AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2694-0248/024
Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India
*Corresponding Author: Jayesh Mhatre, Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India..
Citation: Amit supe, Jayesh Anant Mhatre, Nihar modi (2022). Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature. J. Clinical Orthopedics and Trauma Care, 4(1); DOI:10.31579/2694-0248/024
Copyright: © 2022 Jayesh Mhatre, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 14 December 2021 | Accepted: 30 December 2021 | Published: 12 January 2022
Keywords: broken humerus nail; bridge plating
A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.
A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail. In our case the patient was operated with intramedullary humerus nail 20 years back, mostly are NPPIFs reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but a separate clinical entity with different conceptual and practical considerations. PPFs (peri-prosthetic fractures) have been extensively studied and there are various classification systems and modalities for treatment in the literature. In contrast, the literature addressing NPPIFs is rare [1].
Epidemiology and other social parameters related to diaphyseal humeral fractures have not been extensively studied as those related to fractures occurring in other parts of the human skeleton, such as the proximal femur or the distal radius. Never- theless, the available bibliographical resources report that the general incidence of humeral shaft fractures remain in the area to 1% to 2% of all fractures occurring in the human body and 14% of all fractures of the humerus [2].
The first description of a diaphyseal humeral fracture goes back to ancient Egypt and has been recorded on the Edwin Smith Papyrus, the world’s oldest surviving surgical text that was written in Egyptian hieratic script around the 17th century BC. The papyrus was discovered by Edwin Smith in the 1860s and it was recently decoded by James P. Allen of the Metropoli- tan Museum of Art in New York. The author of the papyrus described the fracture of the humerus and proposed conserva- tive treatment: “Thou shouldst place him prostrate on his back, with something folded between his two shoulder-blades; thou shouldst spread out his shoulders, and to stretch apart his upper arm until that break falls into its place. Thou shouldst make for him two splints of linen, (and) thou shouldst apply one of them to the inside of his arm, (and) the other of them to the underside of his arm. Thou shouldst bind it with cloth, (and) treat afterward with honey every day until he recovers.” It is obvious that little has changed in the treatment of diaphyseal humeral fractures since ancient times, as humeral fractures heal within a short time3. During the treatment patients are mobile whereas shoulder and elbow joints compensate for some malalignment. However, patients in modern times demand faster union rates and earlier return to preinjury activities while preserving functionality and motion of nearby joints. Therefore, over the last few decades, we have witnessed significant advances in the field of surgical management of diaphyseal humeral fractures.
The most common reason for a humeral shaft fracture is a fall, followed by motor vehicle accident. Other causes that account for less than 10% of humeral shaft fractures include sporting activities, working accidents, and fall from a height, violence, and bone pathology. Pathologic and open fractures of the humeral shaft are uncommon (6% to 8% and 2% to 5% of all diaphyseal humeral fractures, respectively) [4].
The commonest associated injury to a closed diaphyseal humeral fracture is the injury of the radial nerve (10% to 12% of all closed humeral shaft fractures). The clinical manifestation is the inability to dorsiflex the wrist and digits while numbness occurs on the dorsoradial aspect of the hand and the dorsal aspect of the radial 3½ digits [3, 4].
A 72-year-old gentleman, farmer by profession presented to our hospital with pain swelling and deformity over distal aspect of right upper arm of two days duration. patient was apparently well two days back, he sustained trauma to his right upper arm due to fall for which patient was taken to Primary Health centre where initial radiographs were done splintage was given and patient was referred to our hospital for further management. On clinical examination there was swelling, tenderness and abnormal mobility along with crepitus over digital 1/3 of right upper arm. He also gave a history of operation over same injured limb 20 years back, however no surgical details were available. Radiographs demonstrated a fracture of distal 1/3 of humerus with a broken intramedullary nail in-situ. Patient did not have distal neurovascular involvement or any other associated injuries and was relatively fit for surgery .He was posted for removal of the broken implant and fixation of fracture with open reduction internal fixation with the distal humerus pre-countered (LC-DCP) plate.
Surgery:
Patient was and assessed for fitness of surgery, after all fitness tests and investigations, he was posted for open reduction internal fixation under supraclavicular and axillary block, in all aseptic conditions in lateral position with the arm abducted 90 degrees on a radiolucent support. Posterior approach is used to generally to expose the distal 2/3 of humorous shaft, longitudinal incision in the midline of the posterior aspect of the arm from tip of the olecranon to about 7 cm distal to acromion was taken The dissection was initiated at the proximal end of the incision where the interval between the long and lateral head of the triceps was identified and developed by blunt dissection. The common tendon of the Biceps and triceps muscle was incised sharply in the midline, as it runs distally and inserts into the olecranon, then after retracting the lateral head of triceps laterally and the long head medially, at the proximal part of the incision, revealed the radial nerve and the profunda brachii artery as they run together in the spiral groove. Longitudinal midline dissection continued to reveal the distal humeral fracture site, fracture site was prepared with removal of excess fibrous tissue and then the distal tip of the broken nail was removed with a grasper as it did not have any locking screws , proximal screws were removed under image intensifier and then from proximal fracture fragment the proximal part of nail was removed , after removal of nail , reaming was done , as the fracture site was distal, the plate needed to be precontoured which is easiest with the use of special flexible templates the reduction was not achieved prior to plate application, so the plate was applied to the bone on one side of the fracture and the other side was aligned with its longitudinal axis. It was then provisionally secured to the bone with reduction clamps and fixed in this position with one screw. The next step done was to reduce the fracture by aligning the bone on the other side of the fracture with the plate. When the alignment was satisfactory, the unsecured end of the plate was clamped to the bone. Care was taken with the use of reduction clamps not to injure any of the neurovascular structures, which in the humerus may be close to the bone. Alignment was confirmed, both visually and with the image intensifier, and the remainder of the screws were inserted. The final reduction and the plate and screw lengths were confirmed with the image intensifier prior to wound closure. the fixation involved the exploration of a nerve that was nearby or crossing the plate (for instance, the radial nerve during the posterior approach), the exact relationship of the nerve to the plate was confirmed and recorded to avoid inadvertent placement of the plate on the nerve and reduce the risk of accidental nerve damage during plate removal at any time in the future. Closure was done in layers. Surgery was uneventful.
Post-operative protocol: for early mobilization of patient passive and active elbow and shoulder exercises were started found the 5th day of surgery. Suture removal was done on 12th day, wound was healthy there were no signs of infection. From second week of surgery patient was given functional humeral brace and full mobilization exercise was started. On follow up after 6 months of surgery patient had no lag in any range of movements of shoulder or elbow joint, his Distal Arm shoulder hand score was 0/100.
NPPIFs are a sparsely reported, the orthopaedic literature has focused on fractures of the proximal femur with very less focus on upper extremity. In the earlier period the cephalo-medullary (CM) nails were introduced for fixation of peri-trochanteric fractures; CM nails had theoretical biomechanical advantages over extramedullary implants such as the sliding hip screw (SHS), unfortunately, these advantages were offset by a high rate of peri-implant fracture at the distal end of the nail. The literature regarding non femoral NPPIFs is extremely sparce [1].
Suboptimal surgical technique, weak implants, and poor bony purchase mainly because of osteoporosis have been recognized as the main reasons for Implant or Prosthesis failure. Intramedullary nailing has more implant specific complications. Dysfunction and pain at the shoulder has been regarded as the most common problem of antegrade intramedullary nailing of diaphyseal humeral fractures. However, many authors believe that nailing alone may not be responsible for this problem5. Nevertheless, iatrogenic injury to the rotator cuff could be avoided with the implementation of the retrograde technique or other approaches that spare the rotator cuff. Other complications that originate from the use of locking screws include neurologic damage and other soft tissue complications such as injury to arteries, muscles, and tendons. Injury to the long head of the biceps and the axillary nerve can be reduced by avoiding the proximal antero-posterior locking screw that many antegrade nails. Retrograde “fixed” nails reduce but do not abolish the incidence of injury to vulnerable soft tissues around the shoulder girdle [6]. Another problem of antegrade nailing is protrusion of the nail and impingement at the acromion. However, it is now recognized that antegrade nails must be embedded within the humeral head and protrusion and impingement should be regarded as technical error. Another under-reported problem of antegrade nailing is backing out of the proximal screws, because of the poor purchase within the can- cellous bone of the head, especially in osteoporotic patients. To overcome this problem some nails, provide either locking proximal screws or a polyethylene augmentation that covers the proximal screw holes and keeps the screws in situ. Sporadic complications of “fixed” nails include heat-induced seg- mental necrosis of the diaphysis and heterotopic ossification of the deltoid, both attributed to the reaming process and fracture at the tip of the nail [6, 7].
For diaphyseal humeral fractures the traditional 4.5-mm narrow dynamic compression plate (DCP) or the more recent limited contact dynamic compression plate (LC-DCP) is used. There should be a minimum of three to four holes in simple fractures an 8- to 10-hole plate should be sufficient, while in comminuted fractures it is recommended that the plate should span the area of comminution (bridging plate) requiring longer plates [7].
LC-DCP plates can also be used as they are easier to contour and offer the additional advantages of decreased stress shielding and preservation of blood supply of the periosteum because of the limited plate–bone contact.
One of the major issues that can affect treatment outcome with ORIF of a diaphyseal humeral fracture, before even fracture reduction and fixation, is the stripping and devitalization of bone fragments during the surgical approach. Another pitfall that could delay or inhibit bone healing is the inadequate reduction of the fracture. Although fracture reduction does not have to be anatomical in the humerus, lack of bone contact or a gap at the fracture site has a poor prognosis for union. Bone defects up to 2 to 3 cm should be dealt with shortening, as the arm can accommodate small discrepancies without functional consequences. Larger bone defects should be bridged with bone grafting, preferably autologous. The fixation technique must provide adequate stability with the plate being strong (4.5 mm DCP) and long enough to allow at least four holes and three to four screws in each main fragment although not every screw hole has to be filled.
Additional screws (e.g., lag screws) that enhance stability can be used. As a general principle, the chosen plate for the fixation should be positioned symmetrically to allow an equal number of screws on both sides of the fracture. Therefore, ORIF of distal humeral fractures could require screw placement in one or both condyles and even double plating to provide the necessary stability to the fracture [8, 9]. Iatrogenic injury to neurovascular structures and most particularly to the radial nerve as it runs around the humerus must be avoided by identifying and protecting the neurovascular structures in most approaches. Apart from direct injury to the radial nerve during dissection, it should be noted that cerclage wiring, or drills and screws inserted from the opposite cortex can also injure the nerve [10].
Our case presented a challenge, the patient was old, osteoporotic so healing of fracture was main concern which had to be addressed along with removal of the previous implant and provision of stability with new implant which could provide adequate healing pace. Most of the literature is focused on non-prosthetic peri-implant fractures of the hip or lower limb. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement in elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case
Conflict of Interest: Nil
Funding: Nil
Ethical approval: in Compliance with ethical standards.
Informed consent: well explained and taken.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
