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Journal of Orthopaedics and... Dec 2014Ankle fractures are extremely common and represent nearly one quarter of all lower-limb fractures. In the majority of patients, fractures involve the distal fibula. The... (Comparative Study)
Comparative Study Review
BACKGROUND
Ankle fractures are extremely common and represent nearly one quarter of all lower-limb fractures. In the majority of patients, fractures involve the distal fibula. The current standard in treating unstable fractures is through open reduction and internal fixation (ORIF) with plates and screws. Due to concerns with potentially devastating wound complications, minimally invasive strategies such as intramedullary fixation have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of intramedullary fixation of distal fibular fractures using either compression screws or nails.
MATERIALS AND METHODS
Numerous databases (MEDLINE, PubMed, Embase, Google Scholar) were searched, 17 studies consisting of 1,008 patients with distal fibular fractures treated with intramedullary fixation were found.
RESULTS
Mean rate of union was 98.5 %, with functional outcome reported as being good or excellent in up to 91.3 % of patients. Regarding unlocked intramedullary nailing, the mean rate of union was 100 %, with up to 92 % of patients reporting good or excellent functional outcomes. Considering locked intramedullary nailing, the mean rate of union was 98 %, with the majority of patients reporting good or excellent functional outcomes. The mean complication rate across studies was 10.3 %, with issues such as implant-related problems requiring metalwork removal, fibular shortening and metalwork failure predominating.
CONCLUSION
Overall, intramedullary fixation of unstable distal fibular fractures can give excellent results that are comparable with modern plating techniques. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcome.
LEVEL OF EVIDENCE
Level IV evidence.
Topics: Ankle Injuries; Bone Nails; Female; Fibula; Fracture Fixation, Intramedullary; Fracture Healing; Fractures, Bone; Humans; Injury Severity Score; Male; Radiography; Range of Motion, Articular; Recovery of Function; Treatment Outcome
PubMed: 25304004
DOI: 10.1007/s10195-014-0320-0 -
Journal of Clinical Orthopaedics and... May 2021Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the... (Review)
Review
BACKGROUND
Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the regeneration, extent and type of regeneration, plus issues related to functional loss are important for the surgeon to know. This review looks at the literature to find answers to the above questions.
PURPOSE
To summarize the evidence in support of hamstring tendon regeneration, and the most appropriate modality for evaluation of regeneration. Additionally, to evaluate the regeneration in terms of complete or partial, extent and its impact on strength deficit and functional outcomes.
METHODS
We did a systematic review of literature through specified search engines and identified 30 of 285 studies to be relevant (19 prospective and 11 retrospective).
RESULTS
Evaluation of above data suggests tissue regeneration at harvest sites does occur (78.9% of semitendinosus and 42.7% of gracilis tendons), but this regeneration is variable. No established definition of regeneration exists; MRI is an adequate tool to identify regeneration, while biopsy is confirmative. USG is a cost-effective screening method and can document distal progress of regenerate. Semitendinosus and gracilis tendons regenerate at different rates and extents, and often fuse together, but there is no evidence to state that one regenerates better than the other. Proximal retraction of the muscle-tendon junction occurs, along with some atrophy, which affects function to a variable extent. Strength deficits may persist, but they may not convert to significant functional deficits.
CONCLUSION
There is variable hamstring regeneration after harvest, with poorly defined definition of "". Some changes in the muscle itself, abnormal distal insertion and absence of regeneration in some are documented, along with strength deficits. Although overall functional deficits have been reported to be minimal, a definite change in the anatomy of the medial hamstrings is a factor to be kept in consideration. More information is needed about the long-term consequences.
PubMed: 33680834
DOI: 10.1016/j.jcot.2021.02.011 -
Medicine Mar 2021The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly. (Comparative Study)
Comparative Study Meta-Analysis
Comparison of clinical outcomes with hip replacement versus PFNA in the treatment of intertrochanteric fractures in the elderly: A systematic review and meta-analysis (PRISMA).
BACKGROUND
The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of HR and PFNA in the treatment of intertrochanteric fractures in the elderly.
METHODS
We carried out this review according to the principle of preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline. The clinical randomized controlled trials (RCTs), prospective cohort studies, retrospective cohort studies (RCSs), and case-control studies involving HR and PFNA in the treatment of intertrochanteric fractures in the elderly from 2000 to 2020 were compared by searching Web of Science, Pubmed, the Cochrane Library, and Embase. The quality of the included cohort study (CS) lines was evaluated using the Newcastle-Ottawa Scale (NOS). The quality of the included RCT lines was evaluated using Jadad. Forest plots were drawn by RevMan5.4 software based on the results and the data were analyzed.
RESULTS
After screening, a total of 9 articles were included, of which one was a clinical RCT and eight were RCSs with 1374 patients. The operative time of the PFNA group was shorter [WMD = 15.20; 95% CI (13.17, 17.23), P < .05] and the intraoperative blood loss was less [WMD = 178.81; 95% CI (97.24, 260.38), P < .05] than the HR group, while the first weight-bearing time of the HR group was shorter [WMD = -7.70; 95% CI (-10.54, -4.86), P < .05] than the PFNA group. There was no significant difference in the length of hospital stay, HHS, postoperative orthopedic complications, and postoperative medical complications between the 2 groups.
CONCLUSION
With the development of HR technology and minimally invasive technology, the trauma caused by surgery is decreasing. Under the premise of improving perioperative management, such as optimizing the preoperative preparation and postoperative management, shortening the operative time, reducing intraoperative blood loss, and actively managing co-existing diseases, HR has more advantages than PFNA in the treatment of senile intertrochanteric fractures.
Topics: Aged; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Bone Nails; Case-Control Studies; Female; Fracture Fixation, Internal; Hip Fractures; Humans; Male; Middle Aged; Operative Time; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 33655910
DOI: 10.1097/MD.0000000000024166 -
Journal of Menopausal Medicine Aug 2018Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there...
OBJECTIVES
Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women.
METHODS
Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018.
RESULTS
Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = -0.996; < 0.001; 95% confidence interval, -1.42 to -0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking . Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women.
CONCLUSIONS
The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy.
PubMed: 30202758
DOI: 10.6118/jmm.2018.24.2.92 -
Journal of Orthopaedic Surgery and... Apr 2018The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy persists concerning the optimal pin fixation technique. The purpose of this study was to compare the safety and efficacy on the configuration of lateral entry only with crossed entry pin fixation for SCHF, including Gartland type II and type III fractures in children.
METHODS
Published literatures, including retrospective studies, prospective studies, and randomized controlled trials, presenting the probability of poor functional consequence of elbow and/or loss of reduction and/or iatrogenic ulnar nerve injury and/or superficial infection and/or cubitus varus were included. Statistical analysis was performed with the Review Manager 5.3 software.
RESULTS
Twenty-four studies were included in the present meta-analysis involving 1163 patients with lateral entry pins and 1059 patients with crossed entry pins. An excellent score of Flynn criteria occurred more commonly in patients who treated with crossed pins than in patients with lateral pins only (RR = 0.93; 95% CI 0.87-0.99; P = 0.03). In accordance with previous systematic review, the incidence of iatrogenic ulnar nerve injury in crossed entry group was significantly more than in lateral entry group with statistical difference (RR = 0.26; 95% CI 0.14-0.47; P < 0.0001). And, results of subgroup analysis on iatrogenic ulnar nerve injury based on experimental design of retrospective study (RR = 0.23; 95% CI 0.10-0.52; P < 0.0004) and randomized control trial (RR = 0.29; 95% CI 0.10-0.79; P < 0.02) were similar.
CONCLUSIONS
In consideration of the contradictoriness of lateral entry with two pins only (possible risk of poor functional consequence of elbow) and crossed entry pins (risk of iatrogenic ulnar nerve injury), the recommended strategy for the treatment of SCHF is the lateral entry technique with introducing divergent three pins which can provide a stable configuration and avoid the injury of the ulnar nerve. And additional protective measures for the ulnar nerve should be taken by surgeons that wish for the more stable structure with the crossed entry technique.
Topics: Bone Nails; Elbow Joint; Fracture Fixation, Internal; Humans; Humeral Fractures; Radiography; Range of Motion, Articular; Ulnar Nerve
PubMed: 29615086
DOI: 10.1186/s13018-018-0768-3 -
Biotribology (Oxford) Dec 2020Tribocorrosion of implants has been widely addressed in the orthopedic and dental research fields. This study is a systematic scoping review about research methods that...
Tribocorrosion of implants has been widely addressed in the orthopedic and dental research fields. This study is a systematic scoping review about research methods that combine tribocorrosion tests with cells/tissues cultures, aimed to identify related current problems and future challenges. We used 4 different databases to identify 1022 records responding to an articulated keywords search-strategy. After removing the duplicates and the articles that didn't meet the search-criteria, we assessed 20 full-text articles for eligibility. Of the 20 eligible articles, we charted 8 records on cell cultures combined with tribocorrosion tests on implant materials (titanium, CoCrMo, and/or stainless steel). The year of publication ranged from 1991 to 2019. The cell line used was mostly murine. Two records used fretting tests, while 6 used reciprocating sliding with pin-on-disc tribometers. An electrochemical three-electrode setup was used in 4 records. We identified overall two experimental approaches: cells cultured on the metal (5 records), and cells cultured near the metal (3 records). Research activities on tribocorrosion processes in the presence of cells have been undertaken worldwide by a few groups. After a limited initial interest on this topic in the 1990's, research activities have restarted in the last decade, renewing the topic with technologically more advanced setups and analytical tools. We identified the main problems to be the lack of test reproducibility and wear particle characterization. We believe that the main challenges lay in the interdisciplinary approach, the inter-laboratory validation of experiments, and the interpretation of results, particularly in relation to potential clinical significance.
PubMed: 33015276
DOI: 10.1016/j.biotri.2020.100145 -
Journal of Orthopaedic Surgery and... May 2022
Meta-Analysis
Letter to the editor regarding "Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures".
Topics: Bone Nails; Bone Screws; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Treatment Outcome
PubMed: 35597991
DOI: 10.1186/s13018-022-03174-6 -
Journal of the American Academy of... Jun 2020Integrated limb lengthening combines both internal and external fixation methods. It has been introduced to improve time to union, patient time in frame, risk of... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Integrated limb lengthening combines both internal and external fixation methods. It has been introduced to improve time to union, patient time in frame, risk of regenerate refracture, and patient function. We systematically review studies to assess whether integrated limb lengthening methods are superior to classic limb lengthening.
METHODS
A total of 457 patients had classic limb lengthening, whereas 488 underwent integrated limb lengthening. The primary outcome measures were total length achieved (cm), external fixator index (month/cm) and bone healing index (month/cm). Problems, obstacles, and sequelae were compared using random effects meta-analyses of all available cases. Kaplan-Meier curves were generated to compare the time spent in frame.
RESULTS
Integrated limb lengthening demonstrated a superior external fixator index ( = 0.0001) and bone healing index ( = 0.0146). The mean time spent in frame for integrated lengthening was significantly shorter ( = 0.0015). Significantly fewer problems ( = 0.000) and sequelae ( = 0.001) were observed with integrated lengthening. Deep infections were more common in the integrated cohort. The lengthening over a nail deep infection rate was significantly higher than with the lengthening and then nailing and lengthening and then plating techniques ( = 0.005).
CONCLUSIONS
Integrated methods of limb lengthening are superior to classic methods. We suggest the integration of plates and nails with circular frames to improve outcomes in patients undergoing limb lengthening procedures.
Topics: Bone Lengthening; External Fixators; Femur; Fracture Fixation; Fracture Fixation, Intramedullary; Humans
PubMed: 32656477
DOI: 10.5435/JAAOSGlobal-D-20-00054 -
Medicine Sep 2018Distal radius metaphyseal (DRM) fractures are very frequent childhood fractures. Whether additional percutaneous pinning improves the outcome remains controversial. In... (Review)
Review
BACKGROUND
Distal radius metaphyseal (DRM) fractures are very frequent childhood fractures. Whether additional percutaneous pinning improves the outcome remains controversial. In this review, we tried to systematically evaluate the effect of percutaneous pinning on re-displacement, secondary reduction, radiographs, function, and complications in children with displaced DRM fractures.
METHODS
PubMed, Medline, Embase, Cochrane Library, and Web of Science databases were explored systematically to identify randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing cast immobilization alone or following reduction to additional percutaneous pinning in the treatment of pediatric displaced DRM fractures. Two reviewers independently screened eligible articles and extracted relevant information from each article. The methodological quality of eligible articles was evaluated using the Cochrane Collaboration risk assessment tool (RCTs) and modified Jadad scale (CCTs).
RESULTS
A total of 4 RCTs and 3 CCTs met the inclusion criteria, with a total patient count of 1144 children. The results showed that additional percutaneous pinning significantly reduced the rate of re-placement (Chi-square tests, P < .001) and complications (Chi-square tests, P = .030). The superior results, both radiographically and functionally seemed to be temporary. No difference was found between the 2 groups after longer-term follow-up.
CONCLUSIONS
This systematic review suggested that compared with casting following reduction, percutaneous pinning had a positive effect on maintaining the initial reduction and reducing fracture complication rate of displaced DRM fractures in children, but with no significant improvement in function and radiographic outcome at the long-term follow-up. We suggest clinicians think twice before percutaneous pinning of displaced pediatric DRM fractures.
Topics: Bone Nails; Child; Controlled Clinical Trials as Topic; Fracture Fixation, Internal; Humans; Radius Fractures
PubMed: 30200107
DOI: 10.1097/MD.0000000000012142 -
Journal of Orthopaedic Surgery and... Apr 2023The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The traction table is generally used in femoral intramedullary nailing surgery. Recently, some published studies have shown that the same or better treatment effects can be gotten without a traction table. It remains no consensus on this issue.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was applied in this study. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for eligible studies. The random-effect model was used to calculate the standardized mean difference (SMD) and risk ratios with 95% CIs. Trial sequential analysis (TSA) was performed to verify the results.
RESULTS
The pooled estimates of seven studies, including 266 cases each in the manual traction group and traction table group, indicated that manual traction could shorten operative time [SMD, - 0.77; 95% CI (- 0.98, - 0.55); P < 0.00001] and preoperative set-up time [SMD, - 2.37; 95% CI (- 3.90, - 0.84); P = 0.002], but it would not reduce intraoperative blood loss volume and fluoroscopy time. No statistical difference was found in their fracture healing time, postoperative Harris scores, and malunion rate. The use of a Traction repositor could reduce the set-up time [SMD, - 2.48; 95% CI (- 4.91, - 0.05); P < 0.00001].
CONCLUSIONS
Compared with manual traction, the traction table in femoral intramedullary nailing surgery lengthened operative time and preoperative set-up time. At the same time, it did not show significant advantages in reducing blood loss volume and fluoroscopy time, or improving prognosis. In clinical practice, the optimal surgical plan must be made on a case-by-case basis to avoid unnecessary traction table use.
Topics: Humans; Fracture Fixation, Intramedullary; Traction; Femoral Fractures; Femur; Fracture Healing; Bone Nails; Treatment Outcome
PubMed: 37020232
DOI: 10.1186/s13018-023-03659-y