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Children (Basel, Switzerland) Mar 2024Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current... (Review)
Review
BACKGROUND
Tibial spine avulsion fractures (TSAFs) account for approximately 14% of anterior cruciate ligament injuries. This study aims to systematically review the current evidence for the operative management of paediatric TSAFs.
METHODS
A search was carried out across four databases: MEDLINE, Embase, Scopus, and Google Scholar. Studies discussing the outcomes of the surgical management of paediatric TSAFs since 2000 were included.
RESULTS
Of 38 studies included for review, 13 studies reported outcomes of TSAF patients undergoing screw fixation only, and 12 studies used suture fixation only. In total, 976 patients underwent arthroscopic reduction and internal fixation (ARIF), and 203 patients underwent open reduction and internal fixation (ORIF). The risk of arthrofibrosis with the use of ARIF ( = 0.45) and screws ( = 0.74) for TSAF repair was not significant. There was a significantly increased risk of knee instability ( < 0.0001), reoperation ( = 0.01), and post-operative pain ( = 0.007) with screw fixation compared to sutures.
CONCLUSIONS
While the overall benefits of sutures over screws and ARIF over ORIF are unclear, there is clear preference for ARIF and suture fixation for TSAF repair in practice. We recommend large-scale comparative studies to delineate long-term outcomes for various TSAF fixation techniques.
PubMed: 38539382
DOI: 10.3390/children11030345 -
The American Journal of Sports Medicine Dec 2021Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management.... (Meta-Analysis)
Meta-Analysis
Early Operative Versus Delayed Operative Versus Nonoperative Treatment of Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.
BACKGROUND
Treatment options for pediatric and adolescent anterior cruciate ligament (ACL) injuries include early operative, delayed operative, and nonoperative management. Currently, there is a lack of consensus regarding the optimal treatment for these injuries.
PURPOSE/HYPOTHESIS
The purpose was to determine the optimal treatment strategy for ACL injuries in pediatric and adolescent patients. We hypothesized that (1) early ACL reconstruction results in fewer meniscal tears than delayed reconstruction but yields no difference in knee stability and (2) when compared with nonoperative management, any operative management results in fewer meniscal tears and cartilage injuries, greater knee stability, and higher return-to-sport rates.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
A systematic search of databases was performed including PubMed, Embase, and Cochrane Library using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were a pediatric and adolescent patient population (≤19 years old at surgery), the reporting of clinical outcomes after treatment of primary ACL injury, and original scientific research article. Exclusion criteria were revision ACL reconstruction, tibial spine avulsion fracture, case report or small case series (<5 patients), non-English language manuscripts, multiligamentous injuries, and nonclinical studies.
RESULTS
A total of 30 studies containing 50 cohorts and representing 1176 patients met our criteria. With respect to nonoperative treatment, knee instability was observed in 20% to 100%, and return to preinjury level of sports ranged from 6% to 50% at final follow-up. Regarding operative treatment, meta-analysis results favored early ACL reconstruction over delayed reconstruction (>12 weeks) for the presence of any meniscal tear (odds ratio, 0.23; = .006) and irreparable meniscal tear (odds ratio, 0.31; = .001). Comparison of any side-to-side differences in KT-1000 arthrometer testing did not favor early or delayed ACL reconstruction in either continuous mean differences ( = .413) or proportion with difference ≥3 mm ( = .181). Return to preinjury level of competition rates for early and delayed ACL reconstruction ranged from 57% to 100%.
CONCLUSION
Delaying ACL reconstruction in pediatric or adolescent patients for >12 weeks significantly increased the risk of meniscal injuries and irreparable meniscal tears; however, early and delayed operative treatment achieved satisfactory knee stability. Nonoperative management resulted in high rates of residual knee instability, increased risk of meniscal tears, and comparatively low rates of return to sports.
Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Child; Humans; Knee Injuries; Retrospective Studies; Tibial Meniscus Injuries; Young Adult
PubMed: 33720764
DOI: 10.1177/0363546521990817 -
Dental Traumatology : Official... Feb 2017The association between trauma and caries is still controversial in the literature. The aim of this study was to evaluate the possible association between caries and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIM
The association between trauma and caries is still controversial in the literature. The aim of this study was to evaluate the possible association between caries and dental trauma through a systematic review with meta-analysis.
DESIGN
A systematic literature search was performed in PubMed, Lilacs, BBO, Scopus, Web of Science, Cochrane Library, and Open Grey databases. The MeSH terms used were 'Tooth injuries', 'Tooth fractures', 'Tooth avulsion', 'Tooth movement'; 'Dental caries'; 'DMF index'; and 'Tooth demineralization'. MeSH synonyms, related terms, and free terms were included. The inclusion criteria comprised clinical investigations of subjects with and without caries that had suffered dental trauma. Quality assessment and bias control were carried out. Meta-analysis was performed using the comprehensive meta-analysis software (version 3.2). Heterogeneity was assessed using the I index, and the odds ratio was also calculated (P < 0.05).
RESULTS
From 1290 abstracts, seven met the inclusion criteria. All studies had high methodological quality and five were included in the meta-analysis. The results demonstrated a positive association (P < 0.001) between dental trauma and dental caries in permanent teeth [OR: 1.490, 95%, CI: 1.209-1.835]. However, for children with primary teeth, the results showed a negative association (P = 0.006) between dental trauma and caries [OR: 0.706, 95%, CI: 0.550-0.906].
CONCLUSIONS
The results demonstrated positive and negative association between the presence of caries and dental trauma in permanent and primary teeth, respectively.
Topics: Dental Caries; Humans; Risk Factors; Tooth Injuries
PubMed: 27439566
DOI: 10.1111/edt.12295 -
Journal of Investigative Surgery : the... Feb 2020The aim of this research is to perform a literature review of the treatments available for the anterior iliac spines avulsion fracture on the young subjects. : We...
The aim of this research is to perform a literature review of the treatments available for the anterior iliac spines avulsion fracture on the young subjects. : We performed a systematic literature search for studies on spines avulsion fractures in young subjects from January 1, 2013, to February 2018; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. : From 112 studies found only six articles were included in this systematic review. All the studies belonged to level IV of scientific evidence. 64 patients suffered an anterior inferior iliac spine fracture while patients 36% patients suffered an anterior superior iliac spine fracture. 93.2% underwent conservative treatment and 6.8% underwent surgery. : The anterior iliac spine avulsions fractures are rare injuries that occur in young male athletes and the conservative option is the most selected treatment modality.
Topics: Adolescent; Age Factors; Athletes; Child; Conservative Treatment; Female; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Ilium; Incidence; Male; Risk Factors; Sex Factors; Spinal Fractures; Treatment Outcome; Young Adult
PubMed: 30212230
DOI: 10.1080/08941939.2018.1483447 -
Frontiers in Pediatrics 2022Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating...
Avulsion fractures of the pelvis and hip region are typical injuries in adolescent athletes. Avulsion sites include the muscle tendon origin or insertion, and treating these injuries surgically or conservatively remains a debated issue. The main goals of this review were to assess and summarize injury types and sites, treatment-related clinical outcomes, and return to sport for adolescent patients with a pelvis avulsion fracture and to provide support for making treatment decisions. The PubMed database was searched in November 2021 to identify all published articles from 2000 to 2021 that reported the outcome and return to sport after conservative or surgical treatment. Eighteen studies with 453 patients were included in this review. The age range was 13.6-16.8 years. The most common injury site the was anterior superior iliac spine (37%), followed by the anterior inferior iliac spine (31%), ischial tuberosity (14%), lesser trochanter (9%), iliac crest (8%), and superior corner of the pubic symphysis (1%). Overall complications were lower in the surgical group compared to the conservative group. The rate of return to pre-injury activity level was greater in patients who underwent surgical treatment ( < 0.05). In conclusion, surgery is preferred for major dislocation and fragment size, providing a better return-to-sport rate and decreasing the risk of complications.
PubMed: 36210934
DOI: 10.3389/fped.2022.947463 -
The Physician and Sportsmedicine Sep 2018to identify all studies of Karate injuries and assess injury rates, types, location, and causes.
OBJECTIVES
to identify all studies of Karate injuries and assess injury rates, types, location, and causes.
METHODS
Six electronic and four grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data and assessed risk-of-bias with the Newcastle-Ottawa scale. Average injury rates/1000AE (AE = athletic-encounter) and/1000minutesAE, injury location and type weighted by study size were calculated.
RESULTS
In competitions rates of injury/1000AE and/1000 minutesAE were similar for males (111.4/1000AE, 75.4/1000 minAE) and females (105.8/1000AE, 72.8/1000 minAE). Location of injury rates/1000AE for males were 44.0 for head/neck, 11.9 lower extremities, 8.1 torso and 5.4 upper extremities and were similar for females: 41.2 head/neck, 12.4 lower extremities, 9.1 torso and 6.3 upper extremities. Injury rates varied widely by study. Rates/1000AE for type of injury were contusions/abrasions/lacerations/bruises/tooth avulsion for males (68.1) and females (30.4); hematomas/bleeding/epistaxis males (11.4) and females (12.1); strains/sprains males (3.5) and females (0.1); dislocations males (2.9) and females (0.9); concussions males (2.5) and females (3.9); and fractures males (2.9) and females (1.4). Punches were a more common mechanism of injury for males (59.8) than females (40.8) and kicks similar (males 19.7, females 21.7). Weighted averages were not calculated for weight class or belt colour because there were too few studies. Nineteen injury surveys reported annual injury rates from 30% to rates ten times higher but used different reporting methods. Studies provided no data to explain wide rate ranges.
CONCLUSIONS
Studies need to adopt one injury definition, one data-collection form, and collect comprehensive data for each study for both training and competitions. More data are needed to measure the effect of weight, age and experience on injuries, rates and types of injury during training, and for competitors with high injury rates. RCTs are needed of interventions such as training and feedback of performance data to reduce injury rates.
Topics: Athletic Injuries; Brain Concussion; Female; Fractures, Bone; Humans; Joint Dislocations; Lower Extremity; Male; Martial Arts; Risk Factors; Sprains and Strains; Upper Extremity
PubMed: 29737221
DOI: 10.1080/00913847.2018.1472510 -
Archives of Orthopaedic and Trauma... Mar 2023To provide a systematic overview of clinical and radiographic outcomes in patients who underwent surgical treatment of a painful avulsion fragment of the distal fibula...
PURPOSE
To provide a systematic overview of clinical and radiographic outcomes in patients who underwent surgical treatment of a painful avulsion fragment of the distal fibula also known as posttraumatic os subfibulare.
METHODS
A systematic literature search across two major sources (PubMed and Scopus) was performed. Twenty-seven studies were included and analyzed using the modified Coleman score to assess the methodologic quality.
RESULTS
The surgical treatment of symptomatic os subfibulare, with or without concomitant ankle instability, generally results in substantial improvement in clinical and radiographic outcomes with relative low complication rates. Clinical outcome measures may not be affected by the presence of ankle instability or by the fragment size. The methodological quality of analyzed studies was satisfactory.
CONCLUSION
Posttraumatic os subfibulare may result in chronic pain and ankle instability. If surgery is indicated, ankle instability should be concomitantly addressed when present. Based on available literature, satisfactory postoperative outcomes can be reliably expected following surgical treatment.
LEVEL OF EVIDENCE
Systematic Review of Level III and Level IV Studies, Level IV.
Topics: Humans; Lateral Ligament, Ankle; Fibula; Fractures, Avulsion; Joint Instability; Treatment Outcome; Ankle Fractures
PubMed: 34820695
DOI: 10.1007/s00402-021-04256-6 -
Journal of Orthopaedics Mar 2024Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical... (Review)
Review
BACKGROUND
Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical intervention in the pediatric population during growth phase are not clearly defined. The current systematic review aims to provide a consensus on the morphological types, treatment options, indications, the outcomes expected and complications and their management.
METHODS
The review was conducted as per the PRISMA guidelines. Inclusion criteria were (a).Articles published in English, (b) Age <18 years, (c) Patellar fractures including osteochondral fractures. Exclusion criteria includes articles with incomplete data, case reports, biomechanical studies, case series with sample size <2, biomechanical studies, reviews, letter to the editor, or editorials and Non-English language.
RESULTS
The review search yielded a total of 18 articles. A total of 288 patients with patellar fractures were included in the review. The average age ranged from 9.6 years to 16 years. The follow-up period ranged from 3 months to 20 years In total, 49 individuals underwent immobilization with cast or brace application, 4 with spica cast application and 48 with cylindrical cast in extension. Overall, 83 patients in 13 studies underwent surgical fixation most of which underwent wiring.
CONCLUSION
Pediatric patella fracture/dislocations or Osteochondral fractures (OCF) although being a rare event, may be associated with a child with knee injury and swelling. Conservative management in terms of casting and immobilization may be an alternative but surgical intervention should be the primary mode of treatment in such cases.
PubMed: 38090603
DOI: 10.1016/j.jor.2023.11.049 -
Journal of Shoulder and Elbow Surgery Apr 2021Fractures of the anteromedial facet (AMF) of the coronoid process are caused by a varus posteromedial rotational injury force, leading to instability in the ulnohumeral... (Review)
Review
BACKGROUND
Fractures of the anteromedial facet (AMF) of the coronoid process are caused by a varus posteromedial rotational injury force, leading to instability in the ulnohumeral joint. AMF fractures are usually accompanied by avulsion of the lateral ulnar collateral ligament (LUCL). O'Driscoll's description and classification of AMF coronoid fractures has increased awareness and interest in this injury, but the optimal treatment has yet to be decided.
METHODS
We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and Embase. The primary objective was to determine outcome scores but also complication and revision rates depending on the fracture and its therapy in order to gain a more comprehensive picture. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied.
RESULTS
Initially, 304 publications were identified. Finally, 10 studies were left for inclusion, all of them retrospective in design, comprising 128 patients; the majority of them were male (75.7%). A total of 114 patients (89.1%) were treated surgically and 14 patients (10.9%) were treated conservatively. Among the surgically treated patients, 70.2% were treated with LUCL refixation. The average Mayo Elbow Performance Score of the surgically treated patients was 91.5 points. The average Mayo Elbow Performance Score of the conservatively treated patients was 91.4 points. A total of 10 patients (7.8%) required reoperation.
CONCLUSION
Surgery of AMF fractures leads to a satisfactory functional outcome in the vast majority of patients independent of the subtype. An algorithm for LUCL fixation is still pending. Conservative treatment may be considered under strict preconditions, especially for nondisplaced subtype 1 and 2 fractures, as these fractures show satisfactory functional outcomes when treated nonoperatively.
Topics: Collateral Ligaments; Elbow Joint; Fracture Fixation, Internal; Fractures, Bone; Humans; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 33010433
DOI: 10.1016/j.jse.2020.09.008 -
European Journal of Orthopaedic Surgery... Apr 2024Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the... (Review)
Review
PURPOSE
Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children.
METHODS
A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries.
FINDINGS/RESULTS
Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18 years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14 months after injury and was 100/100.
CONCLUSIONS
Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status.
LEVEL OF EVIDENCE IV
Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.
PubMed: 38653925
DOI: 10.1007/s00590-024-03920-y