on a normal radiograph, but is disturbed in supracondylar fracture.
695:
1772:
1738:
1584:
532:
520:
130:
137:). Therefore, early surgical reduction is indicated to prevent this type of complication.
8:
1628:
1579:
1569:
1423:
1350:
1317:
1307:
1302:
243:
90:
of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of
1060:
1857:
1847:
1777:
1543:
1428:
1256:
1169:
916:
834:
809:
782:
757:
672:
639:
129:
Swelling and vascular injury following the fracture can lead to the development of the
1748:
1697:
1656:
1613:
1564:
1481:
1476:
1468:
1388:
1297:
1161:
1121:
1098:
Griffin, K.J.; Walsh, S.R.; Markar, S.; Tang, T.Y.; Boyle, J.R.; Hayes, P.D. (2008).
1080:
1041:
986:
948:
904:
894:
866:
839:
787:
773:
677:
659:
540:
512:
223:
87:
41:
1173:
511:
Undisplaced or minimally displaced fractures can be treated by using an above elbow
227:
bone fragments or can cause impingement of these structures into the fracture site.
1806:
1796:
1729:
1719:
1712:
1618:
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1072:
1031:
829:
821:
777:
769:
667:
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651:
528:
516:
432:
354:
Anterior and posterior sail sign in a child who has a subtle supracondylar fracture
91:
83:
825:
1837:
1692:
1687:
1661:
1648:
1555:
1398:
1380:
1370:
1322:
1248:
1157:
1076:
524:
176:
527:
of the fracture site is more than 10 degrees when compared to the normal elbow,
1852:
1842:
1707:
1678:
1633:
1393:
1355:
1116:
1099:
858:
235:
1212:
1020:"Elbow your way into reporting paediatric elbow fractures – A simple approach"
279:
angle. It is the angle between the line perpendicular to the long axis of the
1877:
1829:
1787:
1638:
1605:
1548:
1538:
1312:
1279:
1231:
1084:
1045:
908:
663:
615:
579:
151:
95:
266:
1815:
1491:
1453:
1165:
1125:
1036:
1019:
870:
843:
791:
681:
284:
172:
168:
394:
36:
An elbow X-ray showing a displaced supracondylar fracture in a young child
583:
180:
64:
1195:
1142:
94:(radial, median, and ulnar nerves), and any wounds which would indicate
1862:
1332:
488:
479:
Lateral periosteal hinge intact. Distal fragment goes posterolaterally
107:
640:"Interventions for treating supracondylar elbow fractures in children"
544:
471:
Medial periosteal hinge intact. Distal fragment goes posteromedially
247:
163:
76:
889:
Terry Canale, S.; Azar, Frederick M.; Beaty, James H. (2016-11-21).
258:
462:
Complete displacement but have perisosteal (medial/lateral) contact
275:
Another definition of
Baumann's angle is also known as the humeral-
147:
79:(reduced oxygen supply). This can lead to loss of muscle function.
28:
280:
60:
1207:
942:
1445:
1018:
Kilborn, Tracy; Moodley, Halvani; Mears, Stewart (2015).
491:
disruption with instability in both flexion and extension
637:
1097:
204:
1104:
European
Journal of Vascular and Endovascular Surgery
888:
242:
starts to ossify at 4 to 5 years of age, followed by
1185:
1017:
807:
1278:
1058:
519:and extreme flexion should be avoided to prevent
1875:
979:John, Ebnezar; Rakesh, John (31 December 2016).
398:Supracondylar fractures: Gartland classification
332:- A line drawn along the anterior border of the
865:, Treasure Island (FL): StatPearls Publishing,
234:is the first to ossify at the age of one year.
110:muscle and the subcutaneous layer of the skin.
756:Vineet, Kumar; Ajai, Singh (1 December 2016).
751:
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762:Journal of Clinical and Diagnostic Research
644:The Cochrane Database of Systematic Reviews
559:
1271:
1257:
1006:
978:
921:: CS1 maint: location missing publisher (
857:Hope, Natalie; Varacallo, Matthew (2023),
758:"Fracture Supracondylar Humerus: A Review"
755:
712:
27:
1115:
1035:
947:(12 ed.). Elsevier Health Sciences.
929:
833:
781:
671:
118:
961:
943:S. Terry Canale, James H. Beaty (2012).
798:
393:
257:
568:
1876:
618:can occur for up to 30% of the cases.
201:"neurovascular complications" below).
1252:
523:and vascular compromise. In case the
70:
1366:Zygomaticomaxillary complex fracture
633:
631:
550:
515:in 90 degrees flexion for 3 weeks.
205:Sensory and motor nerve examination
13:
1884:Injuries of shoulder and upper arm
1759:Combined tibia and fibula fracture
1024:South African Journal of Radiology
506:
14:
1900:
1181:
1065:Journal of Pediatric Orthopaedics
945:Campbell's Operative Orthopaedics
891:Campbell's operative orthopaedics
859:"Supracondylar Humerus Fractures"
628:
383:
253:
431:Angulated with intact posterior
371:
359:
347:
294:
240:medial epicondyle of the humerus
113:
1136:
1091:
1052:
985:. JP Medical Ltd. p. 135.
608:
1434:Vertebral compression fracture
882:
850:
688:
656:10.1002/14651858.CD013609.pub2
54:supracondylar humerus fracture
22:Supracondylar humerus fracture
1:
826:10.1080/17453674.2016.1176825
696:"OrthoKids - Elbow Fractures"
621:
498:
1158:10.1016/j.injury.2018.09.046
1077:10.1097/BPO.0000000000002424
774:10.7860/JCDR/2016/21647.8942
590:
334:coronoid process of the ulna
186:
157:
7:
600:Neurovascular complications
196:Vascular system examination
140:
10:
1905:
1409:Craniocervical instability
1117:10.1016/j.ejvs.2008.08.013
387:
218:Diagnosis is confirmed by
122:
1828:
1805:
1786:
1757:
1744:Le Fort fracture of ankle
1728:
1677:
1670:
1647:
1604:
1528:
1499:
1490:
1467:
1444:
1414:Flexion teardrop fracture
1379:
1361:Le Fort fracture of skull
1331:
1290:
1222:
1189:
451:Angulation with rotation
213:
135:metacarpophalangeal joint
40:
35:
26:
21:
982:Textbook of orthopaedics
560:Gartland type III and IV
314:capitulum of the humerus
232:capitulum of the humerus
84:capillary refilling time
1590:Essex-Lopresti fracture
1520:Holstein–Lewis fracture
537:X-ray image intensifier
390:Gartland classification
100:Doppler ultrasonography
1404:Clay-shoveler fracture
1341:Basilar skull fracture
1037:10.4102/sajr.v19i2.881
399:
320:Fat pad sign/sail sign
263:
125:Volkmann's contracture
119:Volkmann's contracture
1768:Trimalleolar fracture
397:
310:Anterior humeral line
261:
56:is a fracture of the
1773:Bimalleolar fracture
1739:Maisonneuve fracture
569:Percutaneous pinning
533:percutaneous pinning
521:compartment syndrome
131:compartment syndrome
1424:Holdsworth fracture
1351:Mandibular fracture
1318:Pathologic fracture
1308:Greenstick fracture
1303:Chalkstick fracture
244:trochlea of humerus
1703:Toddler's fracture
1544:Monteggia fracture
1429:Jefferson fracture
1419:Hangman's fracture
1223:External resources
400:
264:
71:Signs and symptoms
1871:
1870:
1824:
1823:
1749:Bosworth fracture
1698:Gosselin fracture
1657:Duverney fracture
1600:
1599:
1469:Shoulder fracture
1389:Cervical fracture
1298:Avulsion fracture
1246:
1245:
814:Acta Orthopaedica
768:(12): RE01–RE06.
582:, surgical wound
541:operating theater
496:
495:
92:peripheral nerves
88:oxygen saturation
50:
49:
16:Medical condition
1896:
1807:Femoral fracture
1797:Patella fracture
1730:Fibular fracture
1720:Tillaux fracture
1713:Plafond fracture
1675:
1674:
1530:Forearm fracture
1501:Humerus fracture
1497:
1496:
1459:Sternal fracture
1346:Blowout fracture
1284:cartilage damage
1273:
1266:
1259:
1250:
1249:
1187:
1186:
1177:
1130:
1129:
1119:
1095:
1089:
1088:
1056:
1050:
1049:
1039:
1015:
1004:
1003:
1001:
999:
976:
959:
958:
936:
927:
926:
920:
912:
886:
880:
879:
878:
877:
854:
848:
847:
837:
805:
796:
795:
785:
753:
710:
709:
707:
706:
692:
686:
685:
675:
635:
551:Gartland type II
529:closed reduction
517:Orthopaedic cast
402:
401:
375:
363:
351:
31:
19:
18:
1904:
1903:
1899:
1898:
1897:
1895:
1894:
1893:
1874:
1873:
1872:
1867:
1820:
1801:
1782:
1778:Pott's fracture
1753:
1724:
1693:Segond fracture
1688:Bumper fracture
1666:
1662:Pipkin fracture
1649:Pelvic fracture
1643:
1596:
1556:Radius fracture
1524:
1486:
1463:
1440:
1399:Chance fracture
1381:Spinal fracture
1375:
1371:Zygoma fracture
1327:
1323:Spiral fracture
1286:
1277:
1247:
1242:
1241:
1218:
1217:
1198:
1184:
1139:
1134:
1133:
1096:
1092:
1057:
1053:
1016:
1007:
997:
995:
993:
977:
962:
955:
937:
930:
914:
913:
901:
887:
883:
875:
873:
855:
851:
806:
799:
754:
713:
704:
702:
694:
693:
689:
650:(6): CD013609.
636:
629:
624:
611:
602:
593:
571:
562:
553:
509:
507:Gartland type I
501:
392:
386:
379:
376:
367:
364:
355:
352:
297:
289:lateral condyle
262:Baumann's Angle
256:
216:
207:
198:
189:
177:brachial artery
160:
143:
127:
121:
116:
73:
17:
12:
11:
5:
1902:
1892:
1891:
1889:Bone fractures
1886:
1869:
1868:
1866:
1865:
1860:
1855:
1850:
1845:
1840:
1834:
1832:
1826:
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1822:
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1818:
1812:
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1803:
1802:
1800:
1799:
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1791:
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1780:
1775:
1770:
1764:
1762:
1755:
1754:
1752:
1751:
1746:
1741:
1735:
1733:
1726:
1725:
1723:
1722:
1717:
1716:
1715:
1708:Pilon fracture
1705:
1700:
1695:
1690:
1684:
1682:
1679:Tibia fracture
1672:
1668:
1667:
1665:
1664:
1659:
1653:
1651:
1645:
1644:
1642:
1641:
1636:
1631:
1626:
1621:
1616:
1610:
1608:
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1601:
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1587:
1582:
1577:
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1546:
1535:
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152:cubitus varus
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114:Complications
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1816:Hip fracture
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1492:Arm fracture
1454:Rib fracture
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1137:Bibliography
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1103:
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996:. Retrieved
981:
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703:. Retrieved
699:
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609:Epidemiology
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408:Description
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285:growth plate
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173:radial nerve
169:median nerve
161:
144:
128:
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1575:Chauffeur's
1152:: S37–S42.
584:debridement
578:nerves. In
443:Angulation
181:ulnar nerve
154:deformity.
65:epicondyles
1878:Categories
1863:Broken toe
876:2023-03-23
863:StatPearls
705:2017-08-24
622:References
499:Management
489:Periostial
277:capitellar
108:brachialis
46:Orthopedic
1858:Calcaneal
1848:Cuneiform
1624:Bennett's
1280:Fractures
1085:0271-6798
1046:2078-6778
939:Page 1405
917:cite book
909:962333989
664:1469-493X
591:Follow up
545:arm sling
324:sail sign
248:olecranon
224:splintage
187:Diagnosis
164:olecranon
158:Mechanism
77:ischaemia
42:Specialty
1838:Lisfranc
1614:Scaphoid
1585:Barton's
1565:Galeazzi
1510:Proximal
1482:Scapular
1477:Clavicle
1174:52921491
1166:30286976
1126:18851922
998:15 April
871:32809768
844:27168001
792:28208961
682:35678077
283:and the
148:malunion
141:Malunion
1634:Busch's
1629:Boxer's
1619:Rolando
1580:Smith's
1570:Colles'
1291:General
1237:13-A2.3
835:4967285
783:5296534
673:9178297
596:begin.
539:inside
287:of the
281:humerus
61:humerus
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1146:Injury
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535:using
513:splint
433:cortex
214:X-rays
179:, and
58:distal
1853:March
1843:Jones
1213:S42.4
1170:S2CID
1030:(2).
525:varus
476:IIIB
468:IIIA
405:Type
1446:Ribs
1333:Head
1282:and
1162:PMID
1122:PMID
1081:ISSN
1042:ISSN
1000:2018
987:ISBN
949:ISBN
941:in:
923:link
905:OCLC
895:ISBN
867:PMID
840:PMID
788:PMID
678:PMID
660:ISSN
648:2022
531:and
448:IIB
440:IIA
246:and
238:and
1671:Leg
1204:ICD
1154:doi
1112:doi
1073:doi
1032:doi
830:PMC
822:doi
778:PMC
770:doi
668:PMC
652:doi
484:IV
457:III
1880::
1235::
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
