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Injury Apr 2023Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ),... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN.
MATERIALS AND METHODS
Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis.
RESULTS
There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups.
CONCLUSIONS
The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
Topics: Humans; Orthopedics; Hip Fractures; Bone Screws; Fracture Fixation, Intramedullary; Computers; Treatment Outcome; Bone Nails
PubMed: 36759309
DOI: 10.1016/j.injury.2023.02.011 -
The Surgeon : Journal of the Royal... Oct 2023Gender pay gaps are present in a wide range of industries, with the medical profession being no exception. The aim of this systematic review was to analyse the... (Review)
Review
AIMS
Gender pay gaps are present in a wide range of industries, with the medical profession being no exception. The aim of this systematic review was to analyse the peer-reviewed literature to identify whether there is a gender pay gap in orthopaedics.
METHODS
A systematic review was conducted by searching the following databases: MEDLINE, Health & Medical Collection, Nursing & Allied Health Database, Publicly Available Content Database, Consumer Health Database and Healthcare Administration Database. Original research papers pertaining to the earnings of male and female orthopaedic surgeons were included for review.
RESULTS
Of 745 papers acquired through the database search, 12 were eligible for inclusion. These were published in the USA, Canada and Taiwan. 6 looked at the relationship between sex and annual income, 4 studied industry payments, one analysed hourly earnings and one compared payments per case between males and females. Men were found to earn significantly higher annual incomes than women, even when confounding factors such as rank, practice setting and subspeciality were accounted for. Men also receive significantly higher payments from industry, and earn more per hour than women.
CONCLUSION
This systematic review has demonstrated that there is a gender pay gap in orthopaedics, with women commonly earning significantly less than their male colleagues. The reasons for this, however, remain unclear, and deserve further investigation. It is incumbent upon orthopaedic departments, healthcare providers and orthopaedic associations to raise awareness and ensure that men and women are paid the same for equal work.
Topics: Humans; Male; Female; Orthopedics; Salaries and Fringe Benefits; Orthopedic Procedures; Canada
PubMed: 36918303
DOI: 10.1016/j.surge.2023.02.003 -
Archives of Orthopaedic and Trauma... Oct 2021Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in...
PURPOSE
Until now, the use of telemedical applications in orthopedics was limited to sparsely populated countries. However, due to the SARS-CoV-2 pandemic, interest in orthopedics in these procedures has increased significantly. The aim of this systematic review was to find out to what extent there is scientific evidence for the use of telemedicine in the orthopedic field.
METHODS
A systematic literature search was carried out in various databases on randomized controlled trials (RCTs) on telemedical applications in orthopedics.
RESULTS
Altogether, 14 articles were identified that reported about a total of eight RCTs of telemedical applications in orthopedics. Two RCTs were about a patient-to-doctor video consultation and six RCTs were about telerehabilitation after knee and hip arthroplasty (4 × knee arthroplasty, one hip and knee arthroplasty, one hip arthroplasty). For the majority of outcome parameters evaluated, there were no significant differences between the study groups. The cost effectiveness of videoconsultations depended on the workload (number of patient consultations) as well as the effectiveness of telerehabilitation on the distance of the patient's home to the health care center (30 km round-trip).
CONCLUSION
There is sufficient evidence to recommend the use of telemedical methods in orthopedics. However, more research is necessary to further expand the possibilities of telemedical methods with regard to physical examination.
Topics: COVID-19; Humans; Orthopedic Procedures; Orthopedics; SARS-CoV-2; Telemedicine
PubMed: 33635399
DOI: 10.1007/s00402-021-03788-1 -
Arthroscopy : the Journal of... Sep 2021To perform a systematic review that determines the percentage of published orthopedic surgery and sports medicine systematic reviews and meta-analyses that have a...
PURPOSE
To perform a systematic review that determines the percentage of published orthopedic surgery and sports medicine systematic reviews and meta-analyses that have a conclusive conclusion.
METHODS
A systematic review was performed using PRISMA guidelines. Six high-quality orthopedics journals were chosen for analysis over a 10-year eligibility period. Systematic reviews and meta-analyses published in these journals were included in the investigation. Narrative, scoping, and umbrella reviews were excluded. A systematic review or meta-analysis was defined as having an inconclusive conclusion if the conclusion in the manuscript body or abstract was stated directly as inconclusive, indeterminate, unknown, or having a lack of evidence (or no evidence). A conclusive conclusion stated a direct answer to the study's primary and/or accessory outcomes. Due to the categorical nature of the data, comparisons were made using χ test and logistic regression.
RESULTS
There were 1,108 systematic reviews/meta-analyses analyzed (30.9 ± 70.3 studies analyzed per review). More reviews (69.9%) were published with conclusive conclusions rather than without (30.1%). More reviews were surgical (73%) rather than nonsurgical. The United States and North America published the most reviews by country and continent, respectively. There were statistically significant differences between countries (highest proportion with China) and continents (highest proportion with Asia) based on the number of conclusive conclusions in published reviews, respectively. There were no significant differences in the proportion of conclusive conclusion reviews between the 6 analyzed journals. Australia published the largest proportion on nonsurgical reviews. The British Journal of Sports Medicine published a significantly higher proportion of nonsurgical reviews than the other 5 journals. There was no temporal relationship with the proportion of conclusive conclusion reviews.
CONCLUSIONS
This systematic review observed that only 70% of orthopedic systematic reviews and meta-analyses published in 6 high-quality orthopedic journals over a 10-year eligibility period had conclusive conclusions.
LEVEL OF EVIDENCE
Level IV, systematic review and/or meta-analysis of studies with Levels I to IV.
Topics: Humans; Meta-Analysis as Topic; North America; Orthopedic Procedures; Orthopedics; Publications; Sports Medicine; Systematic Reviews as Topic
PubMed: 33887412
DOI: 10.1016/j.arthro.2021.03.073 -
Journal of Orthopaedics Dec 2016E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital... (Review)
Review
E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.
PubMed: 27688638
DOI: 10.1016/j.jor.2016.09.004 -
Journal of Orthopaedics 2021Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. (Review)
Review
PURPOSE
Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes.
METHODS
The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications.
RESULTS
Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA.
CONCLUSION
Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.
PubMed: 33679029
DOI: 10.1016/j.jor.2021.02.019 -
International Journal of Molecular... Dec 2023There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to... (Review)
Review
Magnesium Alloys in Orthopedics: A Systematic Review on Approaches, Coatings and Strategies to Improve Biocompatibility, Osteogenic Properties and Osteointegration Capabilities.
There is increasing interest in using magnesium (Mg) alloy orthopedic devices because of their mechanical properties and bioresorption potential. Concerns related to their rapid degradation have been issued by developing biodegradable micro- and nanostructured coatings to enhance corrosion resistance and limit the release of hydrogen during degradation. This systematic review based on four databases (PubMed, Embase, Web of Science™ and ScienceDirect) aims to present state-of-the-art strategies, approaches and materials used to address the critical factors currently impeding the utilization of Mg alloy devices. Forty studies were selected according to PRISMA guidelines and specific PECO criteria. Risk of bias assessment was conducted using OHAT and SYRCLE tools for in vitro and in vivo studies, respectively. Despite limitations associated with identified bias, the review provides a comprehensive analysis of preclinical in vitro and in vivo studies focused on manufacturing and application of Mg alloys in orthopedics. This attests to the continuous evolution of research related to Mg alloy modifications (e.g., AZ91, LAE442 and WE43) and micro- and nanocoatings (e.g., MAO and MgF2), which are developed to improve the degradation rate required for long-term mechanical resistance to loading and excellent osseointegration with bone tissue, thereby promoting functional bone regeneration. Further research is required to deeply verify the safety and efficacy of Mg alloys.
Topics: Magnesium; Orthopedic Procedures; Orthopedics; Osteogenesis; Alloys
PubMed: 38203453
DOI: 10.3390/ijms25010282 -
The Journal of Foot and Ankle Surgery :... 2022Though foot and ankle surgery fellowships have been around for decades, contributing factors for long-term research productivity remain unreported. Along with enhancing... (Review)
Review
Though foot and ankle surgery fellowships have been around for decades, contributing factors for long-term research productivity remain unreported. Along with enhancing surgical training, the American College of Foot and Ankle Surgeons (ACFAS) tasked programs with fostering research in effort to continue post-fellowship investigations. As the number of fellowship programs and fellows continues to increase, this study attempts to identifies factors associated with postfellowship research success. A PubMed search of peer-reviewed literature authored by ACFAS recognized 1-year fellowship graduates from 2000-2018 was conducted. Demographic data including current practice type and location was collected. Research activity at the 3, 5, and 10-year postfellowship period was investigated between publication history and current practice type. Statistical significance was set at p ≤ .05. Among the 37 fellowships assessed, 132 fellows were eligible for analysis. Most fellows maintained hospital-based employment 46 (34%) followed by private 44 (33%) and orthopedic group 30 (22%) practices. The proportion of fellows that published 5 and 10 years postfellowship was associated with research productivity 3 and 5 years postfellowship (p ≤ .03). The odds of publishing 3 years post-fellowship in orthopedic groups and university-based practices were 1.62 and 4.42 times higher compared to hospital-based graduates, respectively. The odds of publishing 5 years post-fellowship in orthopedic group and university based practices were 3.5 and 6.63 times higher than hospital-based practices, respectively. Despite the growing number of fellowships, a small proportion of fellows continue publishing postfellowship. These findings support the need to provide resources to engage graduates if retaining young practitioners in scholarly activity is desired.
Topics: Ankle; Career Choice; Fellowships and Scholarships; Humans; Orthopedics; Surgeons
PubMed: 35153140
DOI: 10.1053/j.jfas.2021.12.028 -
Journal of Orthopaedic Science :... Jan 2021The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial because there are few comprehensive studies that have investigated the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and to compare the surgical outcomes between anterior decompression with fusion (ADF) and laminoplasty, which are representative procedures for CSM.
METHODS
An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and laminoplasty for CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies of CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and treatments with posterior instrumented fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, cervical alignment, surgical complications and reoperation rates. Then, a meta-analysis was performed on these surgical outcomes.
RESULTS
Nine studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the preoperative JOA score was similar between the ADF and laminoplasty groups. The postoperative JOA scores and neurological recovery rates were not different between the ADF and laminoplasty groups. ADF exhibited more favorable results than laminoplasty in terms of postoperative cervical alignment. In contrast, overall complications were more frequently observed in the ADF group than in the laminoplasty group, leading to higher rates of reoperation. However, postoperative neck pain was more frequently observed in the laminoplasty group than in the ADF group.
CONCLUSIONS
This systematic review and meta-analysis showed both the merits and shortcomings of ADF and laminoplasty. ADF and laminoplasty showed similar results in terms of neurological recovery. Postoperative cervical lordosis was better preserved with ADF than with laminoplasty. However, ADF was associated with a higher incidence of surgical complications than laminoplasty.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Laminoplasty; Spinal Cord Diseases; Spinal Fusion; Spondylosis; Treatment Outcome
PubMed: 32205020
DOI: 10.1016/j.jos.2020.02.008 -
The Journal of Foot and Ankle Surgery :... 2016Although clinicians may have the best of intentions in terms of keeping up with the medical literature, the overwhelming volume of published studies and the press of... (Meta-Analysis)
Meta-Analysis Review
Although clinicians may have the best of intentions in terms of keeping up with the medical literature, the overwhelming volume of published studies and the press of clinical responsibilities can make this difficult. A medical version of the Reader's Digest(©) would thus be a valuable asset. This is something of the role that systematic reviews and meta-analyses play: synthesis and summary of the information in the literature.
Topics: Evidence-Based Medicine; Humans; Orthopedics; Periodicals as Topic
PubMed: 26708077
DOI: 10.1053/j.jfas.2015.10.001