Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.
Identifieur interne : 000A98 ( Main/Corpus ); précédent : 000A97; suivant : 000A99Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.
Auteurs : M Jason Highsmith ; Jason T. Kahle ; Rebecca M. Miro ; Derek J. Lura ; Stephanie L. Carey ; Matthew M. Wernke ; Seok Hun Kim ; William S. QuillenSource :
- Military medicine [ 1930-613X ] ; 2016.
English descriptors
- KwdEn :
- Adult (MeSH), Amputation, Traumatic (complications), Amputation, Traumatic (physiopathology), Biomechanical Phenomena (MeSH), Double-Blind Method (MeSH), Exercise Tolerance (physiology), Foot (physiology), Foot (physiopathology), Humans (MeSH), Male (MeSH), Military Personnel (statistics & numerical data), Prostheses and Implants (standards), Prostheses and Implants (statistics & numerical data), Prosthesis Design (standards), Prosthesis Design (trends), Tibia (injuries), Tibia (physiopathology), Time Factors (MeSH), Veterans (statistics & numerical data).
- MESH :
- complications : Amputation, Traumatic.
- injuries : Tibia.
- physiology : Exercise Tolerance, Foot.
- physiopathology : Amputation, Traumatic, Foot, Tibia.
- standards : Prostheses and Implants, Prosthesis Design.
- statistics & numerical data : Military Personnel, Prostheses and Implants, Veterans.
- trends : Prosthesis Design.
- Adult, Biomechanical Phenomena, Double-Blind Method, Humans, Male, Time Factors.
Abstract
BACKGROUND
Approximately 683 persons engaged in military service experienced transtibial amputation (TTA) related to recent war in Iraq and Afghanistan. Military TTAs function at a level beyond basic ambulation. No empirical data demonstrate which higher functioning prosthetic feet maximize injured service personnel's ability to continue performing at a level commensurate with return to duty. This study's purpose was to determine which of three high-functioning, energy-storing prosthetic feet maximize performance and preference in a field obstacle course (OC) and to quantify physical performance differences between TTAs and high-functioning nonamputees.
PROCEDURES
A randomized, double-blind, repeated measures experimental design compared three prosthetic feet (Ossur Variflex, Endolite Elite Blade, and Ossur Re-Flex Rotate) during performance on a field OC. TTAs accommodated with study feet and the OC before assessment. 14 TTAs and 14 nonamputee controls completed the course. Subjective and objective performance differences were compared across feet conditions and between groups.
RESULTS
Total OC completion times were similar between prosthetic feet: Elite-Blade (419 seconds ± 130), Variflex (425 seconds ± 144), and Re-Flex Rotate (444 seconds ± 220). Controls' OC completion time (287.2 seconds ± 58) was less (p ≤ 0.05) than TTA times. In total, controls had faster completion times (p ≤ 0.05) compared to all prosthetic feet conditions in 13/17 obstacles. Re-Flex Rotate had 2 additional obstacles different (p ≤ 0.05) than controls and required more time to complete. Median RPE values were lower (p ≤ 0.05) for controls than TTA regardless of foot. Regarding foot preference for OC completion, 7/14 (50%) preferred Elite Blade, 5/14 (36%) preferred Re-Flex Rotate, and the remaining 2/14 (14%) preferred Variflex.
CONCLUSION
Controls completed the OC faster and with less effort than TTAs regardless of prosthetic foot. No clear differences in prosthetic feet emerged during OC completion; however, individual task performance, perceived effort, and preference resulted in trends of slight performance improvement with and preference for Elite Blade, a dual function energy-storing and return foot combined with vertical shock absorption. Understanding how to maximally improve performance in such functional tasks may allow service members to best sustain physical fitness, return to their military occupational specialty and possibly in-theater duty.
DOI: 10.7205/MILMED-D-16-00286
PubMed: 27849461
Links to Exploration step
pubmed:27849461Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.</title><author><name sortKey="Highsmith, M Jason" sort="Highsmith, M Jason" uniqKey="Highsmith M" first="M Jason" last="Highsmith">M Jason Highsmith</name><affiliation><nlm:affiliation>Extremity Trauma & Amputation Center of Excellence, 2748 Worth Road, Suite 29, Fort Sam Houston, TX 78234.</nlm:affiliation></affiliation></author><author><name sortKey="Kahle, Jason T" sort="Kahle, Jason T" uniqKey="Kahle J" first="Jason T" last="Kahle">Jason T. Kahle</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Miro, Rebecca M" sort="Miro, Rebecca M" uniqKey="Miro R" first="Rebecca M" last="Miro">Rebecca M. Miro</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Lura, Derek J" sort="Lura, Derek J" uniqKey="Lura D" first="Derek J" last="Lura">Derek J. Lura</name><affiliation><nlm:affiliation>Department of Bioengineering and Software Engineering, Florida Gulf Coast University, 10501 FGCU Boulevard South, Fort Myers, FL 33965.</nlm:affiliation></affiliation></author><author><name sortKey="Carey, Stephanie L" sort="Carey, Stephanie L" uniqKey="Carey S" first="Stephanie L" last="Carey">Stephanie L. Carey</name><affiliation><nlm:affiliation>Mechanical Engineering Department, University of South Florida, 4202 E, Fowler Avenue, ENB 118, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Wernke, Matthew M" sort="Wernke, Matthew M" uniqKey="Wernke M" first="Matthew M" last="Wernke">Matthew M. Wernke</name><affiliation><nlm:affiliation>Willow Wood, 15441 Scioto Darby Road, P. O. Box 130, Mount Sterling, OH 43143.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Seok Hun" sort="Kim, Seok Hun" uniqKey="Kim S" first="Seok Hun" last="Kim">Seok Hun Kim</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Quillen, William S" sort="Quillen, William S" uniqKey="Quillen W" first="William S" last="Quillen">William S. Quillen</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2016">2016</date><idno type="RBID">pubmed:27849461</idno><idno type="pmid">27849461</idno><idno type="doi">10.7205/MILMED-D-16-00286</idno><idno type="wicri:Area/Main/Corpus">000A98</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000A98</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.</title><author><name sortKey="Highsmith, M Jason" sort="Highsmith, M Jason" uniqKey="Highsmith M" first="M Jason" last="Highsmith">M Jason Highsmith</name><affiliation><nlm:affiliation>Extremity Trauma & Amputation Center of Excellence, 2748 Worth Road, Suite 29, Fort Sam Houston, TX 78234.</nlm:affiliation></affiliation></author><author><name sortKey="Kahle, Jason T" sort="Kahle, Jason T" uniqKey="Kahle J" first="Jason T" last="Kahle">Jason T. Kahle</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Miro, Rebecca M" sort="Miro, Rebecca M" uniqKey="Miro R" first="Rebecca M" last="Miro">Rebecca M. Miro</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Lura, Derek J" sort="Lura, Derek J" uniqKey="Lura D" first="Derek J" last="Lura">Derek J. Lura</name><affiliation><nlm:affiliation>Department of Bioengineering and Software Engineering, Florida Gulf Coast University, 10501 FGCU Boulevard South, Fort Myers, FL 33965.</nlm:affiliation></affiliation></author><author><name sortKey="Carey, Stephanie L" sort="Carey, Stephanie L" uniqKey="Carey S" first="Stephanie L" last="Carey">Stephanie L. Carey</name><affiliation><nlm:affiliation>Mechanical Engineering Department, University of South Florida, 4202 E, Fowler Avenue, ENB 118, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Wernke, Matthew M" sort="Wernke, Matthew M" uniqKey="Wernke M" first="Matthew M" last="Wernke">Matthew M. Wernke</name><affiliation><nlm:affiliation>Willow Wood, 15441 Scioto Darby Road, P. O. Box 130, Mount Sterling, OH 43143.</nlm:affiliation></affiliation></author><author><name sortKey="Kim, Seok Hun" sort="Kim, Seok Hun" uniqKey="Kim S" first="Seok Hun" last="Kim">Seok Hun Kim</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author><author><name sortKey="Quillen, William S" sort="Quillen, William S" uniqKey="Quillen W" first="William S" last="Quillen">William S. Quillen</name><affiliation><nlm:affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Military medicine</title><idno type="eISSN">1930-613X</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Amputation, Traumatic (complications)</term><term>Amputation, Traumatic (physiopathology)</term><term>Biomechanical Phenomena (MeSH)</term><term>Double-Blind Method (MeSH)</term><term>Exercise Tolerance (physiology)</term><term>Foot (physiology)</term><term>Foot (physiopathology)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Military Personnel (statistics & numerical data)</term><term>Prostheses and Implants (standards)</term><term>Prostheses and Implants (statistics & numerical data)</term><term>Prosthesis Design (standards)</term><term>Prosthesis Design (trends)</term><term>Tibia (injuries)</term><term>Tibia (physiopathology)</term><term>Time Factors (MeSH)</term><term>Veterans (statistics & numerical data)</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Amputation, Traumatic</term></keywords><keywords scheme="MESH" qualifier="injuries" xml:lang="en"><term>Tibia</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Exercise Tolerance</term><term>Foot</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Amputation, Traumatic</term><term>Foot</term><term>Tibia</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Prostheses and Implants</term><term>Prosthesis Design</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Military Personnel</term><term>Prostheses and Implants</term><term>Veterans</term></keywords><keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Prosthesis Design</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Biomechanical Phenomena</term><term>Double-Blind Method</term><term>Humans</term><term>Male</term><term>Time Factors</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Approximately 683 persons engaged in military service experienced transtibial amputation (TTA) related to recent war in Iraq and Afghanistan. Military TTAs function at a level beyond basic ambulation. No empirical data demonstrate which higher functioning prosthetic feet maximize injured service personnel's ability to continue performing at a level commensurate with return to duty. This study's purpose was to determine which of three high-functioning, energy-storing prosthetic feet maximize performance and preference in a field obstacle course (OC) and to quantify physical performance differences between TTAs and high-functioning nonamputees.</p></div><div type="abstract" xml:lang="en"><p><b>PROCEDURES</b></p><p>A randomized, double-blind, repeated measures experimental design compared three prosthetic feet (Ossur Variflex, Endolite Elite Blade, and Ossur Re-Flex Rotate) during performance on a field OC. TTAs accommodated with study feet and the OC before assessment. 14 TTAs and 14 nonamputee controls completed the course. Subjective and objective performance differences were compared across feet conditions and between groups.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Total OC completion times were similar between prosthetic feet: Elite-Blade (419 seconds ± 130), Variflex (425 seconds ± 144), and Re-Flex Rotate (444 seconds ± 220). Controls' OC completion time (287.2 seconds ± 58) was less (p ≤ 0.05) than TTA times. In total, controls had faster completion times (p ≤ 0.05) compared to all prosthetic feet conditions in 13/17 obstacles. Re-Flex Rotate had 2 additional obstacles different (p ≤ 0.05) than controls and required more time to complete. Median RPE values were lower (p ≤ 0.05) for controls than TTA regardless of foot. Regarding foot preference for OC completion, 7/14 (50%) preferred Elite Blade, 5/14 (36%) preferred Re-Flex Rotate, and the remaining 2/14 (14%) preferred Variflex.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Controls completed the OC faster and with less effort than TTAs regardless of prosthetic foot. No clear differences in prosthetic feet emerged during OC completion; however, individual task performance, perceived effort, and preference resulted in trends of slight performance improvement with and preference for Elite Blade, a dual function energy-storing and return foot combined with vertical shock absorption. Understanding how to maximally improve performance in such functional tasks may allow service members to best sustain physical fitness, return to their military occupational specialty and possibly in-theater duty.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27849461</PMID><DateCompleted><Year>2018</Year><Month>01</Month><Day>16</Day></DateCompleted><DateRevised><Year>2018</Year><Month>06</Month><Day>25</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1930-613X</ISSN><JournalIssue CitedMedium="Internet"><Volume>181</Volume><Issue>S4</Issue><PubDate><Year>2016</Year><Month>11</Month></PubDate></JournalIssue><Title>Military medicine</Title><ISOAbbreviation>Mil Med</ISOAbbreviation></Journal><ArticleTitle>Differences in Military Obstacle Course Performance Between Three Energy-Storing and Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind, Randomized Control Trial.</ArticleTitle><Pagination><MedlinePgn>45-54</MedlinePgn></Pagination><Abstract><AbstractText Label="BACKGROUND">Approximately 683 persons engaged in military service experienced transtibial amputation (TTA) related to recent war in Iraq and Afghanistan. Military TTAs function at a level beyond basic ambulation. No empirical data demonstrate which higher functioning prosthetic feet maximize injured service personnel's ability to continue performing at a level commensurate with return to duty. This study's purpose was to determine which of three high-functioning, energy-storing prosthetic feet maximize performance and preference in a field obstacle course (OC) and to quantify physical performance differences between TTAs and high-functioning nonamputees.</AbstractText><AbstractText Label="PROCEDURES">A randomized, double-blind, repeated measures experimental design compared three prosthetic feet (Ossur Variflex, Endolite Elite Blade, and Ossur Re-Flex Rotate) during performance on a field OC. TTAs accommodated with study feet and the OC before assessment. 14 TTAs and 14 nonamputee controls completed the course. Subjective and objective performance differences were compared across feet conditions and between groups.</AbstractText><AbstractText Label="RESULTS">Total OC completion times were similar between prosthetic feet: Elite-Blade (419 seconds ± 130), Variflex (425 seconds ± 144), and Re-Flex Rotate (444 seconds ± 220). Controls' OC completion time (287.2 seconds ± 58) was less (p ≤ 0.05) than TTA times. In total, controls had faster completion times (p ≤ 0.05) compared to all prosthetic feet conditions in 13/17 obstacles. Re-Flex Rotate had 2 additional obstacles different (p ≤ 0.05) than controls and required more time to complete. Median RPE values were lower (p ≤ 0.05) for controls than TTA regardless of foot. Regarding foot preference for OC completion, 7/14 (50%) preferred Elite Blade, 5/14 (36%) preferred Re-Flex Rotate, and the remaining 2/14 (14%) preferred Variflex.</AbstractText><AbstractText Label="CONCLUSION">Controls completed the OC faster and with less effort than TTAs regardless of prosthetic foot. No clear differences in prosthetic feet emerged during OC completion; however, individual task performance, perceived effort, and preference resulted in trends of slight performance improvement with and preference for Elite Blade, a dual function energy-storing and return foot combined with vertical shock absorption. Understanding how to maximally improve performance in such functional tasks may allow service members to best sustain physical fitness, return to their military occupational specialty and possibly in-theater duty.</AbstractText><CopyrightInformation>Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Highsmith</LastName><ForeName>M Jason</ForeName><Initials>MJ</Initials><AffiliationInfo><Affiliation>Extremity Trauma & Amputation Center of Excellence, 2748 Worth Road, Suite 29, Fort Sam Houston, TX 78234.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kahle</LastName><ForeName>Jason T</ForeName><Initials>JT</Initials><AffiliationInfo><Affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Miro</LastName><ForeName>Rebecca M</ForeName><Initials>RM</Initials><AffiliationInfo><Affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lura</LastName><ForeName>Derek J</ForeName><Initials>DJ</Initials><AffiliationInfo><Affiliation>Department of Bioengineering and Software Engineering, Florida Gulf Coast University, 10501 FGCU Boulevard South, Fort Myers, FL 33965.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Carey</LastName><ForeName>Stephanie L</ForeName><Initials>SL</Initials><AffiliationInfo><Affiliation>Mechanical Engineering Department, University of South Florida, 4202 E, Fowler Avenue, ENB 118, Tampa, FL 33612.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wernke</LastName><ForeName>Matthew M</ForeName><Initials>MM</Initials><AffiliationInfo><Affiliation>Willow Wood, 15441 Scioto Darby Road, P. O. Box 130, Mount Sterling, OH 43143.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Seok Hun</ForeName><Initials>SH</Initials><AffiliationInfo><Affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Quillen</LastName><ForeName>William S</ForeName><Initials>WS</Initials><AffiliationInfo><Affiliation>School of Physical Therapy and Rehabilitation Sciences, University of South Florida, 3515 E, Fletcher Avenue, Tampa, FL 33612.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013486">Research Support, U.S. Gov't, Non-P.H.S.</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Mil Med</MedlineTA><NlmUniqueID>2984771R</NlmUniqueID><ISSNLinking>0026-4075</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000673" MajorTopicYN="N">Amputation, Traumatic</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001696" MajorTopicYN="N">Biomechanical Phenomena</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004311" MajorTopicYN="N">Double-Blind Method</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017079" MajorTopicYN="N">Exercise Tolerance</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005528" MajorTopicYN="N">Foot</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008889" MajorTopicYN="N">Military Personnel</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019736" MajorTopicYN="N">Prostheses and Implants</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="Y">standards</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011474" MajorTopicYN="N">Prosthesis Design</DescriptorName><QualifierName UI="Q000592" MajorTopicYN="Y">standards</QualifierName><QualifierName UI="Q000639" MajorTopicYN="N">trends</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013977" MajorTopicYN="N">Tibia</DescriptorName><QualifierName UI="Q000293" MajorTopicYN="N">injuries</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014728" MajorTopicYN="N">Veterans</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>11</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>11</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2018</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27849461</ArticleId><ArticleId IdType="doi">10.7205/MILMED-D-16-00286</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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