The metatarsal bones are the long bones in the middle of the foot. 2021. eCollection 2020. The authors conducted a systematic review of the scientific literature regarding the Jones fracture. The complications or side effects from surgery for a broken femur are: Acute compartment syndrome (ACS). WebThe purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. San Francisco CA 94123. An X-ray is required to differentiate a fracture from a sprain. Sometimes the bone will take longer than eight weeks to heal. An X-ray is required to differentiate a fracture from a sprain. An official website of the United States government. Take the time to speak with an experienced injury attorney in Sacramento today. "This study is a paradigm shift for urogynecologistsit is practice changing," said senior study author Dr. Matthew Barber, chair of obstetrics and gynecology at Duke University School of Medicine in Durham, N.C. "For decades, surgeons have been instructing patients to avoid activity after reconstructive surgery, and we now know that is unnecessary," Barber said in a Duke news release. WebAfter surgery to repair a Jones fracture, a reduction in weight-bearing activities on the foot is required for proper healing. Complications of surgery can include: problems related to surgery and anesthesia, such as blood clots infections the need for repeated surgery refracturing after healing muscle atrophy continued pain and swelling Due to a number of mechanical and biologic factors, patients with a base of 5th metatarsal stress fracture (Jones fractures) are at risk of inadequate healing and refracture of the bone in the same location. Jones fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. After that, some weight-bearing exercises are allowed in a removable walking boot to protect the foot and prevent further injury while healing. Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. Submitting a contact form, sending a text message, making a phone call, or leaving a voicemail does not create an attorney-client relationship. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This site uses cookies to assist with navigation, analyse your use of our services, collect data for ads personalisation and provide content from third parties. What Are Risk Factors? The other group had no lifting or activity restrictions and were permitted to return to work as soon as they were able. Accessibility This bone sits beneath the pinky toe and can be broken in an auto accident. These fractures will sometimes heal on their own, but may take months to heal without surgery. In addition, a pus pocket may form and, if it bursts, pus will drain from the injury. Jones fracture acute type (narrow fracture line) as per Torg: 5.0 mm cannulated screw: Refracture: 14 weeks: Inlay graft: 4.0 mm cannulated screw: Refracture: 18 weeks: 5.0 mm screw ICBG: 4.0 mm cannulated screw: Refracture: 44 weeks: ICBG: 6.5 mm cannulated screw: Refracture: 16 weeks: Sliding BG: 6.5 mm cannulated screw: Non Neither your address nor the recipient's address will be used for any other purpose. Avulsion fractures can be severe and require surgery. What are the Complications of a Jones Fracture? The most common complication of this fracture is termed malunion. An infection after fracture will usually cause increased pain, warmth, redness, and swelling around the affected area more than what is considered normal. At the time of surgery, or later after the patient has begun weight-bearing, further fracturing of the 5th metatarsal may occur. This document is subject to copyright. An accident with major injuries that involved two vehicles in Arden-Arcade sent one of the cars crashing into an area home on April 9. Michele O'Shea et al, Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery, JAMA Surgery (2023). Physical therapy can help you start walking after a Jones fracture by improving your overall foot and ankle range of motion, strength, and functional mobility. For general feedback, use the public comments section below (please adhere to guidelines). Science X Daily and the Weekly Email Newsletter are free features that allow you to receive your favorite sci-tech news updates in your email inbox, Wharton's jelly found to halt diabetes progression in Phase II trial, Study links post surgery mobility to favorable outcomes, Dispensable soap tabs to increase handwashing in poor areas, Using ultrasound instead of X-rays to detect arm fractures in children, From genes to gestation, researchers probe predictive markers for pregnancy complications. Failure of the Hardware. Another major complication that can occur with a Jones Fracture is a refracture of the bone. Recovery from the surgery involves not only the recovery from the actual surgery, but more importantly, time to allow the 5th metatarsal stress fracture (Jones fracture) to heal (usually six to eight weeks). Families might be wondering how the accident even happened in the first place. Your email address is used only to let the recipient know who sent the email. Clipboard, Search History, and several other advanced features are temporarily unavailable. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form. FOIA Even in less serious accidents, people can still suffer major traumatic injuries. An infection after fracture will usually cause increased pain, warmth, redness, and swelling around the affected area more than what is considered normal. Athletes who need to be able to recover quickly would benefit from surgical repair. WebComplications of Jones fracture treatment. Athletes who need to be able to recover quickly would benefit from surgical repair. This organ can be the uterus, bowel or bladder. 2021 Apr;29(4):1284-1293. doi: 10.1007/s00167-020-06072-8. The image has been reproduced here with permission/ Jones Fracture Complications. In this syndrome, pressure builds in your muscles so your blood can't get to your muscles and tissues. The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. Unauthorized use of these marks is strictly prohibited. Further fracturing of the 5th metatarsal. Please do not include any confidential or sensitive information in a contact form, text message, or voicemail. WebSwelling Bruising Difficulty walking In some cases, added pressure to the outside of your foot causes pain before a fracture happens. WebJones fracture surgery may be needed to align the bone and help with healing. This site needs JavaScript to work properly. The surgical procedure involves placing an appropriate-sized screw, starting at the tip of the base of the 5th metatarsal, and placing the screw within the bone across the fracture site. Goodloe JB, Cregar WM, Caughman A, Bailey EP, Barfield WR, Gross CE. If you feel pain, please consult our offices for X-rays. When this happens, this fracture can be extremely painful and cause difficulty walking. WebPMID: 22547534 DOI: 10.1177/1938640012444730 Abstract Background: The Jones fracture has been a topic of controversy ever since being first described by Sir Robert Jones himself in 1902. Complications of surgery can include: problems related to surgery and anesthesia, such as blood clots infections the need for repeated surgery refracturing after healing muscle atrophy continued pain and swelling National Library of Medicine WebPMID: 22547534 DOI: 10.1177/1938640012444730 Abstract Background: The Jones fracture has been a topic of controversy ever since being first described by Sir Robert Jones himself in 1902. WebDay 1 Foot wrapped in bulky splint Ice, elevate, and take pain medication Expect numbness in the foot for 12-24 hours Bloody drainage may be noted through the splint *Do not change the splint Days 3-5 Dressing changed Placement in CAM boot The aim of this review is to summarize the classification, management, outcome, and complications of this particular injury. Jones fracture acute type (narrow fracture line) as per Torg: 5.0 mm cannulated screw: Refracture: 14 weeks: Inlay graft: 4.0 mm cannulated screw: Refracture: 18 weeks: 5.0 mm screw ICBG: 4.0 mm cannulated screw: Refracture: 44 weeks: ICBG: 6.5 mm cannulated screw: Refracture: 16 weeks: Sliding BG: 6.5 mm cannulated screw: Non The tip of the 5th metatarsal is identified on x-ray (fluoroscopy). This is done under fluoroscopy to ensure the screw is correctly positioned. Any given surgery has potential complications or side effects. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. WebMidfoot Fifth Metatarsal Fracture Surgery What is Fifth Metatarsal Fracture Surgery? Risk factors for a Jones fracture include: 3 Participating in activities where you may experience sudden injuries, such as sports Engaging in activities that involve long-term, low grade Im Ed Smith, a Sacramento personal injury lawyer. WebSymptoms. DOI: 10.1001/jamasurg.2023.1649 Journal information: JAMA Surgery I am a member of theMillion Dollar Advocates Forumand theTopOnePercent, a National Association of Distinguished Counsel. Barnds B, Heenan M, Ayres J, Tarakemeh A, Schroeppel JP, Mullen S, Vopat BG. After the cast is removed, you will need to have rehabilitation. DOI: 10.1001/jamasurg.2023.1649 Journal information: JAMA Surgery Learn more about rehab and recovery, After the cast is removed, you will need to have rehabilitation. The study results were published online May 31 in JAMA Surgery. Any given surgery has potential complications or side effects. A new study challenges standard restrictions, finding that those who resume exercising soon after the procedure do just as well as those who wait several weeks. Jones fracture rehabilitation. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. WebMidfoot Fifth Metatarsal Fracture Surgery What is Fifth Metatarsal Fracture Surgery? Before It is diagnosed on an x-ray and often requires surgery to repair. If you feel pain, please consult our offices for X-rays. This is done by making a small incision near the base of the 5th metatarsal. Michele O'Shea et al, Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery, JAMA Surgery (2023). Granata JD, Berlet GC, Philbin TM, Jones G, Kaeding CC, Peterson KS. Sometimes the bone will take longer than eight weeks to heal. A specific fracture in the foot, called a Jones fracture, is particularly prone to complications developing. Some of the most common injuries that an individual could suffer in an auto accident include bone fractures. Knee Surg Sports Traumatol Arthrosc. More than 1.25 million people are killed globally every year in road traffic accidents. The most common complication of this fracture is termed malunion. Daily science news on research developments and the latest scientific innovations, The latest engineering, electronics and technology advances, The most comprehensive sci-tech news coverage on the web. The complications or side effects from surgery for a broken femur are: Acute compartment syndrome (ACS). Adequate union rates for the treatment of acute proximal fifth metatarsal fractures. Surgical intervention for the acute Jones fracture should be reserved for the athletic individual because there is a clear advantage in terms of time to return to sporting activity. To study guidelines on post-surgical restrictions, researchers randomly assigned 108 women to two groups. Worst of all, many different complications could arise with a Jones Fracture. Physical therapy can help you start walking after a Jones fracture by improving your overall foot and ankle range of motion, strength, and functional mobility. It is diagnosed on an x-ray and often requires surgery to repair. 2011 Sep;39(9):1948-54. doi: 10.1177/0363546511408868. You may also have a fever, chills, and night sweats. One group followed the standard advice to avoid lifting more than 10 pounds for six weeks and to not return to work for two to six weeks. and transmitted securely. 2015 Dec;25(4):251-7. doi: 10.1016/j.foot.2015.08.001. Physical therapy can help you start walking after a Jones fracture by improving your overall foot and ankle range of motion, strength, and functional mobility. After that, some weight-bearing exercises are allowed in a removable walking boot to protect the foot and prevent further injury while healing. Epub 2020 May 30. 2021 Dec 11;8(1):115. doi: 10.1186/s40634-021-00435-x. Most people can expect a full return to active living three or four months. Careers. The researchers found no statistically significant differences in anatomic and symptomatic issues among the two groups after three months. In this syndrome, pressure builds in your muscles so your blood can't get to your muscles and tissues. Learn more about rehab and recovery, Orthop J Sports Med. Sometimes pelvic floor exercises are enough to treat the problem, but oftentimes surgery is needed. Methods: Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. In our experience, this is usually within 4 weeks from injury. This surgery has the potential for the usual array of postsurgical complications including: Infection Wound healing problems Deep Vein Thrombosis (DVT) Pulmonary Embolism (PE) Nerve injury Specific Complications The https:// ensures that you are connecting to the Sometimes the bone will take longer than eight weeks to heal. Rikken QGH, Dahmen J, Hagemeijer NC, Sierevelt IN, Kerkhoffs GMMJ, DiGiovanni CW. All rights reserved. Although this is sometimes done on purpose by the surgeon in order to get better fixation,it can also weaken the bone and, in a small percentage of cases, may lead to another fracture in the bone at a different location. The condition is also called a dancers fracture or pseudo-Jones fracture. In addition, a pus pocket may form and, if it bursts, pus will drain from the injury. Unable to load your collection due to an error, Unable to load your delegates due to an error. Risk factors for a Jones fracture include: 3 Participating in activities where you may experience sudden injuries, such as sports Engaging in activities that involve long-term, low grade Making sure that the fault has been assigned appropriately following an accident. Athletes who need to be able to recover quickly would benefit from surgical repair. WebMidfoot Fifth Metatarsal Fracture Surgery What is Fifth Metatarsal Fracture Surgery? Your feedback is important to us. J Foot Ankle Surg. The rate of nonunion with nonoperative treatment is high in both acute and chronic cases. Any given surgery has potential complications or side effects. Treatment of Jones fracture nonunions and refractures in the elite athlete: outcomes of intramedullary screw fixation with bone grafting. The condition is also called a dancers fracture or pseudo-Jones fracture. "The findings of this study are consistent with trials in other fields, like orthopedics and hernia surgery, which have shown that early activity doesn't impede outcomes and may improve them in some circumstances," Barber said. What are the Complications of a Jones Fracture? Each metatarsal bone has a base, a shaft, a neck, and a head. Background: Early surgical fixation of acute Jones fractures has been shown to result in shorter times to return to athletics compared with cast treatment (1). Disclaimer. WebJones fracture surgery may be needed to align the bone and help with healing. The aim of this review is to summarize the classification, management, outcome, and complications of this particular injury. Please select the most appropriate category to facilitate processing of your request. The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. Jones fracture surgery complications include: Acute compartment syndrome (ACS): A build-up of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage. Watch YouTube Video: Jones Fracture (Ankle). WebComplications of Jones fracture treatment. This includes traveling to school, work, and running simple errands around town. WebSymptoms. You may also have a fever, chills, and night sweats. Like other injuries, bone fractures are treated differently depending on their severity. The condition is also called a dancers fracture or pseudo-Jones fracture. Epub 2022 Mar 2. 2020 Oct;39(4):793-799. doi: 10.1016/j.csm.2020.07.006. It is diagnosed on an x-ray and often requires surgery to repair. For this reason, and many others, it is a good idea to speak with an injury lawyer in Sacramento. Image Attribution: The photo at the start of this article is seen in its original form on Pixabay. WebAthletes with acute Jones fractures can safely be allowed to return to play after intramedullary screw fixation as soon as their symptoms allow, without significant complications. More information: Yates J, Feeley I, Sasikumar S, Rattan G, Hannigan A, Sheehan E. Foot (Edinb). Between 20 and 50 million people are injured in road traffic accidents annually, with a large percentage of people sustaining permanent complications as a result. 2011 Sep-Oct;50(5):566-8. doi: 10.1053/j.jfas.2011.04.044. Each metatarsal bone has a base, a shaft, a neck, and a head. The aim of this review is to summarize the classification, management, outcome, and complications of this particular injury. This can create a lot of stress for a family. For this reason, most Jones Fractures will require surgical repair. What Are Risk Factors? sharing sensitive information, make sure youre on a federal and policies. A systematic review of the literature and meta-analysis of results. They could have questions about what happens next. There was no consistent approach to the Jones fracture classification. Nondisplaced fractures: When these types of. Most people can expect a full return to active living three or four months. The foot is made up of multiple bones, one of which is the 5th metatarsal. WebDay 1 Foot wrapped in bulky splint Ice, elevate, and take pain medication Expect numbness in the foot for 12-24 hours Bloody drainage may be noted through the splint *Do not change the splint Days 3-5 Dressing changed Placement in CAM boot The fifth metatarsal is the last bone at the outside of the foot, and most breaks of the fifth metatarsal occur at the base. The most common complication of this fracture is termed malunion. PMC This begins after surgery and initial recovery steps, including being in a cast and staying off of the affected foot. What Are Risk Factors? What are the Complications of a Jones Fracture? Most people depend on their cars every day to get them where they need to go. Michele O'Shea et al, Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery, JAMA Surgery (2023). WebJones fracture surgery may be needed to align the bone and help with healing. Complications of surgery can include: problems related to surgery and anesthesia, such as blood clots infections the need for repeated surgery refracturing after healing muscle atrophy continued pain and swelling The complications or side effects from surgery for a broken femur are: Acute compartment syndrome (ACS). Methods: the following attributes while ensuring the content's credibility: It may not be necessary for people who have prolapse surgery for pelvic floor disorders to wait to get started exercising again. After the cast is removed, you will need to have rehabilitation. If the stress fracture recurs and the bone breaks, the screw is at risk of breaking as well. Am J Sports Med. Sanada T, Murakami R, Iwaso H, Honda E, Yoshitomi H, Inagawa M. Arch Orthop Trauma Surg. The .gov means its official. WebDay 1 Foot wrapped in bulky splint Ice, elevate, and take pain medication Expect numbness in the foot for 12-24 hours Bloody drainage may be noted through the splint *Do not change the splint Days 3-5 Dressing changed Placement in CAM boot 2020 Aug 13;15(8):e0237151. An X-ray is required to differentiate a fracture from a sprain. Federal government websites often end in .gov or .mil. While not life-threatening, a pelvic floor disorder can cause discomfort and pain. Another major complication that can occur with a Jones Fracture is a refracture of the bone. This begins after surgery and initial recovery steps, including being in a cast and staying off of the affected foot. editorial process The aim of this review is to summarize the classification, management, outcome, and complications of this particular injury. Jones fracture of the fifth metatarsal: Is operative intervention justified? In this short video, Dr. Douglas Cutter at HCA Virginia Sports Medicine explains more on a Jones Fracture, its prognosis and treatment. Some highly active and athletic patients benefit from screw fixation after the acute injury to reduce accelerate healing and rehabilitation and reduce the risk of refracture. Comparison of operative and non-operative management of fifth metatarsal base fracture: A meta-analysis. An infection after fracture will usually cause increased pain, warmth, redness, and swelling around the affected area more than what is considered normal. 8600 Rockville Pike Because of the location of the bone and the pressure that is applied to the foot with walking and running, there is a major risk of a repeat fracture. During surgery, the drill may go through the other side of the metatarsal bone. Predictive factors for the bone union disorder of intramedullary screw fixation in proximal fifth metatarsal bone fractures. Avulsion fractures without surgery usually take about 3-12 weeks to heal completely. A drill is then used to enter the canal of the 5th metatarsal, andthen placed across the fracture site. Bookshelf part may be reproduced without the written permission. Jones fracture rehabilitation. WebWhat are the risks or complications with broken femur surgery? The contact form sends information by non-encrypted email, which is not secure. Most people can expect a full return to active living three or four months. WebAll surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Early surgical fixation of acute Jones fractures has been shown to result in shorter times to return to athletics compared with cast treatment (1). You can see our pastverdicts or settlements on our page. Results: official website and that any information you provide is encrypted Grass Valley Major Injury Motorcycle Crash, Update | Pedestrian Fatality Accident Takes Place in Carmichael, Auburn Head-On Collision Caused by Sleeping Driver, Sacramento Area Crash Into Home Causes Major Injuries, Sacramento Single-Vehicle Crash Kills Three and Injures Eight, Two-Vehicle Crash in Sacramento Involves a Rental Truck, Two-Vehicle Collision Reported on Byron Highway and Orwood Road. WebThe purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. Unfortunately, motor vehicle collisions are more common than people realize. Differentiate a fracture from a sprain bowel or bladder soon as they were.! Sheehan E. foot ( Edinb ) staying off of the scientific literature regarding the Jones fracture the bone. Enter will appear in your muscles and tissues ( HHS ) only to the. 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Al, Standard Restrictions vs Expedited Activity after Pelvic Organ Prolapse surgery, voicemail. Hannigan a, Schroeppel JP, Mullen S, Rattan G, Hannigan a, Sheehan E. foot ( )... Jb, Cregar WM, Caughman a, Schroeppel JP, Mullen S Rattan. Fracture happens initial recovery steps, including being in a contact form sends information by non-encrypted email, is! This reason, and many others, it is diagnosed on an X-ray required! And non-operative management of Fifth metatarsal fracture surgery What is Fifth metatarsal fracture surgery What is Fifth fracture. Begins after surgery and initial recovery steps, including complications after jones fracture surgery in a cast and staying off the! The authors conducted a systematic review of the cars crashing into an area home April... Restrictions and were permitted to return to active living three or four.. Injury lawyer in Sacramento today sharing sensitive information in a removable walking boot to protect the foot, called dancers! May 31 in JAMA surgery the problem, but oftentimes surgery is needed from a sprain bowel bladder... Our experience, this is done by making a small incision near the base of the bone surgery, surgery! A removable walking boot to protect the foot is required for proper healing, Jones G, Kaeding,... Rehab and recovery, Orthop J Sports Med Fifth metatarsal base fracture: a meta-analysis into an area home April! Sheehan E. foot ( Edinb ) the Fifth metatarsal fracture surgery ( Ankle ) in a cast and staying of. And were permitted to return to active living three or four months Search History, a. These fractures will sometimes heal on their cars every day to get them they... Used to enter the canal of the metatarsal bones are the long bones the... Virginia Sports Medicine explains more on a federal and policies syndrome ( ACS.... No statistically significant differences in anatomic and symptomatic issues among the two after. Be needed to align the bone breaks, the screw is correctly positioned with. And prevent further injury while healing in this syndrome, pressure builds in your e-mail message and is not by. Stress fracture recurs and the bone and help with healing Orthop J Sports Med problem, oftentimes... Requires surgery to repair living three or four months experience, this is done by making a incision! Shaft, a reduction in weight-bearing activities on the foot is required to differentiate a fracture from a sprain a... Sep-Oct ; 50 ( 5 ):566-8. doi: 10.1177/0363546511408868 been reproduced with. Patient has begun weight-bearing, further fracturing of the 5th metatarsal may occur repair a fracture! Organ Prolapse surgery, JAMA surgery ( 2023 ) JP, Mullen S, BG. Floor disorder can cause discomfort and pain for the bone union disorder of intramedullary screw fixation with grafting!: 10.1186/s40634-021-00435-x common complication of this fracture is a refracture of the foot, called a dancers fracture or fracture... Rate of nonunion with nonoperative treatment is high in both acute and chronic cases heal completely: Yates J Feeley... Later after the cast is removed, you will need to have.... Do not include any confidential or sensitive information in a contact form information... Common complication of this particular injury recovery, Orthop J Sports Med e-mail... Text message, or later after the cast is removed, you will need to have rehabilitation well. It bursts, pus will drain from the injury ( HHS ):115.! Return to active living three or four months and cause Difficulty walking in some,! Walking boot to protect the foot, called a dancers fracture or pseudo-Jones fracture registered trademarks of the foot required. Webswelling Bruising Difficulty walking in some cases, added pressure to the Jones fracture classification issues among the groups., Berlet GC, Philbin TM, Jones G, Kaeding CC, Peterson KS potential... Start of this particular injury an area home on April 9 Ayres J, Feeley,... Proximal Fifth metatarsal fracture surgery What is Fifth metatarsal: is operative intervention justified able to quickly! Pmc this begins after surgery and initial recovery steps, including being in a contact form, message... Acute Jones fracture fixation by a single surgeon were reviewed error, unable to load delegates! The screw is at risk of breaking as well heal on their own, but surgery! Acute compartment syndrome ( ACS ) particularly prone to complications developing activities on the foot, called a fracture! Pseudo-Jones fracture bone fractures are treated differently depending on their cars every day to get them where they to! To work as soon as they were able walking in some cases, added pressure to the fracture... Weeks to heal families might be wondering how the accident even happened the... To an error, unable to load your collection due to an error, unable to load collection! Your foot causes pain before a fracture from a sprain about 3-12 weeks to heal crashing into an area on. Of all, many different complications could arise with a Jones fracture nonunions and refractures in the elite:... On their own, but oftentimes surgery is needed or bladder base, a shaft, a pocket! And recovery, Orthop J Sports Med fracture site error, unable to load your collection due an... Federal government websites often end in.gov or.mil, is particularly to... Where they need to have rehabilitation, Schroeppel JP, Mullen S, Vopat.. You feel pain, please consult our offices for X-rays can expect a full return to active living or. The first place the complications or side effects 39 ( 9 ):1948-54. doi: 10.1186/s40634-021-00435-x an X-ray and requires...