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Diabetes/metabolism Research and Reviews Mar 2024Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International... (Meta-Analysis)
Meta-Analysis
AIMS
Offloading mechanical tissue stress is arguably the most important of multiple interventions needed to heal diabetes-related foot ulcers. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on offloading interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline.
MATERIALS AND METHODS
We followed the GRADE approach by devising clinical questions and important outcomes in the PICO (Patient-Intervention-Control-Outcome) format, undertaking a systematic review and meta-analyses, developing summary of judgement tables and writing recommendations and rationales for each question. Each recommendation is based on the evidence found in the systematic review, expert opinion where evidence was not available, and a careful weighing of GRADE summary of judgement items including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability.
RESULTS
For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, use a non-removable knee-high offloading device as the first-choice offloading intervention. If contraindications or patient intolerance to non-removable offloading exist, consider using a removable knee-high or ankle-high offloading device as the second-choice offloading intervention. If no offloading devices are available, consider using appropriately fitting footwear combined with felted foam as the third-choice offloading intervention. If such a non-surgical offloading treatment fails to heal a plantar forefoot ulcer, consider an Achilles tendon lengthening, metatarsal head resection, joint arthroplasty, or metatarsal osteotomy. For healing a neuropathic plantar or apex lesser digit ulcer secondary to flexibile toe deformity, use digital flexor tendon tenotomy. For healing rearfoot, non-plantar or ulcers complicated with infection or ischaemia, further recommendations have been outlined. All recommendations have been summarised in an offloading clinical pathway to help facilitate the implementation of this guideline into clinical practice.
CONCLUSION
These offloading guideline recommendations should help healthcare professionals provide the best care and outcomes for persons with diabetes-related foot ulcers and reduce the person's risk of infection, hospitalisation and amputation.
Topics: Humans; Diabetic Foot; Ulcer; Foot Ulcer; Foot; Wound Healing; Diabetes Mellitus
PubMed: 37226568
DOI: 10.1002/dmrr.3647 -
Journal of Bone Oncology Oct 2023Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock... (Review)
Review
Patient specific instrumentation (PSI) and intraoperative surgical navigation (SN) can significantly help in achieving wide oncological margins while sparing bone stock in bone tumour resections. This is a systematic review aimed to compare the two techniques on oncological and functional results, preoperative time for surgical planning, surgical intraoperative time, intraoperative technical complications and learning curve. The protocol was registered in PROSPERO database (CRD42023422065). 1613 papers were identified and 81 matched criteria for PRISMA inclusion and eligibility. PSI and SN showed similar results in margins (0-19% positive margins rate), bone cut accuracy (0.3-4 mm of error from the planned), local recurrence and functional reconstruction scores (MSTS 81-97%) for both long bones and pelvis, achieving better results compared to free hand resections. A planned bone margin from tumour of at least 5 mm was safe for bone resections, but soft tissue margin couldn't be planned when the tumour invaded soft tissues. Moreover, long osteotomies, homogenous bone topology and restricted working spaces reduced accuracy of both techniques, but SN can provide a second check. In urgent cases, SN is more indicated to avoid PSI planning and production time (2-4 weeks), while PSI has the advantage of less intraoperative using time (1-5 min vs 15-65 min). Finally, they deemed similar technical intraoperative complications rate and demanding learning curve. Overall, both techniques present advantages and drawbacks. They must be considered for the optimal choice based on the specific case. In the future, robotic-assisted resections and augmented reality might solve the downsides of PSI and SN becoming the main actors of bone tumour surgery.
PubMed: 37771750
DOI: 10.1016/j.jbo.2023.100503 -
North American Spine Society Journal Jun 2024Chin-on-chest deformity is a rare and severely disabling condition characterized by kyphotic deformity in the cervicothoracic spine. To treat this deformity, various... (Review)
Review
Clinical and radiologic outcomes of posterior column extension, pedicle subtraction, and vertebral column resection osteotomies in adult chin on chest deformity: A systematic review.
BACKGROUND
Chin-on-chest deformity is a rare and severely disabling condition characterized by kyphotic deformity in the cervicothoracic spine. To treat this deformity, various osteotomy techniques were described.
METHODS
A comprehensive literature search of biomedical databases including MEDLINE (via PubMed), Scopus (via Elsevier), Embase (via Elsevier), and Cochrane Library in English from 1/1/1990 to 3/31/2022 was conducted using a combination of text and Medical Subject Headings (MeSH).
RESULTS
The final analysis included 16 studies. All the studies were assigned a level of evidence of four. Except for two articles, all of the articles were non-comparative studies. A total of 288 patients were included in this review. Of the 288 patients, 107 underwent posterior column extension osteotomy (PCEO), 108 underwent pedicle subtraction osteotomy (PSO), and 33 underwent vertebral column resection osteotomy (VCRO). The most common osteotomy level in fifteen of the studies was C7/T1. The studies included in this review described several techniques for cervical sagittal balance correction. The range of preoperative and postoperative visual analogue scale (VAS) scores was 5.5-8.6 to 1.7-4.91, respectively. The range of preoperative and postoperative neck disability index (NDI) was 34.2-65.4 to 22.1-51.3, respectively. The most common complications were upper extremity paresthesia and hand numbness through the C8 dermatome distribution.
CONCLUSIONS
Corrective osteotomies provide satisfactory results in patients with chin-on-chest deformity; however, the quality of the included studies limits the evidence.
PubMed: 38765779
DOI: 10.1016/j.xnsj.2024.100324 -
Orthodontics & Craniofacial Research Jun 2024The aim of this systematic review was to compare the effectiveness of pre-alveolar bonegraft (ABG) orthodontics with no orthodontic treatment for patients with... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of pre-alveolar bone graft orthodontics for patients with non-syndromic complete unilateral cleft lip, alveolus and palate: A systematic review and meta-analysis.
UNLABELLED
The aim of this systematic review was to compare the effectiveness of pre-alveolar bonegraft (ABG) orthodontics with no orthodontic treatment for patients with non-syndromic unilateral cleft lip, alveolus and palate. All relevant studies from 1946 to October 30, 2022, were identified using several sources including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, Scopus, EMBASE, MEDLINE (Ovid) and EPUB ahead of publications and non-indexed citations. Randomized Controlled Trials (RCT) and Controlled Clinical Trials (CCT) were included.
POPULATION
Non-syndromic complete unilateral cleft lip, alveolus and palate patients who have had ABG surgery.
INTERVENTION
Orthodontics prior to ABG. Comparison: No orthodontic treatment prior to ABG.
PRIMARY OUTCOME
Successful eruption of permanent canines. All articles were screened for the title, abstract and full text independently and in duplicate by 2 reviewers. The quality assessment of RCT was performed using Cochrane's risk of bias tool and the CCT was assessed using ROBINS-I tool. Of the 904 studies retrieved in the search, one RCT and one CCT were included. Both studies were judged as high risk of bias. The results from one study showed a statistically significant increase in bone volume and decreased bone defect post-ABG in the orthodontic treatment group. However, there was no difference with respect to other variables. Both included studies were of low quality. There is not enough evidence to recommend orthodontic treatment pre-ABG for patients with complete unilateral cleft lip, alveolus and palate. Future high-quality studies are required to inform patients and clinicians about the effectiveness of pre-graft orthodontic treatment.
Topics: Humans; Cleft Palate; Cleft Lip; Alveolar Bone Grafting; Orthodontics, Corrective; Treatment Outcome; Bone Transplantation
PubMed: 38108550
DOI: 10.1111/ocr.12744 -
Journal of Imaging May 2024Three-dimensional soft tissue simulation has become a popular tool in the process of virtual orthognathic surgery planning and patient-surgeon communication. To apply 3D... (Review)
Review
Three-dimensional soft tissue simulation has become a popular tool in the process of virtual orthognathic surgery planning and patient-surgeon communication. To apply 3D soft tissue simulation software in routine clinical practice, both qualitative and quantitative validation of its accuracy are required. The objective of this study was to systematically review the literature on the accuracy of 3D soft tissue simulation in orthognathic surgery. The Web of Science, PubMed, Cochrane, and Embase databases were consulted for the literature search. The systematic review (SR) was conducted according to the PRISMA statement, and 40 articles fulfilled the inclusion and exclusion criteria. The Quadas-2 tool was used for the risk of bias assessment for selected studies. A mean error varying from 0.27 mm to 2.9 mm for 3D soft tissue simulations for the whole face was reported. In the studies evaluating 3D soft tissue simulation accuracy after a Le Fort I osteotomy only, the upper lip and paranasal regions were reported to have the largest error, while after an isolated bilateral sagittal split osteotomy, the largest error was reported for the lower lip and chin regions. In the studies evaluating simulation after bimaxillary osteotomy with or without genioplasty, the highest inaccuracy was reported at the level of the lips, predominantly the lower lip, chin, and, sometimes, the paranasal regions. Due to the variability in the study designs and analysis methods, a direct comparison was not possible. Therefore, based on the results of this SR, guidelines to systematize the workflow for evaluating the accuracy of 3D soft tissue simulations in orthognathic surgery in future studies are proposed.
PubMed: 38786573
DOI: 10.3390/jimaging10050119 -
Knee Surgery & Related Research Mar 2024This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). (Review)
Review
PURPOSE
This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO).
MATERIALS AND METHODS
The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023.
RESULTS
Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: - 0.80 to - 0.49). Microfracture (mean difference: - 0.75 to - 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: - 1.37 to - 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: - 2.46 to - 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported.
CONCLUSIONS
HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.
PubMed: 38549124
DOI: 10.1186/s43019-024-00221-w -
Journal of Orthodontics Jun 2024The accuracy of artificial intelligence (AI) in treatment planning and outcome prediction in orthognathic treatment (OGT) has not been systematically reviewed.
BACKGROUND
The accuracy of artificial intelligence (AI) in treatment planning and outcome prediction in orthognathic treatment (OGT) has not been systematically reviewed.
OBJECTIVES
To determine the accuracy of AI in treatment planning and soft tissue outcome prediction in OGT.
DESIGN
Systematic review.
DATA SOURCES
Unrestricted search of indexed databases and reference lists of included studies.
DATA SELECTION
Clinical studies that addressed the focused question 'Is AI useful for treatment planning and soft tissue outcome prediction in OGT?' were included.
DATA EXTRACTION
Study screening, selection and data extraction were performed independently by two authors. The risk of bias (RoB) was assessed using the Cochrane Collaboration's RoB and ROBINS-I tools for randomised and non-randomised clinical studies, respectively.
DATA SYNTHESIS
Eight clinical studies (seven retrospective cohort studies and one randomised controlled study) were included. Four studies assessed the role of AI for treatment decision making; and four studies assessed the accuracy of AI in soft tissue outcome prediction after OGT. In four studies, the level of agreement between AI and non-AI decision making was found to be clinically acceptable (at least 90%). In four studies, it was shown that AI can be used for soft tissue outcome prediction after OGT; however, predictions were not clinically acceptable for the lip and chin areas. All studies had a low to moderate RoB.
LIMITATIONS
Due to high methodological inconsistencies among the included studies, it was not possible to conduct a meta-analysis and reporting biases assessment.
CONCLUSION
AI can be a useful aid to traditional treatment planning by facilitating clinical treatment decision making and providing a visualisation tool for soft tissue outcome prediction in OGT.
REGISTRATION
PROSPERO CRD42022366864.
Topics: Humans; Artificial Intelligence; Patient Care Planning; Orthognathic Surgical Procedures; Treatment Outcome
PubMed: 37772513
DOI: 10.1177/14653125231203743 -
Journal of Stomatology, Oral and... Dec 2023Is to systematically review the available evidence of the patient's nutritional state before and after orthognathic surgery METHODS: The protocol to the International... (Meta-Analysis)
Meta-Analysis
PURPOSE
Is to systematically review the available evidence of the patient's nutritional state before and after orthognathic surgery METHODS: The protocol to the International Prospective Register of Systematic Reviews (PROSPERO; registration No. CRD42020177156).
RESULTS
The search strategy yielded a total of 43 articles from all databases. Of the 43 articles, 13 were excluded after an examination of the titles and abstracts, and full-text articles of the remaining 30 studies were reviewed independently for eligibility. Of these 30 studies, 23 were excluded because they did not meet the inclusion criteria. Finally, a total of 7 studies met the inclusion criteria and were processed for critical review CONCLUSION: Patient's body weight and body mass index (BMI) decreases after orthognathic surgery. No significant changes in body fat percentage were observed. The estimated blood loss and the need for blood transfusion increased. No significant changes were observed in hemoglobin levels, lymphocyte counts, total cholesterol levels, and cholinesterase levels between the pre-operative and postoperative periods. Increments in serum albumin levels and total protein counts were observed after orthognathic surgery.
Topics: Humans; Orthognathic Surgery; Orthognathic Surgical Procedures
PubMed: 37422263
DOI: 10.1016/j.jormas.2023.101549 -
Foot and Ankle Surgery : Official... Dec 2023The purpose of this systematic review is to examine the learning curve associated with minimally invasive surgery (MIS) for the treatment of hallux valgus (HV). (Review)
Review
BACKGROUND
The purpose of this systematic review is to examine the learning curve associated with minimally invasive surgery (MIS) for the treatment of hallux valgus (HV).
METHODS
A systematic review was performed using PubMed, ScienceDirect, Web of Science, CINAHL and MEDLINE databases from database inception to February 16th, 2023. Inclusion criteria was articles with level of evidence I-III, any outcomes associated with learning curve, minimally invasive surgery, and diagnosis of hallux valgus' in adult patients.
RESULTS
Six articles out of 165 articles meet inclusion criteria. For all six articles, 368 total patients (422 total feet) were included in the study with an average age of 55.69 years. Three studies reported the number of surgeries needed to reach the plateau phase of the learning curve of MIS for HV, with a frequency weighted mean of 35.5 surgeries (range 27 - 40). In the selected articles, significant results were found for increased operating room (OR) time and fluoroscopy shots in the learning phase. There was no significant increase in complications in the learning phase. There was no significant decrease in patient outcomes, or the quality of correction performed during the learning phase.
CONCLUSION
An average of 35.5 surgeries (range 27 - 40) are needed to reach the plateau phase for MIS for HV. The learning phase of the learning curve of MIS for HV has a significant increase in OR time and fluoroscopy usage. However, the learning phase of the learning curve of MIS for HV is not associated with decreased outcomes or higher complication rates based on the small sample size in this study.
LEVEL OF EVIDENCE
Level III, Systematic Review.
Topics: Adult; Humans; Middle Aged; Hallux Valgus; Learning Curve; Osteotomy; Bunion; Minimally Invasive Surgical Procedures; Treatment Outcome; Retrospective Studies; Metatarsal Bones
PubMed: 37524619
DOI: 10.1016/j.fas.2023.07.012 -
Knee Surgery, Sports Traumatology,... May 2024The aim of this systematic review was to identify the surgical indications of tibial derotational osteotomy (TDO) in patients with idiopathic external tibial torsion...
PURPOSE
The aim of this systematic review was to identify the surgical indications of tibial derotational osteotomy (TDO) in patients with idiopathic external tibial torsion (ETT) and identify common measurement thresholds for surgical correction.
METHODS
A systematic search of MEDLINE and Embase via Ovid, Cochrane Library via Wiley, Web of Science, Scopus, SPORTDiscus via EBSCOhost, ClinicalTrials.gov, WHO ICTRP and Global Index Medicus databases was performed with search terms reflecting the concepts of idiopathic tibial torsion, TDOs, and surgical indications. Studies reporting surgical indications and measurement methods of idiopathic tibial torsion in patients who underwent TDO were included. Two authors independently screened articles and extracted data that was characterized with descriptive statistics.
RESULTS
Seventeen studies were identified for inclusion, with 460 tibias and 351 patients. Nearly all patients who underwent surgery had either anterior knee pain or patellar instability, even if other indications were present. Of all included patients, the most common surgical indications for TDO were anterior knee pain (88%), patellar instability (59%), gait dysfunction (41%) and cosmetic deformity (12%). Twelve studies (71%) cited multiple of these indications as reasons for surgery. On physical exam, tibial torsion was measured most commonly by thigh-foot angle (59%) (TFA) and transmalleolar axis (24%) (TMA). In terms of TFA, the most frequently reported cut-off for ETT was >30° (35%). Computerized tomography (CT) was used by nine studies (53%). The most common CT axes used to measure ETT were the TMA with respect to the posterior tibia condylar axis or the bicondylar tibia axis.
CONCLUSION
Anterior knee pain and/or patellar instability are common indications for TDO in patients with idiopathic tibial torsion. Standardized TFA thresholds (>30°) and CT measurement methods (TMA and posterior tibia condylar or bicondylar tibial axis) may help further establish objective surgical indications.
LEVEL OF EVIDENCE
IV.
PubMed: 38713870
DOI: 10.1002/ksa.12231