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Nutrition (Burbank, Los Angeles County,... Dec 2023Menopause and vitamin D deficiency increase bone reabsorption and bone fracture risk in women in postmenopause, and vitamin D supplementation may improve bone health and... (Review)
Review
Supplementation of vitamin D isolated or calcium-associated with bone remodeling and fracture risk in postmenopausal women without osteoporosis: A systematic review of randomized clinical trials.
Menopause and vitamin D deficiency increase bone reabsorption and bone fracture risk in women in postmenopause, and vitamin D supplementation may improve bone health and decrease bone fracture risk. This study aims to discuss the effect of vitamin D supplementation, isolated or calcium-associated, on remodeling and fracture risk bone in women in postmenopause without osteoporosis. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO database registration: CRD42022359796). A search was conducted in four databases and gray literature using MeSH and similar terms related to supplements, vitamin D, calcium, remodeling, and fracture bone, without the restriction of language and year of publication. A total of 3460 studies were identified, and nine were selected. Vitamin D supplementation increased 25-hydroxyvitamin D levels ≥10 ng/mL and decreased parathyroid hormone secretion dependent on baseline levels. The doses of 400 IU of vitamin D improved the percentage of carboxylated osteocalcin, whereas 800 to 1000 IU combined with calcium resulted in reduced, improved, or maintained bone mineral density and reduced alkaline phosphatase levels. However, 4000 IU alone or combined with calcium for 6 mo did not improve C-telopeptide and procollagen type 1 peptide levels. Additionally, 15 000 IU/wk increased the cortical area of metacarpal bone, whereas 500 000 IU of vitamin D annually for 5 y did not contribute to reducing the fracture risk and falls. Only one study found a reduction in fracture risk (dose of 800 IU of vitamin D plus 1200 mg of calcium). Thus, the vitamin D supplementation, alone or calcium-associated, improved the status of 25-hydroxyvitamin D and bone remodeling, but it was not possible to assert that it reduced fracture bone risk in postmenopausal women.
Topics: Humans; Female; Calcium; Postmenopause; Randomized Controlled Trials as Topic; Vitamin D; Vitamins; Osteoporosis; Fractures, Bone; Calcium, Dietary; Calcifediol; Dietary Supplements; Bone Remodeling
PubMed: 37544189
DOI: 10.1016/j.nut.2023.112151 -
Biomedizinische Technik. Biomedical... May 2017Bone plates for osteosynthesis are subject to biomechanical testing for safety and regulatory purposes. International standards applicable for those devices are designed... (Review)
Review
Bone plates for osteosynthesis are subject to biomechanical testing for safety and regulatory purposes. International standards applicable for those devices are designed for bone plates used in the surgical fixation of the skeletal system but not necessarily for all device variants available. We intend to summarize the test methods and parameters presented in the literature to evaluate bone plates in a clinical environment, especially for modern anatomically shaped implants. We conducted a systematic review on published biomechanical studies for lower and upper extremities (clavicle, humerus, ulna, radius, metacarpal, femur, tibia, fibula, metatarsal). The search process led to the identification of 159 relevant articles containing 330 individual tests, which were analyzed concerning various test criteria including test methods and parameters per bone segment for static and dynamic loading tests, as well as number of cycles, chosen bone model and outcome variables. The biomechanical literature for bone plates is diverse, inconsistent and heterogeneous. Test methods are not commonly applied per bone plate location and test parameters are not uniformly specified and displayed. They vary in particular for bending and torsion tests as well as for the number of loading cycles for dynamic testing. Outcome variables are not commonly applied nor defined. Consequently this paper is the first in a planned chronological series of three to identify the need (this publication), to develop a systematic procedural approach (2. publication) and to apply the process exemplary on a bone plate sample (3. publication).
Topics: Biomechanical Phenomena; Bone Plates; Fracture Fixation, Internal; Humans; Materials Testing
PubMed: 27171385
DOI: 10.1515/bmt-2015-0219 -
Journal of Clinical Medicine Feb 2024: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This... (Review)
Review
: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. : A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. : Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. : Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
PubMed: 38398461
DOI: 10.3390/jcm13041148 -
Hand Surgery & Rehabilitation Oct 2021Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique...
Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique is currently the subject of controversy among hand surgeons. The aim of this systematic review was to gain insight on radiological, functional and patient-rated outcomes reported in literature. A comprehensive literature search of PubMed, Embase, CENTRAL and CINAHL databases was conducted on March 1st, 2021. All studies reporting on fracture union, complications, and functional and patient-rated outcome in IMS fixation of metacarpal and/or phalangeal fractures were selected. Two prospective and 16 retrospective cohort studies were included, encompassing a total of 837 patients with 958 fractures (693 metacarpal, 222 proximal phalangeal and 43 middle phalangeal). Mean surgery duration was 26.4 min (range 5-60 min). Union was ultimately achieved in all fractures in a mean of 5.7 weeks (range 2-12 weeks). The procedure-related complication rate was 3.2%. The most frequently reported complication was limitation of joint motion, occurring in 2.0% of cases. Incidence of other complications, including loss of reduction, infection and screw protrusion did not exceed 1%. Overall mean total active motion averaged 243° and grip strength reached 97.5% of the contralateral side. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 3.7 points. Duration of sick leave was 7.3 weeks. According to the findings of this systematic review, IMS fixation is a time-saving and safe minimally invasive solution for both metacarpal and phalangeal fractures, with a low rate of complications and promising functional and patient-rated results.
Topics: Bone Screws; Fracture Fixation, Internal; Humans; Metacarpal Bones; Prospective Studies; Retrospective Studies; Upper Extremity
PubMed: 33933635
DOI: 10.1016/j.hansur.2021.04.009 -
The Journal of Hand Surgery... Feb 2022Thumb and multiple finger amputations may result in a metacarpal and a metacarpal-like hand deformity. Toe-to-hand transfer is a recognised treatment strategy for this...
Thumb and multiple finger amputations may result in a metacarpal and a metacarpal-like hand deformity. Toe-to-hand transfer is a recognised treatment strategy for this deformity but has risks and is resource intensive. The aim of this study is to conduct a systematic review of the outcomes of toe-to-hand transfer for traumatic metacarpal and metacarpal-like hand deformity in adult patients. Multi-database searching with index and free text terms, duplicate standardised screening and extraction, and quality assessment was performed. The inclusion and exclusion criteria were prespecified. We included any randomised controlled trials, cohort studies, case-control studies, as well as interrupted time series, before and after intervention studies. Screening of 548 articles yielded 20 studies eligible that included 19 retrospective observational studies and one before and after intervention study. A total of 171 patients underwent 274 toe transfers for metacarpal and metacarpal-like hand deformity. No study compared toe-transfer to a control group or to a prosthesis. The before and after intervention study demonstrated significant improvement in activities of daily living, work, aesthetics and satisfaction. Additionally, no significant donor site morbidity occurred in the heterogenous sample. Outcomes from remaining studies at risk of bias suggest that those with a lesser severity of injury and at least two toe transfers score higher in functional tests and scoring systems. There is limited confidence in the effectiveness of toe transfer for metacarpal and metacarpal-like hand deformity. The available evidence indicates that toe transfer(s) may restore acceptable function permitting activities of daily living, return to original or sedentary occupation and affords satisfaction. Level III (Therapeutic).
Topics: Activities of Daily Living; Adult; Amputation, Traumatic; Finger Injuries; Hand Deformities; Humans; Metacarpal Bones; Retrospective Studies; Toes
PubMed: 35135430
DOI: 10.1142/S2424835522500199 -
Cureus Aug 2022A closed fifth metacarpal neck fracture is a frequently encountered upper limb fracture that occurs when the bone breaks right below the little finger's knuckle. At the... (Review)
Review
A closed fifth metacarpal neck fracture is a frequently encountered upper limb fracture that occurs when the bone breaks right below the little finger's knuckle. At the moment, there is no agreement on the best way to treat these fractures. This research seeks to look at the efficacy of buddy taping versus reduction and casting for non-operative management of uncomplicated closed fifth metacarpal neck fractures. A systematic review of PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), and the Cochrane Library databases was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to find relevant studies about buddy taping versus reduction and casting for non-operative management. Disabilities of the arm, shoulder, and hand (DASH) score; satisfaction score; visual analog scale (VAS); range of motion (ROM); strength; and other outcomes were reported in this study. We used Review Manager 5.4 (The Cochrane Collaboration, London, UK) for the meta-analysis. Seven trials with a total of 454 patients were considered in the review and four in the quantitative analysis. All the included studies were randomized controlled trials (RCTs). Our study concluded that buddy taping was effective for improving pain, range of motion, and strength. The DASH score and satisfaction score didn't show any significant difference. Thus, we recommend the use of buddy taping rather than plaster and immobilization for the management of uncomplicated closed fifth metacarpal neck fractures.
PubMed: 36176848
DOI: 10.7759/cureus.28437 -
The Journal of Hand Surgery Jan 2017Many techniques exist for simple syndactyly reconstruction. The most commonly used techniques involve either skin grafts or a dorsal metacarpal advancement flap. Our aim... (Comparative Study)
Comparative Study Review
PURPOSE
Many techniques exist for simple syndactyly reconstruction. The most commonly used techniques involve either skin grafts or a dorsal metacarpal advancement flap. Our aim was to review and compare the outcomes of these 2 techniques systematically.
METHODS
We reviewed articles from PubMed, MEDLINE, EMBASE, and Google Scholar published between January 1966 and January 2016. We identified studies that reported outcomes after reconstruction of simple syndactyly using skin grafts and those using only a dorsal metacarpal advancement flap. Cases of complex syndactyly and those that were not clearly differentiated by technique or type of simple syndactyly were excluded. Outcomes were then stratified by technique and type of syndactyly (complete and incomplete).
RESULTS
We identified 693 articles and selected 34 for inclusion. No standardized outcome measure was uniformly applied in the examined studies. Overall, skin grafting procedures were associated with more complications (eg, flap necrosis/graft failure, contracture, web creep, hypertrophic scarring) and a greater need for revision. When stratified by subtype, patients with simple, complete syndactyly who underwent skin grafting had a significantly higher rate of hypertrophic scarring than those who underwent reconstruction with a dorsal metacarpal advancement flap.
CONCLUSIONS
Simple syndactyly reconstruction with a dorsal metacarpal advancement flap may lead to fewer complications than procedures using skin grafts. However, substantial limitations of currently available evidence do not allow for the recommendation of a specific technique. Future research should use a uniform reporting system for syndactyly classification and complications.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Metacarpal Bones; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Syndactyly
PubMed: 28052826
DOI: 10.1016/j.jhsa.2016.11.006 -
Orthopedic Reviews Jun 2020Aneurysmal bone cysts are benign, rare bony tumours frequently observed among children and young adults principally located in the long bones, pelvis, and spine and...
Aneurysmal bone cysts are benign, rare bony tumours frequently observed among children and young adults principally located in the long bones, pelvis, and spine and rarely in other anatomical district such as the hand. We report the case of a 12-year-old girl with an aneurysmal bone cyst, in active stage, involving the still-open epiphysis of the fourth metacarpal of the right hand, which was in a first time treated by curettage, and 3 months later, occurring a recurrence, by a radically excision of the bone and reconstruction with a graft from the iliac crest. At 10-year follow-up the patient had good cosmetic results and a functioning hand. We also performed a systematic Literature review in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.
PubMed: 32913594
DOI: 10.4081/or.2020.8658 -
Medicina (Kaunas, Lithuania) Sep 2021The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer... (Review)
Review
The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10-91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5-39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7-156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Finger Phalanges; Fingers; Humans; Lung Neoplasms; Male; Middle Aged; Prognosis; Young Adult
PubMed: 34577873
DOI: 10.3390/medicina57090950 -
European Journal of Trauma and... Apr 2016Open reduction and internal fixation (ORIF) of single, closed metacarpal shaft fractures is increasingly preferred over closed reduction and percutaneous fixation... (Review)
Review
Open reduction and internal fixation versus percutaneous transverse Kirschner wire fixation for single, closed second to fifth metacarpal shaft fractures: a systematic review.
PURPOSE
Open reduction and internal fixation (ORIF) of single, closed metacarpal shaft fractures is increasingly preferred over closed reduction and percutaneous fixation (K-wire). The aim of this systematic review is to determine whether the preference for ORIF can be substantiated based on the available literature regarding the functional outcome and complications after surgery.
METHODS
A systematic review was performed using a computer-based search on MedLine and Embase, following the preferred reporting items for systematic and meta-analyses guidelines.
RESULTS
Five non-comparative studies were found. Two studies reported on 36 ORIF-treated patients. Three studies reported on 65 K-wire-treated patients. Complications were reported in 8 ORIF-treated patients (22 %) and in 23 K-wire-treated patients (35 %). Functional outcome was generally reported as good for both techniques. Nonetheless functional impairment requiring reoperation was reported in 6 ORIF-treated patients (17 %) and in none of the K-wire-treated patients.
CONCLUSIONS
Although for both techniques good functional outcomes were reported, the significance of the functional impairment after ORIF requiring reoperation suggests ORIF to be a less favorable technique for single, closed metacarpal shaft fractures.
Topics: Bone Wires; Comparative Effectiveness Research; Fracture Fixation, Internal; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones; Open Fracture Reduction; Outcome and Process Assessment, Health Care
PubMed: 26038026
DOI: 10.1007/s00068-015-0507-y