Next Article in Journal
Depression Mediates the Relationship between Childhood Trauma and Internet Addiction in Female but Not Male Chinese Adolescents and Young Adults
Next Article in Special Issue
Correlation between Platelet Count and Lung Dysfunction in Multiple Trauma Patients—A Retrospective Cohort Analysis
Previous Article in Journal
Effects of Acute Psychological and Physiological Stress on Rock Climbers
Previous Article in Special Issue
The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients

Jordan E. Handcox
Jose M. Gutierrez-Naranjo
Luis M. Salazar
Travis S. Bullock
Leah P. Griffin
3 and
Boris A. Zelle
Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA
Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA
Medical Solutions Division, 3M Health Care, San Antonio, TX 78249, USA
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(21), 5012;
Submission received: 5 October 2021 / Revised: 23 October 2021 / Accepted: 26 October 2021 / Published: 28 October 2021
(This article belongs to the Special Issue Clinical Management and Challenges in Polytrauma)


Macro- and micronutrients play important roles in the biological wound-healing pathway. Although deficiencies may potentially affect orthopaedic trauma patient outcomes, data on nutritional deficiencies in orthopaedic trauma patients remain limited in the literature. The purpose of this study was to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications. This retrospective study identified 867 patients with lower extremity fractures treated with surgical fixation from 2019 to 2020. Data recorded included albumin, prealbumin, protein, vitamins A/C/D, magnesium, phosphorus, transferrin and zinc, as well as wound complications. Nutritional deficiencies were found for prealbumin, albumin and transferrin at 50.5%, 23.4% and 48.5%, respectively. Furthermore, a high prevalence of micronutrient deficiencies (vitamin A, 35.4%; vitamin C, 54.4%; vitamin D, 75.4%; and zinc, 56.5%) was observed. We also recorded a statistically significant difference in wound complications in patients who were deficient in prealbumin (21.6% vs. 6.6%, p = 0.0142) and vitamin C (56.8% vs. 28.6%, p = 0.0236). Our study outlines the prevalence of nutritional deficiencies in an orthopaedic trauma population and identifies areas for possible targeted supplementation to decrease wound complications.

1. Introduction

The important role of nutrition in wound healing has been well documented in the literature, with macro- and micronutrients considered vital at every step of the wound healing pathway [1,2,3]. Unfortunately, malnutrition is common worldwide [4] and can be from a variety of causes, including advanced age, disease-related, food-insecurity/hunger or a mismatch between caloric intake and quality of nutrients consumed [5]. Malnutrition is a known contributor to poor clinical outcomes, from increased morbidity and mortality to wound and surgical complications [6,7]. As such, there is much interest in evaluating the role of nutrition in orthopaedic trauma patients, a vulnerable population sensitive to the effects of malnutrition.
Previous literature has demonstrated that malnutrition, as defined by hypoalbuminemia, is common in the orthopaedic trauma population [8]. Moreover, these authors recorded hypoalbuminemia and obesity as predictors of wound complications. Additionally, albumin deficiencies have been shown to correlate with wound complications in patients undergoing joint replacement surgery [9] and readmission rates for patients undergoing elective spine surgeries [10]. However, prior research has mostly focused on the geriatric populations, elective orthopaedic surgeries, and albumin and prealbumin as serum markers for malnutrition [11,12,13,14].
Even fewer studies have looked at the prevalence of micronutrient deficiencies in orthopaedic trauma patients. Among elderly hospitalized patients, vitamins C and D are commonly deficient [15,16]; however, there is limited data on its prevalence among a younger trauma population. Severe micronutrient deficiencies have well-known consequences, such as severe vitamin D deficiency leading to rickets and osteoporosis. Subtle deficiencies below the reference range may lead to wound-healing complications and other lesser-known sequela [5], and the orthopaedic literature has just started to explore the relationship between micronutrient deficiencies and negative clinical outcomes. For example, it has been shown that zinc deficiencies may lead to wound-healing complications in patients undergoing hemiarthroplasty [17]. Also, vitamin D has been shown to impact fracture healing rates in orthopaedic trauma patients [18]. Yet, data on micronutrient deficiencies in the orthopaedic trauma population remain limited in the literature.
The purpose of this study is to (1) evaluate the prevalence of macro- and micronutrient deficiencies in orthopaedic trauma patients with lower extremity fractures and (2) evaluate the impact of such deficiencies on surgical site complications in patients with high-risk lower extremity fractures. Our hypothesis is that deficiencies are common in the orthopaedic trauma population, and these deficiencies may be associated with an increase in surgical site complications in high-risk lower extremity fractures.

2. Materials and Methods

This study is a retrospective database analysis of orthopaedic trauma patients undergoing surgical fixation of their lower extremity fractures treated at a university-based level 1 trauma center between the years of 2019 and 2020. The study protocol was approved by our Institutional Review Board, and data collection, methods and analysis were performed in accordance with their rules and regulations. Inclusion criteria were patients over 18 years old with a minimum of 3 months follow-up and lower extremity fractures, identified through our electronic medical record system using the coding database. Patients were identified using the OTA classification system to include femur, tibia, tibia/fibula, fibula, talus, calcaneus and foot fractures. Subjects were excluded if they were under 18 years old, mentally or cognitively impaired, prisoners, or if they presented with a pathologic fracture, as well as those with less than 3 months follow-up.
Demographic data included age, gender, race/ethnicity, BMI, and the American Society of Anesthesiologists scale [19], as well as mechanism of injury and closed versus open injury. As our primary outcome measure, we recorded the available laboratory data on patients, including both macro- and micronutrient data: albumin (3.2–5.0 g/dL), prealbumin (17.0–37.1 mg/dL), protein total serum (6.2–8.1 g/dL), albumin/globulin ratio (1.06–1.61), transferrin (206–382 mg/dL), vitamin A (0.30–1.20 mg/L), vitamin C (23–114 mmol/L), vitamin D (30–80 ng/mL), vitamin K (0.22–4.88 nmol/L), magnesium (1.6–2.2 mg/dL), phosphorus (2.4/4.6 mg/dL), zinc (60.0–120 µg/dL), selenium (23–190 µg/L), TSH (0.350–5.500 µIU/mL) and PTH (19–88 pg/mL). An expanded panel of micronutrient data was obtained for patients who were deemed high risk by their treating orthopaedic surgeon; this expanded lab draw was at the discretion of the surgeon.
Secondary clinical outcome measures were tracked through a review of inpatient and outpatient charts and included data on wound complications (surgical site infections, wound dehiscence, hematoma) and surgical complications (malunion, nonunion, symptomatic hardware).
The statistical analysis was performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC, USA). Categorical variables are summarized as count and percent. Chi-squared and Fisher’s exact test were used to calculate differences for categorical variables. All tests were conducted at the alpha level of 0.05.

3. Results

3.1. Patient-Level Demographic Data

We identified 867 patients who met the inclusion criteria. Of these patients, 28.7% were age 65 or older. There were slightly more male patients (56.9%) compared to female patients. A majority of patients identified as White (95.6%) or Hispanic/Latino (62.1%). Finally, nearly 40% of patients were obese, as defined by BMI ≥ 30 (Table 1).

3.2. Nutritional Deficiencies

Albumin was measured for 745 patients, and of these, 23.4% were malnourished, as defined by albumin < 3.5 g/dL. Approximately half of the patients were deficient in prealbumin (50.5%). Finally, nearly half of the patients (48.5%) were deficient in transferrin.
Of those patients who had micronutrient data measured, 35.4% were deficient in vitamin A, 54.4% were deficient in vitamin C, and 75% were deficient in vitamin D. Over half of the patients were deficient in zinc (56.5% of patients). We did not observe significant deficiencies in magnesium, selenium or vitamin K (Table 2).

3.3. Nutritional Deficiencies by Demographic Group

There were significant differences in nutritional deficiencies between demographic groups. Of the patients 65 and older, 83.3% were deficient in prealbumin, compared to only 46.0% of patients younger than 65 years old (p = 0.0153). A similar trend was recorded with age and albumin, where 37% of patients over 65 years old were deficient, compared to 17.7% of patients under 65 years old (p < 0.0001). Compared to younger patients, patients over 65 years old were also at increased risk of deficiency in serum protein (11.7% deficient versus 7.1%, p = 0.0396) and transferrin (81.8% deficient versus 42.1%, p = 0.0158). With regards to age-related differences in micronutrients, patients over 65 years old were not at increased risk of deficiency in vitamins A, C, or zinc. Additionally, advanced age was protective against vitamin D deficiency, as 84.7% of younger patients had vitamin D deficiency, compared to 59.0% of patients over 65 (p < 0.0001).
Females were more likely to be deficient in albumin (29.2%) compared to males (19.2%, p = 0.0015). Micronutrient data showed that Hispanic patients were more likely to be vitamin D deficient than non-Hispanic patients (82.4% versus 65.6%, p = 0.0047). We did not observe statistically significant differences between these demographic groups in the remaining serum markers.

3.4. Complications by Nutritional Deficiency

To measure the rate of wound complications, we assessed the data at the fracture level, identifying 1008 individual lower extremity fractures, 181 (18.0%) of which had a wound complication. Low prealbumin was associated with a statistically significant difference in wound complications. We found that 21.6% of fractures with a prealbumin deficiency had a wound complication, compared to 6.6% of those with normal prealbumin levels (p = 0.0142). Vitamin C deficiency was also associated with wound complications; where 56.8% sustained a wound complication, compared to only 28.6% with normal vitamin C levels (p = 0.0236).

4. Discussion

Identifying macro- and micronutrient deficiencies in our orthopaedic trauma population is important, as it allows us to (1) understand the prevalence of this issue and (2) perform targeted interventions, which may lead to improvement in outcomes. Our data suggest that nutritional deficiencies have a high prevalence in orthopaedic trauma patients. Furthermore, macro- and micronutrient deficiencies may be associated with wound complications, most notably prealbumin and vitamin C deficiency.
There were some limitations to our study. One limitation was its retrospective design; this resulted in limited data for some of the studied micronutrients. Also, expanded micronutrient data collection was at the discretion of the treating surgeon at the time of hospital presentation. This led to variability in which nutritional markers were drawn for each patient. This may have contributed to the underrepresentation of certain micronutrients and difficulties in identifying other surgical complications, such as malunion/nonunion. Also, these data are from our local orthopaedic trauma population, which may lead to geographic variation in deficiency patterns.
Previous studies demonstrated improved outcomes with nutritional supplements in the geriatric population [14,20] and enhanced callus formation with zinc supplementation in young adult trauma patients with lower extremity fractures [21]. To our knowledge, there have not been any data reported on nutritional deficiencies using multiple serum markers in orthopaedic trauma patients with injuries at high risk for infection.
We have demonstrated profound malnutrition rates, including a hypoalbuminemia rate of 23.4%, which is slightly lower than previously found in this population (39.4%, Egbert et al.). Over half of our patients were deficient in prealbumin, which more closely correlates with perioperative nutritional deficiency, given its shorter half-life [22]. Prealbumin deficiency has previously been shown to correlate with surgical site infections in patients undergoing spinal surgery [23], and we did confirm a statistically significant difference in wound complications among those who were prealbumin deficient in our population. Almost half of the patients (48.5%) were deficient in transferrin, which also indicates significant malnutrition [24] and has been implicated in wound complications in arthroplasty [25]. Regarding micronutrient deficiencies, we found substantial deficiencies in vitamins A, C, D, and zinc, which is in line with the data available in the geriatric population [11,14]. In addition, Hispanic patients were also much more likely to be vitamin D deficient. Finally, we demonstrated that vitamin C deficiency is common, as is consistent with the existing literature [15] and found that deficiency in vitamin C may lead to wound complications.
Our study reinforces prior literature on the prevalence and impact of hypoalbuminemia in an orthopaedic trauma population [8,26] and confirms that malnutrition is a risk factor for wound complications [27,28]. Our study also confirms prior research demonstrating significant vitamin D deficiency in a diverse trauma population [12]. Our novel data on micronutrient deficiencies in the orthopaedic trauma population provides preliminary evidence for vitamin/nutritional supplementation in the perioperative period for a younger orthopaedic trauma population in order to improve clinical outcomes.

5. Conclusions

In summary, our study demonstrates a high prevalence of macro- and micronutrient deficiencies in an orthopaedic trauma patient population with lower extremity fractures. Deficiencies in prealbumin, and vitamins C, D and zinc were common, with over half of patients in our study group proving to be deficient. We also identified demographic risk factors for malnutrition, such as age, sex and ethnicity. Finally, we demonstrated that prealbumin and vitamin C may be associated with wound complications. This study lays the groundwork for identifying targeted supplement and nutritional interventions that may reduce the risk of surgical site complications. The reversal of these deficiencies in the perioperative period has the potential to improve patient outcomes and reduce hospital costs.

Author Contributions

Conceptualization, J.E.H., J.M.G.-N., L.M.S., T.S.B., L.P.G. and B.A.Z.; data curation, J.M.G.-N., L.M.S. and T.S.B.; formal analysis, L.P.G.; funding acquisition, L.P.G. and B.A.Z.; investigation, J.M.G.-N., L.M.S. and T.S.B.; methodology, J.E.H., J.M.G.-N., L.M.S., T.S.B., L.P.G. and B.A.Z.; project administration, J.E.H. and B.A.Z.; resources, B.A.Z.; software, L.P.G.; supervision, B.A.Z.; validation, L.P.G.; visualization, J.E.H.; writing—original draft, J.E.H., J.M.G.-N., L.M.S., T.S.B., L.P.G. and B.A.Z.; writing—review and editing, J.E.H., J.M.G.-N., L.M.S., T.S.B., L.P.G. and B.A.Z. All authors have read and agreed to the published version of the manuscript.


This research was partially funded by 3M KCI Inc.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the University of Texas Health Science Center at San Antonio (project ID 165197).

Informed Consent Statement

Patient consent was waived by the IRB of our institution, as our study does not include any specific interventions or patient contact.

Data Availability Statement

The data are not publicly available online.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Palmieri, B.; Vadalà, M.; Laurino, C. Nutrition in wound healing: Investigation of the molecular mechanisms, a narrative review. J. Wound Care 2019, 28, 683–693. [Google Scholar] [CrossRef]
  2. Stechmiller, J.K. Understanding the Role of Nutrition and Wound Healing. Nutr. Clin. Pract. 2010, 25, 61–68. [Google Scholar] [CrossRef]
  3. Wild, T.; Rahbarnia, A.; Kellner, M.; Sobotka, L.; Eberlein, T. Basics in nutrition and wound healing. Nutrition 2010, 26, 862–866. [Google Scholar] [CrossRef] [PubMed]
  4. World Health Organization. Malnutrition. Available online: (accessed on 18 October 2021).
  5. Cederholm, T.; Barazzoni, R.; Austin, P.; Ballmer, P.; Biolo, G.; Bischoff, S.C.; Compher, C.; Correia, I.; Higashiguchi, T.; Holst, M.; et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin. Nutr. 2017, 36, 49–64. [Google Scholar] [CrossRef]
  6. Reber, E.; Gomes, F.; Vasiloglou, M.F.; Schuetz, P.; Stanga, Z. Nutritional Risk Screening and Assessment. J. Clin. Med. 2019, 8, 1065. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  7. Tulchinsky, T.H. Micronutrient deficiency conditions: Global health issues. Public Health Rev. 2010, 32, 243–255. [Google Scholar] [CrossRef] [Green Version]
  8. Egbert, R.C.; Bouck, T.T.; Gupte, N.N.; Pena, M.M.; Dang, K.H.; Ornell, S.S.; Zelle, B.A. Hypoalbuminemia and Obesity in Orthopaedic Trauma Patients: Body Mass Index a Significant Predictor of Surgical Site Complications. Sci. Rep. 2020, 10, 1953. [Google Scholar] [CrossRef]
  9. Gu, A.; Malahias, M.; Strigelli, V.; Nocon, A.A.; Sculco, T.P.; Sculco, P.K. Preoperative Malnutrition Negatively Correlates with Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J. Arthroplast. 2019, 34, 1013–1024. [Google Scholar] [CrossRef] [PubMed]
  10. Adogwa, O.; Elsamadicy, A.A.; Mehta, A.; Cheng, J.; Bagley, C.A.; Karikari, I.O. Preoperative Nutritional Status Is an Independent Predictor of 30-Day Hospital Readmission after Elective Spine Surgery. Spine 2016, 16, S271. [Google Scholar] [CrossRef] [PubMed]
  11. Ernst, A.; Wilson, J.M.; Ahn, J.; Shapiro, M.; Schenker, M.L. Malnutrition and the Orthopaedic Trauma Patient: A Systematic Review of the Literature. J. Orthop. Trauma 2018, 32, 491–499. [Google Scholar] [CrossRef] [PubMed]
  12. Zellner, B.; Dawson, J.; Reichel, L.; Schaefer, K.; Britt, J.; Hillin, C.; Reitman, C. Prospective Nutritional Analysis of a Diverse Trauma Population Demonstrates Substantial Hypovitaminosis D. J. Orthop. Trauma 2014, 28, e210–e215. [Google Scholar] [CrossRef]
  13. Bohl, D.; Shen, M.; Hannon, C.; Fillingham, Y.; Darrith, B.; Della Valle, C. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. J. Bone Jt. Surg. Am. 2017, 99, 2110–2118. [Google Scholar] [CrossRef]
  14. Roberts, J.L.; Drissi, H. Advances and Promises of Nutritional Influences on Natural Bone Repair. J. Orthop. Res. 2020, 38, 695–707. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  15. Teixeira, A.; Carrié, A.S.; Généreau, T.; Herson, S.; Cherin, P. Vitamin C deficiency in elderly hospitalized patients. Am. J. Med. 2001, 111, 502. [Google Scholar] [CrossRef]
  16. Boettger, S.F.; Angersbach, B.; Klimek, C.N.; Wanderley, A.L.M.; Shaibekov, A.; Sieske, L.; Wang, B.; Zuchowski, M.; Wirth, R.; Pourhassan, M. Prevalence and predictors of vitamin D-deficiency in frail older hospitalized patients. BMC Geriatr. 2018, 18, 219. [Google Scholar] [CrossRef]
  17. Zorrilla, P.; Salido, J.A.; Lopez-Alonso, A.; Silva, A. Serum Zinc as a Prognostic Tool for Wound Healing in Hip Hemiarthroplasty. Clin. Orthop. Relat. Res. 2004, 420, 304–308. [Google Scholar] [CrossRef] [PubMed]
  18. Pourfeizi, H.H.; Tabriz, A.; Elmi, A.; Aslani, H. Prevalence of vitamin D deficiency and secondary hyperparathyroidism in nonunion of traumatic fractures. Acta Med. Iran. 2013, 51, 705–710. [Google Scholar] [PubMed]
  19. Daabiss, M. American Society of Anaesthesiologists physical status classification. Indian J. Anaesth. 2011, 55, 111–115. [Google Scholar] [CrossRef] [PubMed]
  20. He, Y.; Xiao, J.; Shi, Z.; He, J.; Li, T. Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. J. Orthop. Surg. Res. 2019, 14, 292. [Google Scholar] [CrossRef] [Green Version]
  21. Sadighi, A.; Roshan, M.M.; Moradi, A.; Ostadrahimi, A. The effects of zinc supplementation on serum zinc, alkaline phosphatase activity and fracture healing of bones. Saudi Med. J. 2008, 29, 1276–1279. [Google Scholar]
  22. Keller, U. Nutritional Laboratory Markers in Malnutrition. J. Clin. Med. 2019, 8, 775. [Google Scholar] [CrossRef] [Green Version]
  23. Tempel, Z.; Grandhi, R.; Maserati, M.; Panczykowski, D.; Ochoa, J.; Russavage, J.; Okonkwo, D. Prealbumin as a serum biomarker of impaired perioperative nutritional status and risk for surgical site infection after spine surgery. J. Neurol. Surg. Part A Cent. Eur. Neurosurg. 2015, 76, 139–143. [Google Scholar]
  24. Gariballa, S.; Forster, S. Effects of acute-phase response on nutritional status and clinical outcome of hospitalized patients. Nutrition 2006, 22, 750–757. [Google Scholar] [CrossRef]
  25. Roche, M.; Law, T.Y.; Kurowicki, J.; Sodhi, N.; Rosas, S.; Elson, L.; Summers, S.; Sabeh, K.; Mont, M.A. Albumin, Prealbumin, and Transferrin May Be Predictive of Wound Complications following Total Knee Arthroplasty. J. Knee Surg. 2018, 31, 946–951. [Google Scholar] [CrossRef]
  26. Wilson, J.; Lunati, M.; Grabel, Z.; Staley, C.; Schwartz, A.; Schenker, M. Hypoalbuminemia Is an Independent Risk Factor for 30-Day Mortality, Postoperative Complications, Readmission, and Reoperation in the Operative Lower Extremity Orthopaedic Trauma Patient. J. Orthop. Trauma 2019, 33, 284–291. [Google Scholar] [CrossRef] [PubMed]
  27. He, Z.; Zhou, K.; Tang, K.; Quan, Z.; Liu, S.; Su, B. Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion. J. Orthop. Surg. Res. 2020, 15, 538. [Google Scholar] [CrossRef] [PubMed]
  28. Cross, M.; Yi, P.; Thomas, C.; Garcia, J.; Della Valle, C. Evaluation of Malnutrition in Orthopaedic Surgery. JAAOS 2014, 22, 193–199. [Google Scholar] [CrossRef] [PubMed]
Table 1. Demographic and clinical data.
Table 1. Demographic and clinical data.
Number of Patientsn = 867
Age ≥ 65249 (28.7%)
Ethnicity—Hispanic538 (62.1%)
Race—White829 (95.6%)
Gender (% Male)493 (56.9%)
BMI ≥ 30343 (39.6%)
Fracture locationn = 1008
Proximal Femur195 (19.4%)
Femoral Shaft107 (10.6%)
Distal Femur34 (3.4%)
Proximal Tibia98 (9.7%)
Tibial Shaft84 (8.3%)
Ankle/Pilon352 (34.9%)
Talus20 (2.0%)
Calcaneus51 (5.1%)
Foot17 (1.7%)
Infection, Non-traumatic38 (3.8%)
Others12 (1.2%)
Table 2. Nutritional deficiencies by macro- or micronutrient.
Table 2. Nutritional deficiencies by macro- or micronutrient.
Nutritional MarkersNDeficient
Prealbumin9950 (50.5%)
Albumin745174 (23.4%)
Protein total serum73562 (8.4%)
Albumin/globulin ratio734512 (69.8%)
Transferrin6833 (48.5%)
Vitamin A8229 (35.4%)
Vitamin C5731 (54.4%)
Vitamin D215162 (75.4%)
Vitamin K421 (2.4%)
Magnesium61921 (3.4%)
Phosphorus609100 (16.4%)
Zinc9252 (56.5%)
Selenium630 (0%)
Thyroid-stimulating hormone1549 (5.8%)
Parathyroid hormone972 (2.1%)
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Handcox, J.E.; Gutierrez-Naranjo, J.M.; Salazar, L.M.; Bullock, T.S.; Griffin, L.P.; Zelle, B.A. Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients. J. Clin. Med. 2021, 10, 5012.

AMA Style

Handcox JE, Gutierrez-Naranjo JM, Salazar LM, Bullock TS, Griffin LP, Zelle BA. Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients. Journal of Clinical Medicine. 2021; 10(21):5012.

Chicago/Turabian Style

Handcox, Jordan E., Jose M. Gutierrez-Naranjo, Luis M. Salazar, Travis S. Bullock, Leah P. Griffin, and Boris A. Zelle. 2021. "Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients" Journal of Clinical Medicine 10, no. 21: 5012.

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop