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EFORT Open Reviews Jan 2022The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft... (Review)
Review
The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures. A PubMed search including original articles comparing different treatments for humeral shaft fractures published since January 2000 was performed. Random effect models with relative risks (RR) and 95% CIs were calculated for treatment groups and outcomes. Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III, 27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nine conservative with operative treatment, four ORIF with minimally invasive plate osteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNP risk was higher for ORIF vs IM (18 studies; RR: 1.80; P = 0.047), ORIF vs MIPO (4 studies; RR: 5.60; P = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68; P = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies; RR: 0.37; P < 0.001), but not significantly different between ORIF and IM (21 studies; RR: 1.00; P = 0.997), or approaches (two studies; RR: 0.36; P = 0.369). Post-operative infection risk was higher for ORIF vs IM (14 studies; RR: 1.84; P = 0.004) but not different between approaches (2 studies; RR: 0.95; P = 0.960). Surgery appears to be the method of choice when aiming to secure bony union, albeit risk for iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posterior approach. Due to the limited number of randomised studies, evidence on the best treatment option remains moderate, though.
PubMed: 35073516
DOI: 10.1530/EOR-21-0097 -
The Western Journal of Emergency... Jun 2023Ultrasound-guided peripheral nerve blockade is a common pain management strategy to decrease perioperative pain and opioid/general anesthetic use. In this article our... (Review)
Review
INTRODUCTION
Ultrasound-guided peripheral nerve blockade is a common pain management strategy to decrease perioperative pain and opioid/general anesthetic use. In this article our goal was to systematically review publications supporting upper extremity nerve blocks distal to the brachial plexus. We assessed the efficacy and safety of median, ulnar, radial, suprascapular, and axillary nerve blocks by reviewing previous studies.
METHODS
We searched MEDLINE and Embase databases to capture studies investigating these nerve blocks across all specialties. We screened titles and abstracts according to agreed-upon inclusion/exclusion criteria. We then conducted a hand search of references to identify studies not found in the initial search strategy.
RESULTS
We included 20 studies with 1,273 enrolled patients in qualitative analysis. Both anesthesiology (12, 60%) and emergency medicine (5, 25%) specialties have evidence of safe and effective use of radial, ulnar, median, suprascapular, and axillary blocks for numerous clinical applications. Recently, multiple randomized controlled trials show suprascapular nerve blocks may result in lower pain scores in patients with shoulder dislocations and rotator cuff injuries, as well as in patients undergoing anesthesia for shoulder surgery.
CONCLUSION
Distal upper extremity nerve blocks under ultrasound guidance may be safe, practical strategies for both acute and chronic pain in perioperative, emergent, and outpatient settings. These blocks provide accessible, opioid-sparing pain management, and their use across multiple specialties may be expanded with increased procedural education of trainees.
Topics: Humans; Analgesics, Opioid; Ultrasonography, Interventional; Upper Extremity; Nerve Block; Peripheral Nerves; Pain
PubMed: 37527380
DOI: 10.5811/westjem.56058 -
Anesthesia and Analgesia Feb 2017Supraclavicular (SC) and infraclavicular (IC) brachial plexus block (BPB) are commonly used for upper extremity surgery. Recent clinical studies have compared the effect... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Supraclavicular (SC) and infraclavicular (IC) brachial plexus block (BPB) are commonly used for upper extremity surgery. Recent clinical studies have compared the effect of SC- and IC-BPB, but there have been controversies over spread of sensory blockade in each of the 4 peripheral nerve branches of brachial plexus.
METHODS
This study included a systemic review, using the Medline and EMBASE database from their inceptions through March 2016. Randomized controlled trials (RCTs) comparing SC- and IC-BPB were included. The prespecified primary outcome was the incidences of incomplete sensory blockade in each of the 4 terminal nerve branches of brachial plexus. Secondary outcome included the incidence of successful blockade, performance time, onset of sensory block, duration of analgesia, and complication rates.
RESULTS
Ten RCTs involving 676 patients were included. Pooled analyses showed the incidence of incomplete block at 30 minutes in radial nerve territory was significantly higher in IC-BPB, favoring SC-BPB (risk ratio 0.39; 95% confidence interval [0.17-0.88], P = .02, I = 0%). However, subgroup analysis according to the number of injections of IC-BPB showed that double or triple injections IC-BPB yielded no difference in the incomplete radial block. Furthermore, the incidence of incomplete ulnar block at 30 minutes was significantly lower in IC-BPB when using double or triple injection IC-BPB. There was no difference in the secondary outcomes between SC- and IC-BPB groups, with the exception of complication rates. The incidence of paresthesia/pain on local anesthetic injection, phrenic nerve palsy, and Horner syndrome was significantly higher in the SC group, favoring IC-BPB.
CONCLUSIONS
This meta-analysis demonstrated that IC-BPB showed a significantly high incidence of incomplete radial nerve sensory block at 30 minutes, which may be avoided by double or triple injection. Furthermore, IC-BPB with multiple injection technique showed significantly lower incidence of incomplete ulnar block than SC-BPB. There were no differences in the incidence of successful blockade, block onset, and duration of analgesia between SC- and IC-BPB. Procedure-related paresthesia/pain and adjacent nerve-related complications were more frequent in SC-BPB. However, because of the small sample size, publication bias remains a concern when interpreting our results. Further studies with sufficient sample size and reporting large number of outcomes are required.
Topics: Humans; Brachial Plexus; Clavicle; Nerve Block; Randomized Controlled Trials as Topic; Treatment Failure; Ultrasonography, Interventional
PubMed: 27828793
DOI: 10.1213/ANE.0000000000001713 -
Work (Reading, Mass.) 2015Musculoskeletal disorders are one of the most common work-related diseases. Frequently this association is thought to have a temporal cause-effect relation. The absence... (Review)
Review
BACKGROUND
Musculoskeletal disorders are one of the most common work-related diseases. Frequently this association is thought to have a temporal cause-effect relation. The absence of accessible diagnostic criteria and ethological cause-effect demonstration are probably important reasons for the lack of good evidence data on these pathologies.
OBJECTIVE
For these reasons, the authors aim to present a systematic review on prevalence and incidence of the upper limb WRMSD.
METHODS
The survey was conducted for papers published between January 1st, 2000 and July 2012, according to the PRISMA statement (2009) guidelines.
RESULTS
From the 2016 papers obtained, 94 met the qualitative selection criteria. From these 27 address upper-limb WRMSD, and 17 present data on prevalence or incidence on upper-limb musculoskeletal diseases, six of them with a control group. Annual incidence ranges from 0.08 to 6.3, and prevalence from 0.14 to 14.9. Rotator cuff syndrome among shoe industry workers, present the highest incidence, and cubital, radial or ulnar nerve entrapment, the highest prevalence among a miscellaneous group of workers.
CONCLUSIONS
More studies are needed to clarify the relation between work and WRMSD's, especially prospective investigations from different economic sectors and work activities, but with similar, reproducible and comparable methodologies.
Topics: Humans; Incidence; Musculoskeletal Diseases; Occupational Diseases; Prevalence; Upper Extremity
PubMed: 26409936
DOI: 10.3233/WOR-152032 -
Journal of Plastic, Reconstructive &... Jan 2022The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity... (Review)
Review
BACKGROUND
The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF.
METHODS
A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure.
RESULTS
Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively.
CONCLUSION
The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap.
Topics: Forearm; Free Tissue Flaps; Humans; Hyperesthesia; Hypesthesia; Incidence; Neuralgia; Plastic Surgery Procedures; Sensation; Skin Transplantation
PubMed: 34736849
DOI: 10.1016/j.bjps.2021.09.028 -
The Journal of Hand Surgery, European... Oct 2016We assessed the proximity of neurological structures to arthroscopic portals in a cadaveric study and through a systematic review. Arthroscopy was performed on ten... (Review)
Review
UNLABELLED
We assessed the proximity of neurological structures to arthroscopic portals in a cadaveric study and through a systematic review. Arthroscopy was performed on ten cadaveric wrists. Subsequently the specimens were dissected to isolate the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the posterior interosseous nerve and the extensor tendons. We measured the distances from the nerves to common portals. For the systematic review Pubmed and EMBASE were searched on the 31 May 2014 for cadaveric studies reporting the proximity of neurological structures to any arthroscopic wrist portal. In the cadaveric study, partial injuries were seen to six extensor tendons and one posterior interosseous nerve; it was assumed this was due to creation of the portals. Seven published studies were included in the systematic review. The dorsal sensory branch of the ulnar nerve was found to be at risk by performing the 6 Ulnar, 6 Radial and ulnar midcarpal portals, the sensory branch of the radial nerve by the 1-2 and 3-4 portals and the posterior interosseous nerve by the 3-4 and 4-5 portals.
LEVEL OF EVIDENCE
V.
Topics: Arthroscopy; Cadaver; Dissection; Humans; Intraoperative Complications; Radial Nerve; Ulnar Nerve; Wrist Joint
PubMed: 27056276
DOI: 10.1177/1753193416641061 -
Neurosurgical Review Apr 2022Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and... (Meta-Analysis)
Meta-Analysis Review
Possible donor nerves for axillary nerve reconstruction in dual neurotization for restoring shoulder abduction in brachial plexus injuries: a systematic review and meta-analysis.
Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.
Topics: Accessory Nerve; Brachial Plexus; Brachial Plexus Neuropathies; Humans; Nerve Transfer; Shoulder; Treatment Outcome
PubMed: 34978005
DOI: 10.1007/s10143-021-01713-z -
JSES Reviews, Reports, and Techniques Nov 2022Arm wrestling is a popular sport/game that may result in various injuries. The most common arm wrestling injury in adults is humeral shaft fracture. This study aimed to... (Review)
Review
BACKGROUND
Arm wrestling is a popular sport/game that may result in various injuries. The most common arm wrestling injury in adults is humeral shaft fracture. This study aimed to elucidate the current understanding of humeral shaft fracture caused by arm wrestling and propose the possible mechanism.
METHODS
The PubMed and Web of Science databases were searched using the terms "arm wrestling" and "humeral fracture" as well as "sports" and "humeral fracture" in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were English full-text articles and notable full-text articles in other languages concerning humeral shaft fracture caused by arm wrestling that described the patients' characteristics and presented adequate images or a detailed description of the fracture to confirm the fracture details. The exclusion criterion was a lack of appropriate images or detailed description of the fracture. Fifty-seven studies were identified. The patients' demographics were evaluated. The details of fractures, primary radial nerve palsy, match status, provided fracture treatment, and outcomes were evaluated using the chi-squared test. The relationship between fracture site and the patient's age was analyzed using Student's -test.
RESULTS
One hundred fifty-three patients, 82% of whom were males aged 15-34 years, were identified. With only a few exceptions, almost all patients were injured in recreational matches. The injured limb was the right arm in 65% of patients (n = 141). The patient's physical characteristics, the opponent's physical characteristics compared with those of the patient, and the match status at the time of injury varied between cases. Among the 46 patients with known match details, all were injured when one of the wrestling opponents suddenly added more force in an attempt to change the match status. The fracture configuration was spiral in all cases, and 48% of fractures had an associated medial butterfly fragment. The fracture site was the distal third or the junction between the distal and middle thirds in 90% of cases. Although primary radial nerve palsy was recognized in 19 of 103 patients (18.4%), all resolved spontaneously.
CONCLUSION
Although humeral shaft fracture caused by arm wrestling occurred mostly in male players aged 15-34 years, this injury may affect any player regardless of the match status, player's and opponent's physical characteristics, and age. The direct cause is torsional force generated by the internal rotators. A sudden change from concentric to eccentric contraction of the internal rotators is likely to cause fracture.
PubMed: 37588473
DOI: 10.1016/j.xrrt.2022.05.005 -
Acta Orthopaedica Belgica Jun 2023The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to...
The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.
Topics: Humans; Adult; Child; Child, Preschool; Radius Fractures; Treatment Outcome; Radial Head and Neck Fractures; Radius; Elbow Joint; Spinal Fractures; Postoperative Complications; Fracture Fixation, Internal; Range of Motion, Articular; Retrospective Studies
PubMed: 37924555
DOI: 10.52628/89.2.9824 -
European Journal of Trauma and... Aug 2022This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications,... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications, general quality of life and shoulder/elbow function.
METHODS
PubMed/Medline/Embase/CENTRAL/CINAHL was searched for observational studies and randomised clinical trials (RCT). Effect estimates were pooled across studies using random effects models. Results were presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95% CI). Subgroup analysis was performed stratified for study design (RCTs and observational studies).
RESULTS
Eighteen observational studies (4906 patients) and ten RCT's (525 patients) were included. The pooled effect estimates of observational studies were similar to those obtained from RCT's. More patients treated with nailing required re-intervention (RD 2%; OR 2.0, 95% CI 1.0-3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD 2%; OR 0.4, 95% CI 0.3-0.6). Notably, all but one of the radial nerve palsies resolved spontaneously in each groups. Nailing leads to a faster time to union (mean difference - 1.9 weeks, 95% CI - 2.9 to - 0.9), lower infection rate (RD 2%; OR 0.5, 95% CI 0.3-0.7) and shorter operation duration (mean difference - 26 min, 95% CI - 37 to - 14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores.
CONCLUSION
Nailing carries a lower risk of infection, postoperative radial nerve palsy, has a shorter operation duration and possibly a shorter time to union. Shoulder impingement requiring re-intervention, however, is an inherent disadvantage of nail fixation. Notably, absolute differences are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities.
Topics: Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Humeral Fractures; Humerus; Radial Neuropathy; Shoulder Impingement Syndrome; Treatment Outcome
PubMed: 34219193
DOI: 10.1007/s00068-021-01728-7