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EFORT Open Reviews Mar 2020Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall... (Review)
Review
Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous.We conducted a systematic review of PubMed, EMBASE, and Cochrane databases. Seventy-five records were identified, of which 13 met our inclusion criteria. In a systematic review we asked: (1) What is the proportion of nonunions with poller screw usage? (2) What is the proportion of malalignment, infection and secondary surgical procedures with poller screw usage? The overall outcome proportion across the studies was computed using the inverse variance method for pooling.Thirteen studies with a total of 371 participants and 376 fractures were included. Mean follow-up time was 21.1 months. Mean age of included patients was 40.0 years. Seven studies had heterogenous populations of nonunions and acute fractures. Four studies included only acute fractures and two studies examined nonunions only.The results of the present systematic review show a low complication rate of IM nailing augmented with poller screws in terms of nonunion (4%, CI: 0.03-0.07), coronal plane malunion (5%, CI: 0.03-0.08), deep (5%, CI: 0.03-0.11) and superficial (6%, CI: 0.03-0.11) infections, and secondary procedures (8%, CI: 0.04-0.18).When compared with the existing literature our review suggests intramedullary nailing with poller screws has lower rates of nonunion and coronal malalignment when compared with nailing alone. Prospective randomized control trial is necessary to fully determine outcome benefits. Cite this article: 2020;5:189-203. DOI: 10.1302/2058-5241.5.190040.
PubMed: 32296553
DOI: 10.1302/2058-5241.5.190040 -
European Urology Jul 2023The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for...
Impact of Epithelial Histological Types, Subtypes, and Growth Patterns on Oncological Outcomes for Patients with Nonmetastatic Prostate Cancer Treated with Curative Intent: A Systematic Review.
CONTEXT
The optimal management for men with prostate cancer (PCa) with unconventional histology (UH) is unknown. The outcome for these cancers might be worse than for conventional PCa and so different approaches may be needed.
OBJECTIVE
To compare oncological outcomes for conventional and UH PCa in men with localized disease treated with curative intent.
EVIDENCE ACQUISITION
A systematic review adhering to the Referred Reporting Items for Systematic Reviews and Meta-Analyses was prospectively registered on PROSPERO (CRD42022296013) was performed in July 2021.
EVIDENCE SYNTHESIS
We screened 3651 manuscripts and identified 46 eligible studies (reporting on 1 871 814 men with conventional PCa and 6929 men with 10 different PCa UHs). Extraprostatic extension and lymph node metastases, but not positive margin rates, were more common with UH PCa than with conventional tumors. PCa cases with cribriform pattern, intraductal carcinoma, or ductal adenocarcinoma had higher rates of biochemical recurrence and metastases after radical prostatectomy than for conventional PCa cases. Lower cancer-specific survival rates were observed for mixed cribriform/intraductal and cribriform PCa. By contrast, pathological findings and oncological outcomes for mucinous and prostatic intraepithelial neoplasia (PIN)-like PCa were similar to those for conventional PCa. Limitations of this review include low-quality studies, a risk of reporting bias, and a scarcity of studies that included radiotherapy.
CONCLUSIONS
Intraductal, cribriform, and ductal UHs may have worse oncological outcomes than for conventional and mucinous or PIN-like PCa. Alternative treatment approaches need to be evaluated in men with these cancers.
PATIENT SUMMARY
We reviewed the literature to explore whether prostate cancers with unconventional growth patterns behave differently to conventional prostate cancers. We found that some unconventional growth patterns have worse outcomes, so we need to investigate if they need different treatments. Urologists should be aware of these growth patterns and their clinical impact.
Topics: Humans; Male; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Intraepithelial Neoplasia; Prostatic Neoplasms
PubMed: 37117107
DOI: 10.1016/j.eururo.2023.03.014 -
Archives of Orthopaedic and Trauma... Nov 2022This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in... (Review)
Review
INTRODUCTION
This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in developed countries that have aged populations. Ankle fractures are the third most common fractures after hip and wrist fractures. The purpose of this review is to provide an overview of the treatments and the used outcome factors.
METHODS
PubMed, Embase, Cochrane Library, and CINAHL were searched to retrieve relevant studies. Studies published in English or Dutch concerning the treatment of ankle fractures in patients aged 80 and over were included.
RESULTS
Initially 2054 studies were found in the databases. After removing duplicate entries, 1182 remained. Finally, after screening six studies were included, of which three cohorts studies and three case series. Six different treatments were identified and described; ORIF, transarticular Steinmann pin, plaster cast with or without weight-bearing, Gallagher nail and the TCC nail. Furthermore, 32 outcome factors were identified.
DISCUSSION
The various studies show that practitioners are careful with early weight-bearing. However, if we look closely to the results and other literature, this seems not necessary and it could potentially be of great value to implement early weight-bearing in the treatment. Furthermore, quality of life seems underreported in this research field.
CONCLUSIONS
ORIF with plaster cast and permissive weight-bearing should be considered for this population since it seems to be a safe possibility for a majority of the relatively healthy patients aged 80 and over. In cases where surgery is contra-indicated and a plaster cast is the choice of treatment, early weight-bearing seems to have a positive influence on the outcome in the very old patient.
Topics: Aged; Aged, 80 and over; Ankle Fractures; Ankle Joint; Casts, Surgical; Female; Humans; Male; Quality of Life; Treatment Outcome
PubMed: 34546421
DOI: 10.1007/s00402-021-04161-y -
Archives of Orthopaedic and Trauma... Aug 2023This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes.
METHODS
Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI).
RESULTS
Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76-22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49-171.12, p = 0.02), favoring intramedullary fixation.
CONCLUSION
Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.
Topics: Humans; Fracture Fixation, Internal; Bone Nails; Fracture Fixation, Intramedullary; Bone Screws; Hip Fractures
PubMed: 37129692
DOI: 10.1007/s00402-023-04902-1 -
Orthopaedics & Traumatology, Surgery &... Sep 2017Previous studies have reported conflicting findings concerning the efficacy and safety of the treatment of intertrochanteric fractures (OTA 31-A1,A2 and A3) using short... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Previous studies have reported conflicting findings concerning the efficacy and safety of the treatment of intertrochanteric fractures (OTA 31-A1,A2 and A3) using short intramedullary nails (SIN) and long intramedullary nails (LIN). The present meta-analysis and literature review investigated the outcomes of SIN and LIN, thereby providing guidance for the treatment of intertrochanteric femur fractures. When used to treat intertrochanteric femur fractures, LIN did not decrease the secondary femoral shaft refracture or reoperation rates. Eight electronic databases were searched for studies related to the use of SIN compared to LIN in treating intertrochanteric fractures. The modified Jadad Scale and the Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality and the risk of bias of these studies. The two groups were compared based on nine indicators, including the surgical times, intraoperative blood loss, transfusion, length of hospital stay, secondary femoral shaft refracture, reoperation, 1-year mortality, Harris hip scores (1 year) and complications. A total of 2431 patients were included in the analysis, with 1498 LIN cases and 940 SIN cases (bilateral nails were used in 7 cases), and the average patient age was 74.83 years. The pooled results indicated that patients in the LIN group had longer surgical times (MD [mean difference]: 12.56; 95% CI: 8.28-16.84; P<0.00001), more intraoperative blood loss (MD: 37.44; 95% CI: 8.06-66.82, P=0.01) and a higher transfusion rate (OR [odds ratio]: 1.53; 95% CI: 1.12-2.10, P=0.008) than patients in the SIN group. However, there was no significant difference in the length of hospital stay (MD: 0.24; 95% CI: -0.58-1.06, P=0.56), occurrence of secondary femoral shaft refractures (OR: 0.72; 95% CI: 0.34-1.53, P=0.39), reoperation rate (OR: 0.95; 95% CI: 0.60-1.50, P=0.82), 1-year mortality (OR: 1.1; 95% CI: 0.67-1.8, P=0.71), Harris hip score (MD: 1.87; 95% CI: -2.8-6.54, P=0.43) or complication rate (OR: 1.29; 95% CI: 0.84-1.99, P=0.25). LIN may not be a better method or provide more effective treatment for intertrochanteric femur fractures; the LIN patients demonstrated the same prognosis as the SIN patients, particularly in terms of secondary femoral shaft refracture and reoperation rate, but they experienced greater trauma. Due to the limitations of the included studies, however, more highly powered randomized controlled trials are needed to clarify the findings. Systematic review and meta-analysis.
LEVEL OF EVIDENCE
III.
Topics: Blood Loss, Surgical; Blood Transfusion; Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Length of Stay; Operative Time; Prognosis; Reoperation; Treatment Outcome
PubMed: 28546048
DOI: 10.1016/j.otsr.2017.04.003 -
Strategies in Trauma and Limb... 2022In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening... (Review)
Review
AIM
In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique.
MATERIALS AND METHODS
A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the . The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication.
RESULTS
Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13-51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5-7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6-1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50-93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120-228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration.
CONCLUSION
Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques.
CLINICAL SIGNIFICANCE
Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery.
HOW TO CITE THIS ARTICLE
Lorange JP, Alamiri N, Marwan Y, . Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022;17(3):165-171.
PubMed: 36756294
DOI: 10.5005/jp-journals-10080-1568 -
European Journal of Trauma and... Oct 2022Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing.
METHOD
This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down's and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis.
RESULTS
Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (-2.41 weeks, 95% confidence interval: -4.77, -0.05) with EWB and a significant Odd's Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion.
CONCLUSION
The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic.
Topics: Bone Nails; Diaphyses; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Tibia; Tibial Fractures; Treatment Outcome; Weight-Bearing
PubMed: 35238986
DOI: 10.1007/s00068-022-01919-w -
World Journal of Orthopedics Nov 2021Infection at the pin tract is a frequent and feared complication of external fixators (EF). The type of pin material and coatings have been regarded as possibly...
BACKGROUND
Infection at the pin tract is a frequent and feared complication of external fixators (EF). The type of pin material and coatings have been regarded as possibly influencing infection rates. Over the last 20 years, few prospective clinical studies and systematic reviews addressed the role of coated pins on the rate of pin site infection in human clinical studies.
AIM
To assess the EF literature over the past 20 years on the clinical benefits of pins manufactured from varied materials and coating systems and their possible role in pin tract infection rates.
METHODS
We performed a systematic review according to the PRISMA and PICOS guidelines using four scientific platforms: PubMed, LiLacs, SciELO, and Cochrane. We searched the literature for related publications over the past 20 years.
RESULTS
A literature search yielded 29 articles, among which seven met the inclusion criteria. These studies compared stainless-steel pins and pins coated with hydroxyapatite (HA), titanium and silver. The pin tract infection definitions were arbitrary and not standardized among studies. Most studies included a low number of patients in the analysis and used a short follow-up time. Three meta-analyses were carried out, comparing stainless steel silver pins, stainless steel HA-coated pins, and titanium HA-coated pins. None of this analysis resulted in statistically significant differences in pin tract infection rates.
CONCLUSION
Currently, no clinical evidence supports the advantage of EF pins manufactured with materials other than stainless steel or coated over uncoated pins in reducing the rates of pin tract infections. A standardized definition of pin tract infection in external fixation is still lacking.
PubMed: 34888152
DOI: 10.5312/wjo.v12.i11.920 -
Orthopaedic Journal of Sports Medicine Apr 2021Compared with extracortical suspensory fixation, the close-to-joint transcondylar cross-pin fixation method in anterior cruciate ligament reconstruction (ACLR) is... (Review)
Review
BACKGROUND
Compared with extracortical suspensory fixation, the close-to-joint transcondylar cross-pin fixation method in anterior cruciate ligament reconstruction (ACLR) is believed to entail less intratunnel graft motion and subsequently lead to less tunnel widening.
PURPOSE
To assess femoral tunnel widening via the transcondylar cross-pin method or the suspensory femoral fixation method in patients who had undergone ACLR.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
This review focused on studies on femoral-tunnel widening after single-bundle ACLR with cross-pin (Rigidfix or Transfix) and/or Endobutton closed loop (CL). Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACLR.
RESULTS
Overall, 19 studies were included in this meta-analysis. There was no significant difference between cross-pin and Endobutton CL fixations in the pooled absolute change in tunnel widening from the immediate postoperative period to the final follow-up; this was true at both the tunnel aperture (2.48 mm [95% CI, 1.76-3.2 mm] vs 2.93 mm [95% CI, 1.73-4.13 mm], respectively; = .527) and the midpoint of the femoral tunnel (2.43 mm [95% CI, 1.77-3.1 mm] vs 2.54 mm [95% CI, -0.33 to 5.42 mm], respectively; = .937). No significant difference was found in the relative percentage of femoral-tunnel widening between the 2 fixation methods (cross-pin, 43.3% [95% CI, 25.8%-60.8%] vs Endobutton CL, 42.0% [95% CI, 34.1%-49.9%]; = .965).
CONCLUSION
No significant difference in femoral tunnel widening was found to be associated with the use of either cross-pin or extracortical suspensory fixation in patients who underwent single-bundle ACLR.
PubMed: 33869645
DOI: 10.1177/2325967121993811 -
Knee Surgery & Related Research Jan 2020The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation. (Review)
Review
Comparison of femoral tunnel widening after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral cross-pin fixation: a systematic review and meta-analysis.
BACKGROUND
The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation.
METHODS
The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to 11 April 2019. The study included all levels of evidence in studies that reported femoral tunnel widening and compared cortical button and cross-pin femoral fixation for ACLR.
RESULTS
Six studies were included, covering a total of 344 knees. Using transtibial techniques for ACLR, the mean absolute amount of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross-pin fixation (-0.30 mm; 95% confidence interval (CI) -0.56,-0.05 mm; p= 0.02). Using the transtibial technique, the mean relative percentage of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross pin fixation (-5.73%; 95% CI -10.32, -1.14% ; p= 0.01).
CONCLUSION
The present meta-analysis revealed greater widening of the femoral tunnel when using cortical button fixation for hamstring ACLR via the transtibial technique than when using transfemoral cross-pin fixation.
PubMed: 32660647
DOI: 10.1186/s43019-020-0028-9