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Zhou X, Liu Y, Zhang A, Wang C, Zhao X, Dong J, Liu F, Xu W, Feng F, Li L, Lu S. Are all cases of floating hip the same? Further understanding of floating hip. BMC Musculoskelet Disord 2024; 25:988. [PMID: 39623368 PMCID: PMC11613749 DOI: 10.1186/s12891-024-08105-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/22/2024] [Indexed: 12/06/2024] Open
Abstract
PURPOSE Floating hip is a severe high-energy injury. Femoral fracture is an essential component of floating hip. However, few studies have addressed the relationship between the femoral fracture pattern and floating hip injury. In this study, we reviewed and summarized the epidemiological and clinical data of patients with floating hip. PATIENTS AND METHODS We retrospectively reviewed patients with a diagnosis of floating hip at our trauma center from January 2014 to December 2021. Data on patient demographics, characteristics of the injuries, associated injuries, whether sciatic nerve palsy (SNP) occurred, the number of operations performed, and the total length of hospital stay were analyzed. RESULTS A total of 76 patients met the diagnostic criteria for floating hip, 45 of whom had proximal femoral fractures. The mean Injury Severity Scores in patients with proximal and non-proximal femoral fractures were 21.47 ± 10.67 and 17.61 ± 7.64, respectively, and the mean Abbreviated Injury Scale scores were 13.31 ± 9.71 and 9.52 ± 4.32, respectively. Motor vehicle collision and a fall from a height were the main causes of injury. Chest injury was the most common associated injury. Twenty-two patients were diagnosed with SNP, 17 of whom had a proximal femoral fracture. Of the patients with pelvic fractures, 15 were diagnosed with SNP, 14 of whom also had a proximal femoral fracture. Of the patients with acetabular fractures, seven were diagnosed with SNP, three of whom also had a proximal femoral fracture. CONCLUSION More than half of patients with floating hips have a combined proximal femoral fracture. In this study, fracture of the pelvis or acetabulum combined with a proximal femoral fracture had a higher AIS score and higher risk of SNP than fracture of the pelvis or acetabulum combined with a non-proximal femoral fracture. Patients with a single pelvic fracture showed similar results, but patients with a single acetabular fracture did not. A pelvic or acetabular fracture combined with a proximal femoral fracture has a different outcome than a mid-distal femoral fracture, which may be a "true" floating hip.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
| | - Yu Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
- Department of Orthopedics, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Ajuan Zhang
- Department of Intensive Care Unit, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), Qingdao, People's Republic of China
| | - Chenglong Wang
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Xuehui Zhao
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Jinlei Dong
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Fanxiao Liu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Weicheng Xu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Fan Feng
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China
| | - Lianxin Li
- Department of Orthopaedics Surgery, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China.
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China.
| | - Shun Lu
- Department of Orthopaedics Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, People's Republic of China.
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Medellin Rincon MR, Navarro Pimiento DC, Ortegon Candela EN, Muñoz Vanegas C, Gonzalez Chavez RE. Radioulnar Synostosis after Endomedullary Fixation of the Radius and Ulna in a Patient with Floating Elbow: A Case Report. Rev Bras Ortop 2024; 59:e207-e211. [PMID: 39735460 PMCID: PMC11679606 DOI: 10.1055/s-0044-1779333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/28/2023] [Indexed: 12/31/2024] Open
Abstract
Floating elbow is a complex and rare entity caused by high-energy trauma. In this paper, we present the case of a patient who suffered a traffic accident with severe head trauma, floating elbow (humeral diaphyseal fracture, radial proximal diaphyseal fracture, and ulnar segmental fracture) and radial nerve injury. Fixations were made with a humeral plate and intramedullary rods in the forearm. Although the outcome was satisfactory, radioulnar synostosis was identified in postoperative controls. Due to the neurological compromise, type of fractures, and stabilization selected, we believe that the use of forearm intramedullary rods for similar cases should be carefully evaluated.
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Ditsios K, Christidis P, Konstantinou P, Pinto I, Christidis G, Ditsios T, Kostretzis L, Katsimenzas T, Chitas K, Papadopoulos P. Floating Elbow in Adults: A Systematic Review and Meta-Analysis. Orthop Rev (Pavia) 2022; 14:31843. [PMID: 38350018 PMCID: PMC9036515 DOI: 10.52965/001c.31843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/20/2021] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND We aimed to systematically review all papers examining floating elbow injuries in adults. MATERIAL AND METHODS MEDLINE, Cochrane Bone, Joint and Muscle Trauma, PROSPERO, and Scopus databases were searched up to August 31, 2020. Included studies had as a primary or secondary outcome the functional outcomes after a floating elbow injury on patients aged 17 or older. Methodological quality of the included studies was assessed. RESULTS Thirty-two studies met the inclusion criteria. Patients were male at 73,1%. Median age of the patients was 33,0 years and median time of follow-up was 19,5 months. Articular surfaces were affected at 24,4%, whereas 51,2% of the fractures was open. Approximately, 34,9% of the patients suffered neural injury. Ipsilateral and multiple-system injuries were present in 34,8% and 76,3 % of the cases, respectively. Multivariate analysis showed that intra-articular and nerve damage, open fractures and multi-system injuries affected range of motion, union and complications. Sex, age, vascular damage and ipsilateral injuries of the patient did not adversely impact the outcome. All of the included studies were classified as very-low quality of evidence. CONCLUSIONS The current knowledge regarding the characteristics of floating elbow in adults is limited, albeit we were able to provide possible pre-operative predictor outcomes.
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Affiliation(s)
- Konstantinos Ditsios
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | - Panagiotis Konstantinou
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Iosafat Pinto
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | | | - Lazaros Kostretzis
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Triantafyllos Katsimenzas
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Konstantinos Chitas
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Pericles Papadopoulos
- Second Academic Department of Orthopedic Surgery, General Hospital of Thessaloniki "G. Gennimatas", Greece
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Verma S, Kumar D, Hooda A, Sodavarapu P, Kumar K, Goni VG. A Prospective Study Evaluating Factors Affecting Functional Outcome in Patients with Floating Elbow Injury. Indian J Orthop 2021; 56:142-149. [PMID: 35070154 PMCID: PMC8748571 DOI: 10.1007/s43465-021-00448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Floating elbow injuries are complex injuries. Due to frequent association with severe soft tissue injuries and polytrauma, they have unpredictable functional outcome. This prospective study is aimed to evaluate the factors affecting functional outcome. METHODS Thirty patients with floating elbow injuries were treated at a level 1 trauma center from July 2018 to June 2019 with minimum follow-up of 9 months. The outcome was assessed by disability for arm shoulder and hand score (DASH) and mayo elbow performance score (MEPS). RESULTS The overall incidence was 16.09 per 1000, mostly caused by road traffic accidents and all cases were managed surgically. Age, gender, education, occupation, arm dominance, and mechanism of injury did not significantly affect the outcomes. Open fractures and patients requiring staged procedure were associated with poorer outcomes (p < 0.05); however, delay in surgery for more than 24 h significantly increased the rate of complications. There was no statistical difference in the proportion of patients who had nerve injury pre operatively and post operatively on the final outcome. CONCLUSION Floating elbow injuries are relatively rare but nowadays the numbers are on the rise. Timely intervention with a multimodal approach and well-supervised rehabilitation can assure better final outcome.
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Affiliation(s)
- Sumeet Verma
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Deepak Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Aman Hooda
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Praveen Sodavarapu
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Karmesh Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Vijay G. Goni
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Huang GH, Tang JA, Yang TY, Liu Y. Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report. World J Clin Cases 2021; 9:3372-3378. [PMID: 34002147 PMCID: PMC8107907 DOI: 10.12998/wjcc.v9.i14.3372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury, although elbow dislocation or fracture of the ulna and radius may occur separately.
CASE SUMMARY We report the case of a 37-year-old woman with open (IIIA) fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony. After providing advanced trauma life support, damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room. Subsequently, one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling. The patient achieved good outcome at the 7 mo follow-up.
CONCLUSION One- or two-stage treatment must be performed according to the type of injury; we efficiently used the “damage control principle.”
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Affiliation(s)
- Guo-Hua Huang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Jiang-An Tang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Tie-Yi Yang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Yue Liu
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
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Abstract
BACKGROUND The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating. OBJECTIVES The aim of this article was to define the term "floating" used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.
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Affiliation(s)
| | | | - Ying Qin
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Combined Ipsilateral Humeral Shaft and Galeazzi Fractures Creating a Floating Elbow Variant. Case Rep Orthop 2018; 2018:7430297. [PMID: 30533237 PMCID: PMC6250006 DOI: 10.1155/2018/7430297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/21/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023] Open
Abstract
“Floating elbow” injuries of the arm traditionally represent a combination of humeral shaft and forearm fractures which require anatomic rigid open reduction and internal fixation of all fractures to allow for early range of motion exercises of the elbow. There are published variants of the floating elbow injury which include ipsilateral diaphyseal humeral fracture, proximal ulna fracture with proximal radioulnar joint disruption, and ipsilateral diaphyseal humeral fracture with elbow dislocation and both bones forearm fracture. We present the case of a 21-year-old woman whose left arm became caught between the side of a waterslide and adjacent rocks at a park. She sustained a torsional and axial loading injury to her left upper extremity resulting in ipsilateral humeral shaft and Galeazzi fractures. The combination of ipsilateral humeral shaft and Galeazzi fractures resulted in a rare floating elbow variant. Prompt open reduction and internal fixation of both fractures and early range of motion of the elbow and wrist resulted in an excellent clinical and radiographic result. Floating elbow injuries and their variants should be promptly recognized as early anatomic reduction, and rigid internal fixation can allow for good elbow function with minimization of stiffness.
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Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation. Arch Phys Med Rehabil 2017; 98:1863-1892.e14. [DOI: 10.1016/j.apmr.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/04/2023]
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Jiménez-Díaz V, Auñón-Martín I, Olaya-González C, Aroca-Peinado M, Cecilia-López D, Caba-Doussoux P. Analysis of complications after a floating elbow injury. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:607-615. [PMID: 27738769 DOI: 10.1007/s00590-016-1866-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 09/22/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of the present study is to analyse complications after a floating elbow injury, attempting to establish which of them act as a poor prognosis factor regarding clinical and functional results. MATERIALS AND METHODS Twenty-three patients who suffered a floating elbow injury, treated at our institution from 2004 to 2013, were retrospectively reviewed. Patients were divided into four groups depending on the type of injury. An analysis of demographic data, associated injuries, treatment options and complications was carried out. Clinical evaluation was made by a conventional goniometer, testing flexo-extension and prono-supination ranges. For functional evaluation, the Mayo Elbow Performance Score was employed. Association between radioulnar synostosis, articular surface disruption, nerve injury and clinical and functional results was analysed. RESULTS Patients with radioulnar synostosis had worse results in functional evaluation than patients without it (56.6 vs. 75); this difference was statistically significant (p = 0.05). Regarding intra-articular extension, we found statistical association with worse results in functional evaluation (p = 0.018); however, nerve palsy does not seem to influence functional results. CONCLUSIONS Radioulnar synostosis and intra-articular extension of the injury are poor prognosis factor in floating elbow.
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Affiliation(s)
- Verónica Jiménez-Díaz
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain.
| | - Ismael Auñón-Martín
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain
| | - Carlos Olaya-González
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain
| | - Miguel Aroca-Peinado
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain
| | - David Cecilia-López
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain
| | - Pedro Caba-Doussoux
- Hospital 12 de Octubre, Avda. de Córdoba s/n, Orthopaedic and Trauma Surgery Secretariat, 7th floor, 28041, Madrid, Spain
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Treatment of Ipsilateral Distal Humerus and Diaphyseal Ulna Fractures by Using an Olecranon Osteotomy and Intramedullary Nail. J Orthop Trauma 2016; 30:251-5. [PMID: 26618661 DOI: 10.1097/bot.0000000000000495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the results of treatment of an osteotomy of the olecranon and an ulnar diaphyseal fracture with a single nail, in cases with an ipsilateral ulnar diaphyseal fracture and a comminuted fracture of the distal humerus. DESIGN Retrospective clinical study. SETTING University-affiliated teaching hospital. PATIENTS Eight patients with comminuted fractures of the distal humerus and ipsilateral ulnar diaphyseal fractures were included. INTERVENTION Using a transolecranon approach, internal fixation of the distal humeral fracture with medial and lateral plates was performed. The ulnar diaphyseal fracture and additional osteotomy were fixed using a locked intramedullary nail. Subjective pain assessment was performed by using a visual analog scale (VAS). RESULTS There were 6 (75%) male and 2 (25%) female patients, with a mean age of 40.9 (range, 32-56) years. The mean follow-up period was 24.6 (range, 12-36) months. All patients achieved union of the ulnar diaphyseal fracture and olecranon osteotomy. Union of the distal humeral fracture was observed in 7 (87.5%) patients. The mean time to union was 16.3 (range, 12-22) weeks, mean visual analog scale score was 1.8 (range, 0-3), median elbow performance score was 85 (range, 70-95), and median disabilities of the arm, shoulder, and hand score was 17.9 (range, 5-45.8). CONCLUSIONS Osteotomy of the olecranon and ulnar diaphyseal fracture using an intramedullary nail was a cosmetically advantageous and safe technique that enabled rehabilitation during the early postoperative period. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
A 22-year-old man was admitted to our hospital because of polytrauma following a car accident. The instrumental investigations detected parenchymatous and bone lesions, including a floating elbow (articular distal humerus fracture associated with ipsilateral forearm fracture). After initial temporary stabilization with external fixator and restoration of hemodynamics, we proceeded to the fixation of the upper limb. To reduce local and general risks of complications, a two-stage reconstruction technique has been applied.
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Affiliation(s)
- Gianluca Bisinella
- Division of Orthopaedics and Trauma, Hospital of Este (Padova), Via San Fermo 10, I-35042 Este (Padova), Italy.
| | - Nicola Bellon
- Division of Orthopaedics and Trauma, Hospital of Este (Padova), Via San Fermo 10, I-35042 Este (Padova), Italy
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Floating dislocated elbow with ipsilateral shoulder dislocation: double dislocation upper arm. J Orthop Sci 2015; 20:761-4. [PMID: 24430240 DOI: 10.1007/s00776-013-0522-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022]
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