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Clinics in Orthopedic Surgery Mar 2018Surgical and conservative methods have been reported by various studies for high rates of fracture union and subsequent regain of function among patients with... (Comparative Study)
Comparative Study Meta-Analysis Review
A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Surgical versus Conservative Treatments for Acute Undisplaced or Minimally-Displaced Scaphoid Fractures.
BACKGROUND
Surgical and conservative methods have been reported by various studies for high rates of fracture union and subsequent regain of function among patients with undisplaced or minimally-displaced scaphoid fractures. Hence, this study aims to analyze the best available evidence to comprehend the relative benefits and risks of these therapeutic options.
METHODS
A systematic search of the literature from different databases and search engines was performed with strict eligibility criteria to obtain the highest quality of evidence. All randomized controlled trials delineating the outcomes of surgical versus conservative treatments for acute undisplaced or minimally-displaced scaphoid fractures were included and then evaluated using scoring tools: Cochrane risk of bias tool and PEDro scale. Data were pooled using random-effects models with standard mean differences for continuous outcomes and risk ratios for dichotomous variables.
RESULTS
The search yielded 339 potentially related articles, further trimmed down to eight studies based on the eligibility criteria. The meta-analysis revealed that surgical treatment resulted in significantly better functional outcomes than conservative treatment. Furthermore, surgery resulted in the prevention of delayed union of fractures and reduction of time needed to return to work.
CONCLUSIONS
While four studies reported advantages of surgical treatment, evidence was insufficient to provide a definitive conclusion that surgery is a better option. Due to the significant limitations with respect to certain variables, the superiority of one method to the other could not be established.
Topics: Conservative Treatment; Fracture Healing; Fractures, Bone; Humans; Pinch Strength; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Return to Work; Scaphoid Bone; Time Factors
PubMed: 29564049
DOI: 10.4055/cios.2018.10.1.64 -
The Journal of Hand Surgery... Mar 2017The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical...
BACKGROUND
The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA.
METHODS
Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines.
RESULTS
295 unique results were identified from the search strategy after duplicates were filtered. 21 articles met the eligibility criteria.
CONCLUSIONS
Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. Distal scaphoid excision remains an effective pain relief treatment with improved grip and pinch strengths post-operatively. The procedure is technically less demanding than arthrodesis, does not carry the risks of non-union and complication rate of STT joint arthrodesis, and has a shorter immobilisation requirement. It produces reliable results, but is contraindicated if there is either scapholunocapitate pathology or midcarpal instability. STT joint fusion has a place, typically producing 75% range of movement of the non-operated wrist. However it has a higher associated complication rate, and simultaneous radial styloidectomy is recommended to reduce ongoing pain from impingement. Implant arthroplasty using a graphite-coated pyrocarbon implant has been used more recently. The patients gained significant pain relief, although there have been reports of implant dislocation secondary to surgical errors. A reduction in post-operative wrist extension and radial deviation has been noted. From this systematic review, we have composed a treatment algorithm for the surgical management of STT joint OA.
Topics: Arthrodesis; Arthroplasty, Replacement; Arthroscopy; Carpal Joints; Hand Strength; Humans; Osteoarthritis; Scaphoid Bone; Trapezium Bone; Trapezoid Bone
PubMed: 28205478
DOI: 10.1142/S0218810417300017 -
The Journal of Rheumatology Nov 2015Description of use and metric properties of instruments measuring pain, physical function, or patient's global assessment (PtGA) in hand osteoarthritis (OA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Description of use and metric properties of instruments measuring pain, physical function, or patient's global assessment (PtGA) in hand osteoarthritis (OA).
METHODS
Medical literature databases up to January 2014 were systematically reviewed for studies reporting on instruments measuring pain, physical function, or PtGA in hand OA. The frequency of the use of these instruments were described, as well as their metric properties, including discrimination (reliability, sensitivity to change), feasibility, and validity.
RESULTS
In 66 included studies, various questionnaires and performance- or assessor-based instruments were applied for evaluation of pain, physical function, or PtGA. No major differences regarding metric properties were observed between the instruments, although the amount of supporting evidence varied. The most frequently evaluated questionnaires were the Australian/Canadian Hand OA Index (AUSCAN) pain subscale and visual analog scale (VAS) pain for pain assessment, and the AUSCAN function subscale and Functional Index for Hand OA (FIHOA) for physical function assessment. Excellent reliability was shown for the AUSCAN and FIHOA, and good sensitivity to change for all mentioned instruments; additionally, the FIHOA had good feasibility. Good construct validity was suggested for all mentioned questionnaires. The most commonly applied performance- or assessor-based instruments were the grip and pinch strength for the assessment of physical function, and the assessment of pain by palpation. For these measures, good sensitivity to change and construct validity were established.
CONCLUSION
The AUSCAN, FIHOA, VAS pain, grip and pinch strength, and pain on palpation were most frequently used and provided most supporting evidence for good metric properties. More research has to be performed to compare the different instruments with each other.
Topics: Activities of Daily Living; Aged; Antirheumatic Agents; Disability Evaluation; Disease Progression; Female; Hand; Hand Strength; Humans; Male; Middle Aged; Netherlands; Osteoarthritis; Pain Measurement; Quality of Life; Risk Assessment; Self Care; Sickness Impact Profile
PubMed: 26472412
DOI: 10.3899/jrheum.141228 -
The Journal of Hand Surgery, European... Dec 2018Arthroscopic management of thumb carpometacarpal (CMC) osteoarthrosis (OA) is an approach that has unclear results. We performed a systematic review encompassing three... (Meta-Analysis)
Meta-Analysis
Arthroscopic management of thumb carpometacarpal (CMC) osteoarthrosis (OA) is an approach that has unclear results. We performed a systematic review encompassing three electronic databases up to May 2016 for studies describing arthroscopic-assisted techniques for thumb CMC OA. Meta-analyses of visual analogue scores (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength and pinch strength before and after arthroscopy were performed for ten included non-randomized cohort studies comprising 294 patients. Based on Hedges' g measure, we found a large effect on VAS and DASH scores, a small effect on grip strength and no effect on pinch strength. On average, VAS improved by 4.1 cm, DASH by 22 points and grip strength by 2.8 kg. Complications were reported in 4% of patients. The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment.
Topics: Arthroscopy; Carpometacarpal Joints; Disability Evaluation; Hand Strength; Humans; Osteoarthritis; Thumb; Visual Analog Scale
PubMed: 29451099
DOI: 10.1177/1753193418757122 -
Physiotherapy Theory and Practice Nov 2022The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.
OBJECTIVE
This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA.
DESIGN
Systematic review and meta-analysis of randomized clinical trials.
METHODS
An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA.
RESULTS
Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group.
CONCLUSIONS
In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.
Topics: Humans; Thumb; Carpometacarpal Joints; Osteoarthritis; Musculoskeletal Manipulations; Pinch Strength; Hand Strength; Pain
PubMed: 34074220
DOI: 10.1080/09593985.2021.1926026 -
Journal of Wrist Surgery Dec 2022First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated...
First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. This is a Level III study.
PubMed: 36504539
DOI: 10.1055/s-0042-1744493 -
Neuromuscular Disorders : NMD Mar 2022Since the introduction of disease modifying treatments there is an unmet need to identify biomarkers of spinal muscular atrophy (SMA) natural history. We performed a... (Meta-Analysis)
Meta-Analysis
Since the introduction of disease modifying treatments there is an unmet need to identify biomarkers of spinal muscular atrophy (SMA) natural history. We performed a systematic review and meta-analysis to summarize available evidence. We searched MEDLINE, Embase, Cochrane Library and gray literature until February 2021. The primary outcome was biomarkers longitudinal course in adolescents and adults. The secondary outcome was the discrimination of patients from controls. We included 42 records examining 606 patients from 19 population cohorts over a maximum follow-up of 17-years. Lung function and serum biomarkers could not depict disease progression. We identified potential biomarkers of disease activity [SMA functional rating scale, MoviPlate, pinch strength, compound muscle action potential (CMAP), motor unit number estimation (MUNE)] that require further investigation. Data regarding Hammersmith functional motor scale expanded, Revised upper limb module, 6-minute walk test were contradictory impeding any pooled estimate. The pooled analysis regarding our secondary outcome revealed that upper limb CMAP amplitudes and MUNE mean values differed significantly between SMA patients and controls [mean difference -3.63(-6.2, -1.06), -119.74(-153.93, -85.56) respectively]. Given the lack of natural history data on this population, our qualitative synthesis and meta-analysis could provide valuable evidence and identify promising predictive biomarkers requiring further longitudinal examination. PROSPERO Registration: CRD42021235605.
Topics: Adolescent; Adult; Biomarkers; Disease Progression; Humans; Muscular Atrophy, Spinal; Spinal Muscular Atrophies of Childhood
PubMed: 35115230
DOI: 10.1016/j.nmd.2021.12.005 -
International Journal of Oral and... Jan 2021Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question "Are the range... (Meta-Analysis)
Meta-Analysis
Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question "Are the range of wrist movements (range of motion, ROM) and hand strength affected after RFF harvesting?" The PubMed, Embase, Scopus, and Cochrane Library electronic databases were systematically searched (to December 2019). Self-controlled studies evaluating hand biomechanics after RFF harvest were included. Weighted mean differences with 95% confidence intervals were calculated using the random-effects model. The outcome variables were ROM, forearm movements, grip, and pinch strengths. Thirteen studies involving a total of 335 patients were included. With the exception of grip strength and supination, which showed statistically significant reductions of about 2.40 kg and 2.86° (P < 0.05), all other ROM, forearm movements, and pinch strengths showed an insignificant difference when the operated hand was compared to the non-operated hand (P > 0.05). Regression analysis showed that the method of donor site closure and size of the donor site defect had an insignificant impact on hand biomechanics. This study confirms the lack of discernible biomechanical morbidity after RFF transfer. The minimal reduction in hand biomechanics after RFF is considered to be clinically negligible.
Topics: Humans; Biomechanical Phenomena; Forearm; Plastic Surgery Procedures; Range of Motion, Articular; Surgical Flaps; Tissue and Organ Harvesting
PubMed: 32665139
DOI: 10.1016/j.ijom.2020.06.016 -
Journal of Plastic, Reconstructive &... Oct 2023Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical...
Injuries to the extensor mechanism of the hand and forearm are common and cause significant functional disability. Complete tendon lacerations are managed with surgical repair, whereas selected partial tendon injuries may be managed without repair but with splinting and physiotherapy alone. There is limited evidence to support the management of partial lacerations, in particular the decision of whether to repair or not. We aimed to systematically review the literature to determine the optimal management of partial extensor tendon lacerations in the hand and forearm. A protocol for the systematic review was developed prospectively and registered with PROSPERO (CRD42021250431). PubMed, EMBASE, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1990 to 27/05/2022. 4565 studies were screened, of which 88 underwent full text review. Five studies were included, one randomised control trial and four cohort studies. One study examined outcomes of partial lacerations treated without repair; the other four studies examined outcomes following repair. Pinch and grip strength and time to return to work were similar regardless of management. Adverse outcomes were reported for patients undergoing surgical repair; none were observed in those managed without repair. Meta-analysis was precluded by study heterogeneity and high risk of bias. There is limited evidence to support the management of partial extensor tendon lacerations, with some low-quality evidence that non-operative management of selected partial lacerations is safe. There is a pressing need for pragmatic, multicentre randomised trials to assess the cost-effectiveness of current treatments.
Topics: Humans; Forearm; Hand; Lacerations; Tendon Injuries; Tendons
PubMed: 37454548
DOI: 10.1016/j.bjps.2023.06.004 -
BMC Musculoskeletal Disorders Apr 2020Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS).... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) both have advantages and disadvantages for the treatment of carpal tunnel syndrome (CTS). We compared the effectiveness and safety of ECTR and OCTR based on evidence from a high-level randomized controlled trial.
METHODS
We comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Medline to identify relevant articles published until August 2019. Data regarding operative time, grip strength, Boston Carpal Tunnel Questionnaire scores, digital sensation, patient satisfaction, key pinch strength, return to work time, and complications were extracted and compared. All mean differences (MD) and odds ratios (OR) were expressed as ECTR relative to OCTR.
RESULTS
Our meta-analysis contained twenty-eight studies. ECTR was associated with significantly higher satisfaction rates (MD, 3.13; 95% confidence interval [CI], 1.43 to 4.82; P = 0.0003), greater key pinch strengths (MD, 0.79 kg; 95% CI, 0.27 to 1.32; P = 0.003), earlier return to work times (MD, - 7.25 days; 95% CI, - 14.31 to - 0.19; P = 0.04), higher transient nerve injury rates (OR, 4.87; 95% CI, 1.37 to 17.25; P = 0.01), and a lower incidence of scar-related complications (OR, 0.20; 95% CI, 0.07 to 0.59; P = 0.004). The permanent nerve injury showed no significant differences between the two methods (OR, 1.93; 95% CI, 0.58 to 6.40; P = 0.28).
CONCLUSIONS
Overall, evidence from randomized controlled trials indicates that ECTR results in better recovery of daily life functions compared to OCTR, as revealed by higher satisfaction rates, greater key pinch strengths, earlier return to work times, and fewer scar-related complications. Our findings suggest that patients with CTS can be effectively managed with ECTR.
Topics: Carpal Tunnel Syndrome; Decompression, Surgical; Endoscopy; Hand Strength; Humans; Neurosurgical Procedures; Operative Time; Patient Satisfaction; Postoperative Complications; Randomized Controlled Trials as Topic; Return to Work; Safety; Surveys and Questionnaires; Treatment Outcome
PubMed: 32340621
DOI: 10.1186/s12891-020-03306-1