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Journal of Clinical Medicine May 2024: Pelvic insufficiency fractures (PIF) are typical in geriatric populations with reduced bone quality, most commonly in elderly postmenopausal women. These fractures are... (Review)
Review
: Pelvic insufficiency fractures (PIF) are typical in geriatric populations with reduced bone quality, most commonly in elderly postmenopausal women. These fractures are usually caused by low-energy forces over the bones during ordinary life and cause disabling pain. Treatment options range from conservative to operative. The aim of this study is to assess the outcomes of treatments for pelvic insufficiency fractures, determining optimal approaches between surgical intervention and conservative management. : This literature review systematically examines articles focusing on patients with PIF, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and using PubMed, Medline, and the Cochrane Library database. We took into account only full-text articles in indexed journals with available English abstracts, considering data about patient demographics, surgery, and outcomes. After screening 128 articles, this study reviewed 20 manuscripts involving 1499 patients, mostly elderly females and focusing on sacrum fractures. Common treatments included conservative methods and sacroplasty, with a few complications reported. Osteoporosis was the prevalent comorbidity, and the survival rate post-treatment was high at 92.3%. Mobility outcomes varied, with some patients experiencing significant autonomy loss. The average follow-up period was over 17 months. : This study found a cautious approach to surgery (timing of three weeks), which is reserved only for specific patterns, and it leads to increased autonomy and a lower risk of mortality. Due to the lack of pre- and postoperative scores as well as conflicting results, it is imperative to undertake further studies and research to be able to compare the alternative treatments efficiently.
PubMed: 38892887
DOI: 10.3390/jcm13113176 -
Archives of Orthopaedic and Trauma... Jun 2023Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and benefits of PAO in patients with hip dysplasia in studies reporting both adverse events and patient-reported hip pain and function.
MATERIALS AND METHODS
A systematic search combing PAO and patient-reported outcomes was performed in the databases MEDLINE, CINAHL, EMBASE, Sports Discuss and PsychINFO. Studies including both harms and benefits defined as adverse events and patient-reported hip pain and function were included. Risk of bias was assessed using The Cochrane Risk of Bias In Non-Randomized Studies - of Interventions.
RESULTS
Twenty-nine cohort studies were included, of which six studies included a comparison group. The majority of studies had serious risk of bias and the certainty of evidence was very low. The proportion of adverse events was 4.3 (95% CI 3.7; 4.9) for major adverse events and 14.0 (95% CI 13.0; 15.1) for minor adverse events. Peroneal nerve dysfunction was the most frequent adverse event among the major adverse events, followed by acetabular necrosis and delayed union or non-union. All patient-reported hip pain and function scores improved and exceeded the minimal clinically important differences after PAO. After 5 years, scores were still higher than the preoperative scores.
CONCLUSION
PAO surgery has a 4% risk of major, and 14% risk of minor adverse events and a positive effect on patient-reported hip pain and function among patients with hip dysplasia.
Topics: Humans; Hip Dislocation; Treatment Outcome; Retrospective Studies; Hip Dislocation, Congenital; Acetabulum; Arthralgia; Osteotomy; Hip Joint
PubMed: 36175675
DOI: 10.1007/s00402-022-04627-7 -
ANZ Journal of Surgery May 2016Free vascularized bone flaps are widely recognized as the optimal reconstruction for patients who undergo mandibular resection. The fibula-free flap is currently... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Free vascularized bone flaps are widely recognized as the optimal reconstruction for patients who undergo mandibular resection. The fibula-free flap is currently considered the gold standard, workhorse flap for mandibular reconstruction. Although previous studies have analysed individual success of each flap type, few have compared iliac- and fibula-free flaps.
METHODS
A systematic review of the literature was conducted in line with the PRISMA protocol searching the PubMed and EBSCO databases. Twenty-four studies were included as per predetermined inclusion criteria. Double-arm random effect meta-analysis was conducted with STATA 12, and single-arm meta-analysis was conducted utilizing Meta-XL.
RESULTS
The results of this meta-analysis confirm that there is no significant difference in total flap loss between fibula- and iliac-free flap reconstruction of mandibular defects. In terms of recipient site complication, there was a significantly higher risk of delayed healing and suture line breakdown in the iliac flap group (P = 0.05). Donor site complications showed a trend towards being higher in the fibula flap group. Osseointegrated dental implant loss in fibula flaps was higher than in iliac flaps (5.3% compared with 1.7%).
CONCLUSION
Both iliac- and fibula-free flaps should be considered for use in mandibular reconstruction. We suggest the iliac crest as the first choice for mandibular angle or body defects (better contour match) or also defects requiring greater soft-tissue bulk for intra-oral lining. The fibula flap is best when bony length is required such as in subtotal or total mandibulectomy.
Topics: Bone Transplantation; Fibula; Free Tissue Flaps; Humans; Ilium; Mandibular Reconstruction
PubMed: 26331293
DOI: 10.1111/ans.13274 -
Annals of Surgical Oncology Oct 2022Although internal hemipelvectomies with sacroiliac resections are not traditionally reconstructed, surgeons are increasingly pursuing pelvic ring reconstruction to... (Review)
Review
BACKGROUND
Although internal hemipelvectomies with sacroiliac resections are not traditionally reconstructed, surgeons are increasingly pursuing pelvic ring reconstruction to theoretically improve stability, function, and early ambulation. This study aims to systematically compare complications and functional and oncologic outcomes of sacroiliac resection with and without reconstruction.
METHODS
PubMed and MEDLINE were queried for studies published between January 1990 and October 2020 pertaining to sacroiliac neoplasm resection with subsequent reconstruction. Patient demographics, histopathologic diagnoses, reconstruction techniques, Musculoskeletal Tumor Society (MSTS) functional scores, and oncologic outcomes were pooled.
RESULTS
Twenty-three studies (201 patients) were included for analysis. Reconstruction was performed in 79.1% of patients, most commonly with nonvascularized autografts (45.8%). The overall complication rate was 54.8%; however, resection followed by reconstruction demonstrated significantly higher complication (62.3% versus 25.7%, p < 0.001) and infection rates (13.7% versus 0%, p = 0.020). Mean MSTS functional score trended higher in nonreconstructed patients (82% versus 71.6%).
CONCLUSIONS
Reconstruction after sacroiliac resection produced higher complication rates and poorer physical recovery when compared with nonreconstructed resection. This systematic review suggests that patients without spinopelvic junction instability may experience superior outcomes without reconstruction. Ultimately, the need to reconstruct the pelvic girdle depends on tumor size, prognosis, and functional goals.
Topics: Bone Neoplasms; Hemipelvectomy; Humans; Osteotomy; Retrospective Studies; Treatment Outcome
PubMed: 35904659
DOI: 10.1245/s10434-022-11890-w -
European Spine Journal : Official... Jun 2020A variety of alternative grafts to autologous iliac crest bone (ICBG) have been developed for lumbar spondylodesis, due to frequent complications following ICBG harvest.... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
A variety of alternative grafts to autologous iliac crest bone (ICBG) have been developed for lumbar spondylodesis, due to frequent complications following ICBG harvest. The optimal alternative graft to ICBG, however, remains elusive till now. The purpose of this study was to compare the efficacy and safety of fusion materials in lumbar degeneration diseases and to provide a ranking spectrum of the grafts.
METHODS
Randomized controlled trials (RCTs) comparing different bone grafts in lumbar arthrodesis were eligible for inclusion. A network meta-analysis was performed for endpoints including fusion rate and incidence of adverse events.
RESULTS
Twenty-seven RCTs involving 2488 patients and 13 available interventions were included. rhBMP-2 provided the highest fusion rate, being significantly superior to that of ICBG (OR = 0.21, p < 0.001), autograft local bone (ALB) (OR = 0.18, p = 0.022), rhBMP-7 (OR = 0.15, p < 0.001), allograft (OR = 0.13, p = 0.009), and DBM + ALB (OR = 0.07, p = 0.048). The treatment efficacy of allograft could be significantly enhanced by bone marrow concentrate (BMC) supplying (OR = 0.16, p = 0.010). ICBG ranks second on the frequency of complications, which is significantly higher than that of allograft (OR = 0.14, p = 0.041) and ALB (OR = 0.14, p = 0.030). All of the other comparisons showed similar efficacy and safety profiles between groups.
CONCLUSION
Ranking spectrums of the efficacy and safety for various bone grafts were provided graphically. Though rhBMP-2 was of the highest success rate, the application should be taken with proper caution because of the widely proposed life-threatening adverse events. ALB, ALB plus synthetic ceramic materials and allograft mixed with BMC were also proved to be potentially effective alternative graft to ICBG. These slides can be retrieved under Electronic Supplementary Material.
Topics: Bone Substitutes; Bone Transplantation; Humans; Ilium; Lumbar Vertebrae; Network Meta-Analysis; Randomized Controlled Trials as Topic; Recombinant Proteins; Spinal Fusion; Treatment Outcome
PubMed: 31872300
DOI: 10.1007/s00586-019-06257-x -
Journal of Orthopaedic Trauma Sep 2018The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and...
INTRODUCTION
The purpose of this article is to review the available literature on anterior subcutaneous internal pelvic fixation (ASIPF) to identify indications, clinical and radiographic outcomes, and compare these with alternative fixation methods.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search on PubMed and Google Scholar was performed. Articles included were in the English language or English translations and published between 2007 and 2018. Studies included were appraised with narrative data synthesis.
RESULTS
Twenty-five articles with 496 patients were included. These included 17 case series, with 3 case reports reporting adverse events.
CONCLUSIONS
ASIPF and the appropriate posterior fixation resulted in healing of pelvic ring injuries in 99.5% of cases. Indications include unstable pelvic ring injuries with the appropriate posterior fixation. Radiographic parameters and outcome measures were infrequently reported. ASIPF is a valuable tool for reduction and fixation in unstable pelvic ring injuries. Complications include lateral femoral cutaneous nerve irritation (26.3%); heterotopic ossification (36%); infection (3%); and femoral nerve palsy (1%), which is likely related to placing the bar and screws too deep.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators; Patient Selection; Pelvic Bones
PubMed: 30095678
DOI: 10.1097/BOT.0000000000001248 -
The Journal of Arthroplasty Sep 2015The effect of varying corticosteroid regimens on hip osteonecrosis incidence remains unclear. We performed a meta-analysis and systematic literature review to determine... (Meta-Analysis)
Meta-Analysis Review
The effect of varying corticosteroid regimens on hip osteonecrosis incidence remains unclear. We performed a meta-analysis and systematic literature review to determine osteonecrosis occurrences in patients taking corticosteroids at varying mean and cumulative doses and treatment durations, and whether medical diagnoses affected osteonecrosis incidence. Fifty-seven studies (23,561 patients) were reviewed. Regression analysis determined significance between corticosteroid usage and osteonecrosis incidence. Osteonecrosis incidence was 6.7% with corticosteroid treatment of >2 g (prednisone-equivalent). Systemic lupus erythematosus patients had positive correlations between dose and osteonecrosis incidence. Each 10 mg/d increase was associated with a 3.6% increase in osteonecrosis rate, and >20 mg/d resulted in a higher osteonecrosis incidence. Clinicians must be wary of osteonecrosis in patients on high corticosteroid regimens, particularly in systematic lupus erythematosus.
Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Child; Child, Preschool; Dose-Response Relationship, Drug; Humans; Incidence; Lupus Erythematosus, Systemic; Middle Aged; Osteonecrosis; Pelvic Bones; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 25900167
DOI: 10.1016/j.arth.2015.03.036 -
Injury Feb 2022Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3.
RESULTS
Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%.
CONCLUSIONS
Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Reoperation
PubMed: 34625237
DOI: 10.1016/j.injury.2021.09.004 -
Orthopaedic Surgery Apr 2022To perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and... (Review)
Review
OBJECTIVE
To perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and functional outcomes reported in literature written in English.
METHODS
This review was performed by searching PubMed, Cochrane Library, Scopus, and Web of Science without a filter for time limitation in line with Preferred Reporting Items for Systematic Reviews Protocols (PRISMA-P) guidelines. Two authors took part in screening and evaluating the literature between December 2020 and January 2021. The terms acetabulum fracture, reduction, fixation, femur head fracture, fracture dislocation of the hip, hip trauma and arthroscopy or arthroscopic, and their combinations were used to search four database engines in the titles and abstracts of the reported papers. Only papers with English titles and abstracts were included. The assessment of the data related to descriptions of the techniques, indications for fracture fixation using arthroscopy, and patient-related outcomes.
RESULTS
Perfect agreement was detected between the two reviewers during all steps of the review process (κ = 0.81-1.00). Although a meta-analysis was planned to be carried out, no randomized controlled study comparing either the radiological or functional results of different surgical techniques was detected in the literature. Nineteen studies were included in the study. Of these, 15 were retrospective case reports and four were case series. Twenty-seven patients were operated on for acetabulum fractures (18 male/nine female). The mean age was 28.3 years (range, 15-53 years). High-energy traumas including motor vehicle accidents were the most common reason (81%). The duration of follow-up was a mean of 32 months (range, 12-68 months). Sixteen patients were operated on for femur fractures (12 male/three female). The mean age was 30.1 years (range, 17-50 years). Motor vehicle accident was the most common trauma (70%). Duration of follow-up had a mean of 18 months (range, 4-60 months). Patient-related outcomes were excellent for reported cases in both groups despite the fact that an objective scoring system was not used for most of the cases. Moreover, there was no consensus on surgical indications or the techniques.
CONCLUSIONS
The techniques of arthroscopic-assisted fixation of acetabulum and femoral head fracture are so heterogeneous that conclusions cannot be made at this time, but there is potential for this method of treatment to become more popular as the devices used in the procedure develop and as exposure to and experience with hip arthroscopy improves. Further descriptions of reduction and fixation techniques and analysis of outcomes of RCTs are needed.
Topics: Acetabulum; Adult; Arthroscopy; Female; Femoral Fractures; Femur Head; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 35293674
DOI: 10.1111/os.13245 -
Archives of Orthopaedic and Trauma... Nov 2023The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures... (Review)
Review
INTRODUCTION
The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures primarily seen in adult patients versus geriatric patients mostly suffering from low-energy trauma. Historically, acetabular fractures have been treated either non-operatively or surgically following open reduction and internal fixation (ORIF), whereas nowadays total hip arthroplasty (THA) provides a true alternative. Aim of this study was to perform a systematic review on the outcome following THA in acute acetabulum fractures.
METHODS
PubMed/MEDLINE, Cochrane and Google databases were systematically searched on December 9, 2021. The key terms were [acetabular fracture] AND [[arthroplasty] OR [fixation]]. All retrospective and prospective original studies in English and German were analyzed the outcome following THA in acute acetabulum fractures were included.
RESULTS
A total of 2459 studies were screened, which includes 15 studies that met the inclusion criteria with a total of 590 patients at a mean age of 61.3 years (SD 11.48). Most studies described good to excellent results. Especially, THA allows elderly patients quicker mobilization and rehabilitation as well as symptomatic relief, as compared to ORIF or non-operative treatment. Patients who underwent non-operative treatment showed better results compared to those who underwent ORIF initially.
CONCLUSION
In acetabulum fractures, THA provides a good alternative with very good results when patients are carefully selected. Good to excellent outcomes are reported for both acute and delayed use of THA in elderly patients.
LEVEL OF EVIDENCE
Level 2, systematic review.
Topics: Adult; Humans; Aged; Middle Aged; Fractures, Bone; Arthroplasty, Replacement, Hip; Acetabulum; Retrospective Studies; Fracture Fixation, Internal; Prospective Studies; Hip Fractures; Spinal Fractures; Treatment Outcome
PubMed: 37543998
DOI: 10.1007/s00402-023-05007-5