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Clinics in Shoulder and Elbow Dec 2023Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic... (Review)
Review
BACKGROUND
Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder.
METHODS
This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: "shoulder," "rotator cuff," "biceps," "acromion" AND "monopolar," "bipolar," "ablation," "coblation," and "radiofrequency ablation." The title and abstract review were performed independently. Any discrepancies were addressed through open discussion.
RESULTS
A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case.
CONCLUSIONS
Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.
PubMed: 36330719
DOI: 10.5397/cise.2022.01067 -
International Wound Journal Aug 2023This systematic review examined peer-reviewed literature published from 2010 to 2020 to investigate the health care system costs, hidden out-of-pocket expenses and... (Review)
Review
This systematic review examined peer-reviewed literature published from 2010 to 2020 to investigate the health care system costs, hidden out-of-pocket expenses and quality of life impact of surgical site infections (SSIs) and to develop an overall summary of the burden they place on patients. SSI can significantly impact patients' treatment experience and quality of life. Understanding patients' SSI-related burden may assist in developing more effective strategies aimed at lessening the effects of SSI in financial and well-being consequences. Peer-reviewed articles on adult populations (over 18 years old) in orthopaedic elective hip and knee surgeries published from 2010 to 2020 were considered. Only publications in English and studies conducted in high-income countries were eligible for inclusion. A search strategy based on the MESH term and the CINAHL terms classification was developed. Five databases (Scopus, EMBASE, CINAHL, Medline, Web of Science) were searched for relevant sources. Reviewers categorised and uploaded identified citations to Covidence and EndNoteX9. Reviewers will assess article titles, abstracts and the full text for compliance with the inclusion criteria. Ongoing discussions between reviewers resolved disagreements at each selection process stage. The final scoping review reported the citation inclusion process and presented search results in a PRISMA flow diagram. Four main themes were extracted from a thematic analysis of included studies (N = 30): Hospital costing (n = 21); Societal perspective of health system costing (n = 2); Patients and societal well-being (n = 6) and Epidemiological database and surveillance (n = 22). This systematic review has synthesised a range of themes associated with the overall incidence and impact of SSI that can inform decision making for policymakers. Further analysis is required to understand the burden on SSI patients.
Topics: Adult; Humans; Adolescent; Surgical Wound Infection; Quality of Life; Orthopedic Procedures; Arthroplasty, Replacement, Knee; Health Care Costs
PubMed: 36573252
DOI: 10.1111/iwj.14032 -
European Journal of Trauma and... Dec 2022This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies... (Review)
Review
PURPOSE
This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed.
METHODS
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible.
RESULTS
57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%.
CONCLUSION
The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully.
LEVEL OF EVIDENCE
Level IV, systematic review.
Topics: Humans; Pandemics; Orthopedics; COVID-19; SARS-CoV-2; Orthopedic Procedures; Fractures, Bone
PubMed: 35523966
DOI: 10.1007/s00068-022-01978-z -
World Journal of Orthopedics Nov 2022Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might...
BACKGROUND
Although the impact of microbial infections on orthopedic clinical outcomes is well recognized, the influence of viral infections on the musculoskeletal system might have been underestimated.
AIM
To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.
METHODS
We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), the Reference Citation Analysis (RCA), and Scopus for completed studies published before January 30, 2021, to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries. Quality assessment was performed using SYRCLE's risk of bias tool for animal studies, Moga score for case series, Wylde score for registry studies, and Newcastle-Ottawa Scale for case-control studies.
RESULTS
Six human and four animal studies were eligible for inclusion in the qualitative synthesis. Hepatitis C virus was implicated in several peri- and post-operative complications in patients without cirrhosis after major orthopedic surgery. Herpes virus may affect the integrity of lumbar discs, whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.
CONCLUSION
Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis. Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms. Therefore, based on our literature search, the proposed clinical and pathogenetic classification scheme is as follows: (1) Viral infections of bone or joint; (2) Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues; and (3) Viral infection as a risk factor for post-surgical bacterial infection.
PubMed: 36439372
DOI: 10.5312/wjo.v13.i11.1015 -
Cureus Apr 2022Pycnodysostosis (PYCD) is an autosomal recessive lysosomal storage disorder of the bone which leads to stereotypical abnormalities consisting of, but not limited to,... (Review)
Review
Pycnodysostosis (PYCD) is an autosomal recessive lysosomal storage disorder of the bone which leads to stereotypical abnormalities consisting of, but not limited to, sclerotic and fragile bone, shortened distal phalanges, and obtuse mandibular angle. Current literature describes the otolaryngological manifestations and treatment of this disorder; however, the treatment of orthopedic fractures in PYCD patients is seldom described and remains a controversial topic. We aim to systematically review the current evidence regarding the optimal treatment of PYCD patients with fractures. We performed a literature search using PubMed, MEDLINE, Web of Science, and Google Scholar databases. Elig-ibility criteria consisted of English-language literature of PYCD patients undergoing treatment for orthopedic surgery fractures. Non-English papers or literature focused on maxillofacial manifestations/treatment were excluded. The database search resulted in the identification of 500 articles. After removing duplicates and enforcing our inclusion criteria, 29 case reports/series (40 patients) were included. The average age was 31.25 (-±18.2) years, with 57.5% of patients being female. Overall, 62.5% of patients had consanguineous parents. Additionally, 86.2% reported a history of previous fractures while 47.5% reported a spontaneous or minor trauma fracture, with most fractures occurring in the femur (60.0%) and tibia (40.0%). Radiographic features consisted of densification in the femur 45.0% (18/40), tibia 37.5% (15/40), and spine 25.0% (10/40). Overall, 84.2% of patients were treated with surgical management consisting of internal plate fixation (IPF) (48.3%), intramedullary fixation (20.7%), and Ilizarov external fixation (IEF) (13.8%). Overall, the refracture rate was 25.0% and was lowest in intramedullary fixation (0/6), compared to IPF (3/14) and IEF (3/4). Average time until refracture was 40.6 months (3-132 months). Long-term follow-up is recommended in patients with PYCD due to the propensity for fractures/refractures. While this study provides the groundwork for the treatment of PYCD patients, further research with higher-evidence studies should be conducted to establish the optimal orthopedic treatment of this disorder.
PubMed: 35602818
DOI: 10.7759/cureus.24275 -
European Journal of Trauma and... Aug 2021Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of... (Review)
Review
BACKGROUND
Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice.
QUESTION/PURPOSE
As part of the HYGArzt-Project ("Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics"), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery.
METHODS
The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period.
RESULTS
The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions.
CONCLUSION
Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology.
Topics: Cross Infection; Humans; Infection Control; Orthopedics; Prospective Studies; Traumatology
PubMed: 32914198
DOI: 10.1007/s00068-020-01477-z -
Journal of Foot and Ankle Research Sep 2023Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this study was to conduct a systematic review and meta-analysis to compare the surgical results of dorsal and plantar approaches.
METHODS
The literatures of PubMed, Cochrane library, Embase and Web of Science were searched on April 26th, 2023. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The data were extracted after screening the literature and evaluating the quality of the methodology included in the study. The RevMan5.4 software was used to analyze and calculate the OR value and 95% confidence interval.
RESULTS
A total of 7 randomized controlled trials and comparative studies were published, of which only 5 were included. There were 158 feet via plantar approach (plantar group, PG) and 189 via dorsal approach (dorsal group, DG). There was no significant difference between PG and DG in overall adverse events, sensory problems, incision infection and deep vein thrombosis (p > 0.05). In terms of scar problems, PG showed more than DG (OR, 2.90[95%CI, 1.40 to 5.98]; p = 0.004). Other outcome indicators such as visual analogue scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were difficult to be included in the comparison.
CONCLUSIONS
Based on the relatively low quality and small amount of available evidence, the meta-analysis conducted produces a hypothesis that the frequency of adverse events in surgical treatment of Morton's neuroma, dorsal approach and plantar approach may be the same, but the types are different. More high-level evidence is needed to further verify this hypothesis.
Topics: Humans; Morton Neuroma; Consensus; Lower Extremity; Orthopedics; Software
PubMed: 37674248
DOI: 10.1186/s13047-023-00660-w -
Bone & Joint Open Nov 2020Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have... (Review)
Review
BACKGROUND
Due to the overwhelming demand for trauma services, resulting from increasing emergency department attendances over the past decade, virtual fracture clinics (VFCs) have become the fashion to keep up with the demand and help comply with the BOA Standards for Trauma and Orthopaedics (BOAST) guidelines. In this article, we perform a systematic review asking, "How useful are VFCs?", and what injuries and conditions can be treated safely and effectively, to help decrease patient face to face consultations. Our primary outcomes were patient satisfaction, clinical efficiency and cost analysis, and clinical outcomes.
METHODS
We performed a systematic literature search of all papers pertaining to VFCs, using the search engines PubMed, MEDLINE, and the Cochrane Database, according to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Searches were carried out and screened by two authors, with final study eligibility confirmed by the senior author.
RESULTS
In total, 21 records were relevant to our research question. Six orthopaedic injuries were identified as suitable for VFC review, with a further four discussed in detail. A reduction of face to face appointments of up to 50% was reported with greater compliance to BOAST guidelines (46.4%) and cost saving (up to £212,000).
CONCLUSIONS
This systematic review demonstrates that the VFC model can help deliver a safe, more cost-effective, and more efficient arm of the trauma service to patients.Cite this article: 2020;1-11:683-690.
PubMed: 33263108
DOI: 10.1302/2633-1462.111.BJO-2020-0107.R1 -
Orthopaedic Journal of Sports Medicine Jan 2022Distal biceps tendon tears can cause weakness and fatigue with activities requiring elbow flexion and supination. Surgical management of chronic tears (>21 days) is not... (Review)
Review
BACKGROUND
Distal biceps tendon tears can cause weakness and fatigue with activities requiring elbow flexion and supination. Surgical management of chronic tears (>21 days) is not well described in the literature.
PURPOSE
To determine the clinical outcomes of chronic distal biceps repairs and reconstructions.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
We performed a search of Medline (PubMed and Ovid), EMBASE, CINAHL physical therapy, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, and PubMed Central from inception until September 29, 2020, to identify articles on chronic distal biceps ruptures. The inclusion criteria were studies with at least 1 outcome measure and 10 patients with chronic distal biceps ruptures treated surgically. The quality of the included studies was assessed with the methodological index for nonrandomized studies (MINORS) score. Functional outcomes and complications were reviewed.
RESULTS
A total of 12 studies were included after systematic database screenings. The MINORS scores ranged from 5 to 19. There were a total of 1704 distal biceps ruptures, of which 1270 were acute and 434 were chronic. Average follow-up time was 12 months to 5.1 years. Single-incision (n = 3), 2-incision (n = 2), or both (n = 6) surgical techniques were used in these studies. Four studies described the use of autografts, and 4 articles used allografts in the chronic repair. Range of motion, function, and strength outcomes were similar when compared with the contralateral arm. Pain was reduced to minimal levels. Main postoperative complications were of paresthesia (specifically to the lateral antebrachial cutaneous nerve), which were temporary in 69.1% of cases.
CONCLUSION
The results of this review indicate that surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. Although there may be a slightly higher immediate complication rate, the functional outcomes remain comparable with those seen in the patient population with acute distal biceps.
PubMed: 35005052
DOI: 10.1177/23259671211065772 -
International Journal of Environmental... Sep 2022Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this... (Review)
Review
Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this systematic review was to identify factors that patients look for that help build a strong therapeutic alliance in their pediatric sports or orthopedics healthcare provider, to identify if these factors differ across healthcare professions, and to identify any differences in therapeutic alliance between patients and their provider regarding in-person and telehealth visits. Scientific databases were searched from inception until August 2022. The search strategy resulted in 2195 articles with 11 studies included in the final analysis. The main attributes adolescents look for in their pediatric sports healthcare provider were shared decision making and understanding patients' sports and goals. These factors were found to differ among parents, sex, race, and socioeconomic status. The top factors improving therapeutic alliance in telehealth were having an already established relationship with the provider, visits lasting longer than 30 min, and having an English-speaking provider for English-speaking patients. The available literature highlights factors that contribute to the development of a stronger therapeutic alliance in the pediatric sports and orthopedics population. As these factors differ among adolescents, parents, sex, race, and socioeconomic status, this review provides insight in what patients and families look for in their provider when seeking care.
Topics: Adolescent; Child; Health Personnel; Humans; Orthopedics; Telemedicine; Therapeutic Alliance
PubMed: 36142080
DOI: 10.3390/ijerph191811813