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Chinese Journal of Traumatology =... Aug 2017To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular... (Comparative Study)
Comparative Study Meta-Analysis Review
Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis.
PURPOSE
To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular fractures.
METHODS
Case-controlled trials (CCTs) published from January 2010 to August 2015 that compared the ilioinguinal approach and Stoppa approach in the management of displaced acetabular fractures were retrieved from the databases of Cochrane Library, Pubmed, CNKI, and so on. Methodological quality of the trials was critically assessed. Statistical software RevMan 5.0 was used for data analysis.
RESULTS
Eight articles were included in the meta-analysis. Through comparing the efficacy and safety of ilioinguinal approach and Stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time [WMD = 68.29, 95% CI (10.52, 126.05), p < 0.05] and the median intraoperative blood loss [WMD = 142.26, 95% CI (9.30, 275.23), p < 0.05]. However, there existed no statistical significance in the fracture end reset satisfaction rate [RR = 0.63, 95% CI (0.17, 2.37), p > 0.05], the early complications rate [RR = 0.89, 95% CI (0.33, 2.40), p > 0.05], the late complications rate [RR = 0.91, 95% CI (0.27, 3.01), p > 0.05], and Harris hip score good function rate [RR = 0.52, 95% CI (0.25, 1.10), p > 0.05].
CONCLUSION
Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.
Topics: Acetabulum; Fracture Fixation, Internal; Fractures, Bone; Humans; Open Fracture Reduction; Postoperative Complications
PubMed: 28709737
DOI: 10.1016/j.cjtee.2017.01.005 -
Archives of Orthopaedic and Trauma... May 2023There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently available literature regarding the indications and methods for surgical fixation of fragility fractures of the pelvic ring in elderly patients after low-energy trauma.
MATERIALS AND METHODS
The Pubmed and Embase databases were searched using the key words pelvic fractures, geriatric, fragility, osteoporosis, and surgical fixation, and their synonyms. Extracted data including the indication, method of operative fixation, and post-operative outcomes (pain levels, mobility, complications and mortality) were analyzed using descriptive statistics. The studies were too heterogeneous to perform a meta-analysis.
RESULTS
Eleven cohort studies (3 comparative and 8 noncomparative) were included. The methodological quality was poor to moderate; the studies were heterogeneous regarding study design and reported outcomes. In all included studies operative treatment for all fracture types was preceded by a period of conservative treatment comprising physiotherapy-guided full weight-bearing. Time to surgery differed widely. For posterior ring fixation, the majority of the included studies used minimally invasive surgery with trans-iliosacral screws. Five studies described a form of additional fixation of the anterior pelvic ring but did not report the indications.
CONCLUSIONS
Fixation of low-energy pelvic ring fractures in elderly is commonly performed after a period of conservative treatment, with persistent pain as the most frequent indication for fixation. Fracture classification based on stability seems to be of secondary importance. Timing for surgical fixation of the pelvic ring fracture in elderly patients remains diverse. Large well-designed comparative prospective studies and randomized controlled trials are needed to provide clearly substantiated guidelines.
Topics: Aged; Humans; Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Pain; Pelvic Bones; Prospective Studies; Retrospective Studies
PubMed: 35462589
DOI: 10.1007/s00402-022-04438-w -
BioMed Research International 2021Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this... (Meta-Analysis)
Meta-Analysis
PURPOSE
Three-dimensional (3D) printing technology has been widely used in orthopedics surgery. However, its efficacy in acetabular fractures remains unclear. The aim of this systematic review and meta-analysis was to examine the effect of using 3D printing technology in the surgery for acetabular fractures.
METHODS
The systematic review was performed following the PRISMA guidelines. Four major electronic databases were searched (inception to February 2021). Studies were screened using a priori criteria. Data from each study were extracted by two independent reviewers and organized using a standardized table. Data were pooled and presented in forest plots.
RESULTS
Thirteen studies were included in the final analysis. Four were prospective randomized trials, and nine used a retrospective comparative design. The patients aged between 32.1 (SD 14.6) years and 51.9 (SD 18.9) years. Based on the pooled analyses, overall, 3D printing-assisted surgery decreased operation time by 38.8 minutes (95% CI: -54.9, -22.8), intraoperative blood loss by 259.7 ml (95% CI: -394.6, -124.9), instrumentation time by 34.1 minutes (95% CI: -49.0, -19.1). Traditional surgery was less likely to achieve good/excellent function of hip (RR, 0.53; 95% CI: 0.34, 0.82) and more likely to have complications than 3D printing-assisted surgery (RR, 1.19; 95% CI: 1.07, 1.33).
CONCLUSIONS
3D printing technology demonstrated efficacy in the treatment of acetabular fractures. It may improve surgery-related and clinical outcomes. More prospective studies using a rigorous design (e.g., randomized trial with blinding) are warranted to confirm the long-term effects of 3D printing technology in orthopedics surgeries.
Topics: Acetabulum; Animals; Fracture Fixation, Internal; Hip Fractures; Humans; Printing, Three-Dimensional; Randomized Controlled Trials as Topic; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 34458367
DOI: 10.1155/2021/5018791 -
EFORT Open Reviews Jul 2024This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates,...
PURPOSE
This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive search of databases from 2000 to 2023, identifying 33 relevant studies. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria.
RESULTS
Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization.
CONCLUSION
Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.
PubMed: 38949162
DOI: 10.1530/EOR-23-0164 -
The Bone & Joint Journal May 2016We performed a systematic review of the literature pertaining to the functional outcomes of the surgical management of acetabular fractures. A total of 69 articles met... (Review)
Review
UNLABELLED
We performed a systematic review of the literature pertaining to the functional outcomes of the surgical management of acetabular fractures. A total of 69 articles met our inclusion criteria, revealing that eight generic outcome instruments were used, along with five specific instruments. The majority of studies reported outcomes using a version of the d'Aubigne and Postel score, which has not been validated for use in acetabular fracture. Few validated outcome measures were reported. No psychometric testing of outcome instruments was performed. The current assessment of outcomes in surgery for acetabular fractures lacks scientific rigour, and does not give reliable outcome data for either scientific comparison or patient counselling.
TAKE HOME MESSAGE
The use of non-validated functional outcome measures is a major limitation of the current literature pertaining to surgical management of acetabular fractures; future studies should use validated outcome measures to ensure the legitimacy of the reported results. Cite this article: Bone Joint J 2016;98-B:690-5.
Topics: Acetabulum; Disability Evaluation; Fracture Fixation, Internal; Fractures, Bone; Humans; Patient Outcome Assessment; Surveys and Questionnaires
PubMed: 27143743
DOI: 10.1302/0301-620X.98B5.36292 -
Journal of Orthopaedics and... Dec 2021The reamer irrigator aspirator (RIA) is a relatively recent device that is placed in the medullary canal of long bones to harvest a large volume of bone marrow, which is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The reamer irrigator aspirator (RIA) is a relatively recent device that is placed in the medullary canal of long bones to harvest a large volume of bone marrow, which is collected in a filtered canister. This study compares outcomes and complications of the RIA versus a traditional iliac crest bone graft (ICBG) for the treatment of bone defects.
METHODS
This meta-analysis was conducted according to the PRISMA guidelines. The Embase, Google Scholar, PubMed, and Scopus databases were accessed in June 2021. All clinical trials comparing the RIA and ICBG with a minimum of 6 months follow-up were included.
RESULTS
Data from 4819 patients were collected. The RIA group demonstrated lower site pain (P < 0.0001), fewer infections (P = 0.001), and a lower rate of adverse events (P < 0.0001). The ICBG group demonstrated a greater rate of bone union (P < 0.0001). There was no difference between groups in VAS (P = 0.09) and mean time to union (P = 0.06).
CONCLUSION
The current evidence supports the use of the RIA, given its low morbidity and short learning curve.
Topics: Bone Transplantation; Humans; Ilium; Tissue and Organ Harvesting; Transplantation, Autologous
PubMed: 34851462
DOI: 10.1186/s10195-021-00612-9 -
Orthopaedics & Traumatology, Surgery &... Sep 2019A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the...
INTRODUCTION
A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the acetabular orientation when aligning a cup (pelvic tilt-, lumbo-pelvic kinematics-, and spine-hip relationship-adjusted cup alignment techniques).
METHOD
Eight eligible articles reported the outcomes of total hip arthroplasty (THA) performed with alternative techniques. Clinical and radiological data were extracted. One study had a control group of patients who underwent conventional THAs (level III) while the seven other studies were level IV. Computer navigation system (CAS), Optimized Positioning System (OPS™), and manual instrumentation were used to align components in four, two, and two studies, respectively. A meta-analysis was not carried out because there was a lack of homogeneity between included articles regarding the method to position the cup and the nature of the reported data.
RESULTS
THA performed with alternative techniques had an early dislocation rate ranging from 0 to 1.9%, no unexpected catastrophic failure, and acceptable radiographic cup orientations. One study compared kinematically and mechanically aligned THAs and found no dislocation in either groups, similar patient reported outcome measures (43 Oxford-12 Score for both groups), and similar proportions of cup in the Lewinnek zone (respectively 65% and 70%).
DISCUSSION/CONCLUSION
Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs. Their values compare to those of more conventional techniques for cup implantation remain to be determined. We developed a classification of the multiple methods for aligning an acetabular component.
LEVEL OF EVIDENCE
IV, systematic review of level III and IV studies.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Prosthesis; Humans; Osteoarthritis, Hip; Patient Reported Outcome Measures; Prosthesis Design; Radiography
PubMed: 31054840
DOI: 10.1016/j.otsr.2019.03.015 -
Journal of Orthopaedics and... Jul 2022To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability.
MATERIALS AND METHODS
Three databases-PubMed, Embase and the Cochrane Library-were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices.
RESULTS
Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47-0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.26-0.69, p < 0.01) and due to hemorrhage (RR = 0.26, 95% CI = 0.14-0.50, p < 0.01). The usage of PP also decreased the need for pre-operative transfusion (SMD = - 0.44, 95% CI = - 0.69 to - 0.18, p < 0.01), but had no influence on total transfusion during the first 24 h after admission (SMD = 0.05, 95% CI = - 0.43-0.54, p = 0.83) and length of hospitalization (ICU stay and total stay).
CONCLUSIONS
This meta-analysis indicates that a treatment protocol including PP could reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability vs. angiography and embolization. This latter technique could be used as a feasible and complementary technique afterwards.
Topics: Attention; Fractures, Bone; Hemorrhage; Humans; Pelvic Bones; Pelvis
PubMed: 35799073
DOI: 10.1186/s10195-022-00647-6 -
Orthopaedics & Traumatology, Surgery &... Dec 2018Modular hip arthroplasty is widely recognized in hip surgery; nevertheless, despite advances in prosthetic design, the incidence of hip revision surgery is increasing....
BACKGROUND
Modular hip arthroplasty is widely recognized in hip surgery; nevertheless, despite advances in prosthetic design, the incidence of hip revision surgery is increasing. In these procedures, a modular adapter that engages the femoral stem and the modular femoral head could be useful in order to protect the neck-head junction and restore preoperative biomechanics and soft tissue tension when the femoral or acetabular component should be retained. The Merete™ BioBall™ system (Merete Medical, Berlin, Germany) could fill this need. However the literature regarding this device is sparse, therefore we performed a systematic review to analyze: the indications for its use and clinical results and the causes of second revision and survival in hip revision surgery, mainly focus in complications of its use.
MATERIALS AND METHODS
Databases including PubMed and Google Scholar were searched for English-language articles published between 01/01/1999 and 01/04/2017, using search terms related to the system Merete™ BioBall™. Studies that reported the clinical use of the Merete™ BioBall™ system in hip revision surgery were selected. Data related to the indications, characteristics of the implant, clinical results, causes of second revision and survival were gathered.
RESULTS
A total of 14 studies with a level IV evidence were analyzed. Information related to the implant was provided in 194 cases. Isolated acetabular revision was the main indication of implant use (139/194 [71.6%]). The most common combination used was the standard implant (69/110 specified [59.4%]), 3XL length (28/107 specified [26.2%]) with 32mm metal head (58/187 specified [31%]). After a follow-up ranging from 2 to 97 months, there were 16 complications, thirteen (81,2%) were revised, including one neck fracture of the stem (6.25%), two ceramic head fractures (12,5%) and six recurrent dislocations (37,5%). Implant survival was 92.8% at 52.5 months of follow-up in the longest published series. Clinical and functional results were provided in a heterogeneous way.
CONCLUSIONS
There is insufficient evidence to recommend for or contraindicate the use of the Merete™ BioBall™ system. The Isolated acetabular revision was the main indication of implant use. When dislocation is the indication of its use the rate of second revision is high. Some important complications possibly related with the implant design have been reported but as isolated cases. The neck adapter failure or corrosion phenomena have not been reported. Further prospective and controlled trials are needed to assess the use of this type of implant and its survival.
LEVEL OF EVIDENCE
Level III systematic review of case series.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 30391216
DOI: 10.1016/j.otsr.2018.06.016 -
Journal of the National Comprehensive... Sep 2018Cancer treatments can damage the ovaries, causing primary ovarian insufficiency (POI), a condition associated with numerous sequelae that impact long-term quality of...
Cancer treatments can damage the ovaries, causing primary ovarian insufficiency (POI), a condition associated with numerous sequelae that impact long-term quality of life. This article systematically reviews the literature on the prevalence, surveillance, and treatment of POI in survivors of pediatric and adolescent and young adult (AYA) cancers. A systematic review of the literature was conducted in January 2018 through a search of Medline, Embase, Web of Science, and SCOPUS, alongside the screening of relevant reference lists. An initial search identified 746 potentially relevant studies. A total of 36 studies were included in the final review. Studies were categorized into one of the following categories: incidence/prevalence of POI, measurement of ovarian reserve, and other. Depending on patient characteristics, cancer diagnosis, and treatment, the prevalence of POI ranged from 2.1% to 82.2%. Risk factors for POI included exposure to alkylating agents and abdominal/pelvic radiation. POI may be associated with a number of complications, including low bone mineral density and poor cardiovascular health. Radiotherapy and chemotherapy are known to cause gonadal damage in female survivors of pediatric and AYA cancers. Acute or chronic effects depend on the dose of treatment, age of the individual, radiotherapy field, and ovarian reserve of the individual. Some women experience short-term loss of reproductive function and then may resume menstrual cycles, months or even years later. Although protecting fertility through banking of mature eggs, embryos, and tissue samples has become standard of care, additional steps need to be taken to ensure that patients have adequate hormone levels to maintain whole-body health, including life expectancy, bone health, cardiovascular health, quality of life, sexual and genitourinary function, and neurologic function. Surveillance and management of each of these comorbidities is critically important to survivor health.
Topics: Adolescent; Adult; Behavior Therapy; Cancer Survivors; Child; Child, Preschool; Estrogen Replacement Therapy; Female; Fertility; Fertility Preservation; Humans; Incidence; Infant; Infant, Newborn; Neoplasms; Ovary; Prevalence; Primary Ovarian Insufficiency; Quality of Life; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Young Adult
PubMed: 30181423
DOI: 10.6004/jnccn.2018.7023