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Journal of Orthopaedic Trauma Feb 2023Differences in function, pain, and reoperation rates were compared between the following treatment options: (1) operative vs. nonoperative treatment and (2) various... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Differences in function, pain, and reoperation rates were compared between the following treatment options: (1) operative vs. nonoperative treatment and (2) various surgical treatments including open reduction internal fixation, intramedullary nail, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA).
DATA SOURCES
MEDLINE, Embase, and Cochrane were searched through February 1, 2022. All English-language randomized trials comparing operative and nonoperative treatment of proximal humeral fractures with a control group in patients 18 years or older were included.
DATA EXTRACTION
Demographic data, functional and pain scores and re-operation rates were extracted. Study quality was determined with the Cochran risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Heterogeneity was determined with the I-squared statistic.
DATA SYNTHESIS
Meta-analysis of included studies using mean difference and odds ratios where appropriate.
CONCLUSIONS
Surgical treatment with either locked plates or HA results in similar functional scores and pain outcomes as nonoperative treatment, although plates were associated with higher reoperation rates in 3-part and 4-part fractures. In 3-part and 4-part fractures, RSA results in higher function and pain scores compared with HA. Further high-quality trials should focus on RSA, and further study is required to better define the role of open reduction internal fixation in the younger patient population.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Adult; Hemiarthroplasty; Arthroplasty, Replacement; Fracture Fixation; Open Fracture Reduction; Shoulder Fractures; Treatment Outcome
PubMed: 36155560
DOI: 10.1097/BOT.0000000000002494 -
World Journal of Surgical Oncology Jul 2020Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and meta-analysis from the current evidence-based literature.
AIM
To expand the current knowledge on feasibility and safety, and also to analyze postoperative outcomes of several reconstructive techniques after proximal gastrectomy.
METHODS
PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1966 and 2019 concerning various reconstructive techniques on proximal gastrectomy were selected. The postoperative outcomes and complications of the reconstructive techniques were assessed. Meta-analyses were performed using Rev-Man 5.0. A total of 29 studies investigating postoperative outcomes of double tract reconstruction, jejunal pouch interposition, jejunal interposition, esophagogastrostomy, and double flap reconstruction were finally selected in the quantitative analysis.
RESULT
Pooled incidences of reflux esophagitis for double tract reconstruction, jejunal pouch interposition, jejunal interposition esophagogastrostomy, and double flap reconstruction were 8.6%, 13.8%, 13.8%, 19.3%, and 8.9% respectively. Meta-analysis showed a decreased length of hospital in the JI group as compared to the JPI group (heterogeneity: Chi = 1.34, df = 1 (P = 0.25); I = 26%, test for overall effect: Z = 2.22 (P = 0.03). There was also a significant difference between JI and EG in length of hospital stay with heterogeneity: Chi = 1.40, df = 3 (P = 0.71); I = 0%, test for overall effect: Z = 5.04 (P < 0.00001). Operative time was less in the EG group as compared to the JI group (heterogeneity: Chi = 31.09, df = 5 (P < 0.00001); I = 84%, test for overall effect: Z = 32.35 (P < 0.00001).
CONCLUSION
Although current reconstructive techniques present excellent anti-reflux efficacy, the optimal reconstructive method remains to be determined. The double flap reconstruction proved to lower the rate of complication, but the DTR, JI, JPI, and EG groups showed higher incidence of complications in anastomotic leakage, anastomotic stricture, and residual food. In the meta-analysis result, the complications between the JI, JPI, and EG were comparable but the EG group showed to have better postoperative outcomes concerning the operative time, blood loss, and length of hospital stay.
Topics: Gastrectomy; Humans; Jejunum; Postoperative Complications; Prognosis; Stomach Neoplasms; Treatment Outcome
PubMed: 32677956
DOI: 10.1186/s12957-020-01936-2 -
Spine Deformity Mar 2022Proximal junctional kyphosis (PJK) is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead... (Review)
Review
PURPOSE
Proximal junctional kyphosis (PJK) is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead to post-operative deformity, pain, and dissatisfaction. Understanding the risk factors of PJK can be useful for pre-operative informed consent as well as to identify any potential preventative strategies.
METHODS
We performed a systematic review and critical analysis following the PRISMA statement in July 2019 by searching the PubMed, Scopus, and Embase databases, including all prior published studies. We included articles with data on PJK in patients with operative pediatric and adolescent scoliosis and those that detailed risk factors and/or preventative strategies for PJK. Levels of evidence were determined based on consensus. Findings were summarized and grades of recommendation were assigned by consensus. This study was registered in the PROSPERO database; 202,457.
RESULTS
Six hundred and thirty five studies were identified. Thirty-seven studies met criteria for inclusion into the analysis. No studies including neuromuscular scoliosis met inclusion criteria. No findings had Grade A evidence. There were 4 findings found to contribute to PJK with Grade B evidence in EOS: higher number of distractions, disruption of posterior elements, greater sagittal plane correction. There was no difference in incidence noted between etiology of the curvature. Five findings with Grade B evidence were found to contribute to PJK in AIS populations: higher pre-operative thoracic kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs, greater sagittal plane correction, and posterior versus anterior fusion constructs.
CONCLUSION
Greater sagittal plane correction has Grade B evidence as a risk factor for PJK in both EOS and AIS populations. In EOS patients, an increased number of distractions and posterior element disruption are Grade B risk factors. In AIS patients, longer fusion constructs, higher pre-operative thoracic kyphosis and lumbar lordosis, and posterior (as opposed to anterior) constructs also contributed to PJK with Grade B evidence. These findings can guide informed consent and surgical management, and provide the foundation for future studies.
Topics: Adolescent; Child; Humans; Kyphosis; Postoperative Complications; Retrospective Studies; Scoliosis; Spinal Fusion
PubMed: 34704232
DOI: 10.1007/s43390-021-00429-w -
Medicine and Science in Sports and... Jul 2020Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Chronic ankle instability (CAI) is known to induce impairments throughout the lower quarter kinetic chain, however there is currently no synthesized information on proximal adaptations of the trunk, hip, thigh, and knee for neuromuscular and biomechanical outcomes during strength, balance, jumping, and gait among CAI patients. The purpose of this systematic review and meta-analysis was to synthesize trunk, hip, thigh and knee neuromuscular and biomechanical outcome measures during functional assessments when comparing CAI to healthy groups.
METHODS
Cumulative Index of Nursing and Allied Health Literature and Medical Literature Analysis and Retrieval System Online with PubMed databases were searched on June 3, 2019. Studies comparing outcomes at the trunk, hip, thigh, or knee regardless of assessment type in CAI versus healthy groups were considered for inclusion. Assessment categories were used to differentiate adaptations by assessment type after inclusion. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Database scoring criteria. Data pertaining to study methodology and primary proximal adaptation outcomes were extracted. Separate random effects meta-analyses were performed for consistently reported outcome measures.
RESULTS
Pooled estimates reflected that CAI patients had decreased triplanar isometric hip strength outcomes (P < 0.001, effect size range: 0.52-0.93). Knee kinematics did not differ from healthy groups during dynamic balance testing (P = 0.26). Few studies found CAI patients have altered knee kinematics during jumping tasks. The remaining findings were isolated to individual studies and thus inconclusive.
CONCLUSIONS
The CAI groups demonstrated triplanar hip strength deficits and altered knee flexion angles during jumping assessments. Clinicians should consider proximal evaluations and interventions for CAI patients.
Topics: Adaptation, Physiological; Ankle Injuries; Ankle Joint; Chronic Disease; Gait Analysis; Hip; Humans; Joint Instability; Knee; Muscle Strength; Plyometric Exercise; Postural Balance; Sprains and Strains; Thigh; Torso
PubMed: 31977639
DOI: 10.1249/MSS.0000000000002282 -
Journal of Vascular Surgery Mar 2023To provide an updated systematic literature review summarizing current evidence on aortic neck dilatation (AND) after endovascular aortic aneurysm repair (EVAR) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To provide an updated systematic literature review summarizing current evidence on aortic neck dilatation (AND) after endovascular aortic aneurysm repair (EVAR) in patients with infrarenal abdominal aortic aneurysm.
METHODS
An extensive electronic search in major electronic databases was conducted between January 2000 and December 2021. Eligible for inclusion were observational studies that followed up with patients (n ≥ 20) undergoing EVAR with self-expanding endografts, for 12 or more months, evaluated AND with computed tomography angiography and provided data on relevant outcomes. The primary end point was the incidence of AND after EVAR, and the secondary end points were the occurrence of type Ia endoleak, stent graft migration, secondary rupture, and reintervention.
RESULTS
We included 34 studies with a total sample of 12,038 patients (10,413 men; median age, 71 years). AND was defined clearly in 18 studies, but significant differences in AND definition were evidenced. The pooled incidence of AND based on quantitative analysis of 16 studies with a total of 9201 patients (7961 men; median age, 72 years) was calculated at 22.9% (95% confidence interval [CI], 14.4-34.4) over a follow-up period ranging from 12 months to 14 years. The risk of a type Ia endoleak was significantly higher in AND patients compared with those without AND (odds ratio, 2.95; 95% CI, 1.10-7.93; P = .030). Similarly, endograft migration was more common in the AND group compared with the non-AND group (odds ratio, 5.95; 95% CI, 1.80-19.69; P = .004). The combined incidence of secondary rupture and reintervention did not differ significantly between the two groups, even though the combined effect was in favor of the non-AND group.
CONCLUSIONS
Proximal AND after EVAR is common and occurs in a large proportion of patients with infrarenal abdominal aortic aneurysm. AND can influence the long-term durability of proximal endograft fixation and is significantly related to adverse outcomes, often leading to reinterventions.
Topics: Male; Humans; Aged; Blood Vessel Prosthesis Implantation; Endoleak; Treatment Outcome; Dilatation; Risk Factors; Endovascular Procedures; Retrospective Studies; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis
PubMed: 35948244
DOI: 10.1016/j.jvs.2022.07.182 -
Journal of Endovascular Therapy : An... Mar 2023To gain insight into safety and efficacy of in situ and ex-situ fenestration techniques for total endovascular arch repair. The term ex-situ fenestration is referring to... (Review)
Review
PURPOSE
To gain insight into safety and efficacy of in situ and ex-situ fenestration techniques for total endovascular arch repair. The term ex-situ fenestration is referring to physician-modified stent-graft technique where fenestration is performed on a back table.
METHODS
Electronic search was conducted according to PRISMA (Preferred Reporting Items for Systematic review and Meta-analyses) guidelines from 2000 to 2020. The main outcomes measured were 30-day mortality, stroke, aortic-related mortality, and reintervention rates.
RESULTS
Fifteen studies were eligible: 7 ex-situ fenestration (189 patients) and 8 in-situ fenestration (149 patients). In ex-situ group, dissection was the main pathology treated and proximal sealing zones were Z0 or 1 in 53.5% of patients. In in-situ group, dissection and aneurysm were equally represented in around 40% of cases and proximal sealing zones were Z0 or 1 in 46.5% of patients. Cumulative 30-day all-cause mortality was similar in both groups: 3.8% (95% confidence interval [CI]: 1.7%-8.2%) and 3.8% (95% CI: 1.6%-8.9%), respectively, in ex-situ and in-situ groups and stroke rate of 2.8% (95% CI: 1.1%-7%) and 5.3% (95% CI: 2.6%-10.5%). After a 11.1 ± 2.6 months mean follow-up for ex-situ and 16.7 ± 2.3 months for in-situ group, there were 5.2 and 1.4 reinterventions per 100 patients-years, respectively, for ex-situ and in situ groups. Aortic-related mortality rates of, respectively, 3.2% (95% CI: 1.3%-7.4%) and 2.6% (95% CI: 0.9%-7.3%) were noted in ex-situ and in situ groups.
CONCLUSION
The reported data show favorable short-term results of both ex-situ and in-situ fenestration techniques with low mortality and strokes rates. However, durability is still questionable given the lack of long-term data. Both options may have their place in arch repair beyond the spectrum of emergent and urgent cases, on condition that results stand the test of time.
CLINICAL IMPACT
In situ and ex-situ fenestration techniques have been initially developed to overcome emergency or as a bail out techniques however giving the promessing favorable short term results indications of these techniques may be extended to elective patients ineligible to customized stent-grafts and possibly in the futur to more elective cases as an option for total endovascular arch repair.
PubMed: 36896884
DOI: 10.1177/15266028231157639 -
Animals : An Open Access Journal From... Jun 2021The assessment of limb conformations in veterinary orthopedics is a significant tool used to determine the quantitative degree of limb malalignments. As in human... (Review)
Review
The assessment of limb conformations in veterinary orthopedics is a significant tool used to determine the quantitative degree of limb malalignments. As in human medicine, various studies have been undertaken in veterinary medicine to determine the values in different dog breeds and to determine the values in healthy and diseased dogs. The objectives of this systematic review were to evaluate the reported values in these articles separately, to compile the standard values, and to compare the values between dogs with and without various orthopedic diseases. All of the articles included in this systematic review were collected by screening the Scopus, PubMed/Medline, and Web of Science databases. The articles were evaluated according to the measured alignments, imaging methods, dog breeds, and the health status of the dogs. Each alignment was investigated separately, and the results are summarized. Twenty-nine studies were included in this systematic review. According to the studies, in the frontal plane, distal femoral alignments, as well as proximal and distal tibial alignments, corresponded to the severity of the medial patellar luxation. The difference between affected and non-affected dogs with cranial cruciate ligament disease was limited to the proximal tibial alignments in the sagittal plane.
PubMed: 34204283
DOI: 10.3390/ani11061804 -
Journal of Cancer 2023The incidence of gastroesophageal junction adenocarcinoma has gradually increased. Proximal gastrectomy or total gastrectomy is recommended for early gastric cancer of... (Review)
Review
The incidence of gastroesophageal junction adenocarcinoma has gradually increased. Proximal gastrectomy or total gastrectomy is recommended for early gastric cancer of the upper third of the stomach. Because total gastrectomy is often accompanied by body mass loss and nutrient absorption disorders, such as severe hypoproteinemia and anemia, Proximal gastrectomy is more frequently recommended by researchers for early upper gastric cancer (T1N0M0) and Siewert II gastroesophageal junction cancer less than 4 cm in length. Although some functions of the stomach are retained after proximal gastrectomy, the anatomical structure of the gastroesophageal junction can be destroyed, and the anti-reflux effect of the cardia is lost. In recent years, as various reconstruction methods for anti-reflux function have been developed, some functions of the stomach are retained, and serious reflux esophagitis is avoided after proximal gastrectomy. In this article, we summarized the indications, advantages, and disadvantages of various classic reconstruction methods and latest improved reconstruction method including esophageal and residual stomach anastomosis, tubular gastroesophageal anastomosis, muscle flap anastomosis, jejunal interposition, and double-tract reconstruction.
PubMed: 37859825
DOI: 10.7150/jca.87315 -
Biomedicines Jun 2023Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is... (Review)
Review
BACKGROUND
Infected nonunion of the tibia represents a challenging complication for orthopedic surgeons and poses a major financial burden to healthcare systems. The situation is even more compounded when the nonunion involves the metaphyseal region of long bones, a rare yet demanding complication due to the poor healing potential of infected cancellous bone; this is in addition to the increased likelihood of contamination of adjacent joints. The purpose of this study was to determine the extent and level of evidence in relation to (1) available treatment options for the management of septic tibial metaphyseal nonunions; (2) success rates and bone healing following treatment application; and (3) functional results after intervention.
METHODS
We searched the MEDLINE, Embase, and CENTRAL databases for prospective and retrospective studies through to 25 January 2021. Human-only studies exploring the efficacy of various treatment options and their results in the setting of septic, quiescent, and metaphyseal (distal or proximal) tibia nonunions in the adult population were included. For infection diagnosis, we accepted definitions provided by the authors of source studies. Of note, clinical heterogeneity rendered data pooling inappropriate.
RESULTS
In terms of the species implicated in septic tibial nonunions, staphylococcus aureus was found to be the most commonly isolated microorganism. Many authors implemented the Ilizarov external fixation device with a mean duration of treatment greater than one year. Exceptional or good bone and functional results were recorded in over 80% of patients, although the literature is scarce and possible losses of the follow-up were not recorded.
CONCLUSION
A demanding orthopedic condition that is scarcely studied is infected metaphyseal tibial nonunion. External fixation seems promising, but further research is needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO No. CRD42020205781.
PubMed: 37371760
DOI: 10.3390/biomedicines11061665 -
Heart, Lung & Circulation Jan 2022Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource... (Review)
Review
OBJECTIVE
Proximal aortic graft infection (PAGI) is a rare but often fatal postoperative complication. Its management often relied on surgical preferences and resource availability of each centre, until the recent unifying guidelines published by the European Society for Vascular Surgery (ESVS). This paper aimed to amalgamate the published experience in managing PAGI and their outcomes.
METHODS
PubMed, Scopus and Cochrane Library databases were searched systematically. All primary studies besides single-patient case reports were included. Data extracted included study and patient characteristics, type of index surgery, type of microorganisms involved, definitive treatment modality, and any outcome measures reported.
RESULTS
Of the 20 studies included, 157 of the 290 PAGI patients underwent complete graft explantation and replacement, 106 underwent graft-preservation interventions (debridement and/or irrigation), and 25 had antibiotics alone. Adjunctive interventions included graft coverage, vacuum-assisted closure, use of infection-resistant graft materials, and lifelong suppressive therapy. In-hospital mortality was 20.8% (n=60), with postoperative sepsis and multiorgan failure (n=24) being the most common cause. Recurrent infection occurred in 10 post-discharge patients. Post-discharge mortality rate was 11.4% (n=33), with cardiac complications and stroke being the most common cause in surgically-treated and medically-treated patients, respectively.
CONCLUSIONS
Given the risk of mortality, the management approach of PAGI highly depends on the fitness of the patient. We believe that early referral to specialised aortic centres is essential to plan for optimal management strategies and improve patient outcomes. Further studies are also required to parse out the most effective adjunctive interventions to maximise patient outcomes.
Topics: Aftercare; Aorta; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Patient Discharge; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome
PubMed: 34602347
DOI: 10.1016/j.hlc.2021.07.026