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Medicine Nov 2019Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as... (Meta-Analysis)
Meta-Analysis
BACKGROUNDS
Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as an alternative method of detecting hand fractures. In this study, we used meta-analysis to assess the diagnostic value of ultrasound for hand fractures.
METHODS
Web of Science, PubMed, Embase, and Cochrane Library databases were searched for relative citations up to June 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC), and summary receiver operating characteristic (SROC) curve were estimated.
RESULTS
Seven studies including 842 participants (845 examined hands) met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of ultrasound for detecting hand fractures were 91%, 96%, 20.66, and 0.09, respectively. The pooled DOR was 231.17, indicating a very powerful diagnostic ability of ultrasound. Meta-regression showed that there was no heterogeneity with respect to age, cut-off, the performer of the ultrasound, and the types of hand fractures.
CONCLUSIONS
Our results showed that ultrasound had an excellent diagnostic value for hand fractures. In clinic, we proposed using ultrasound as a first-line and radiation-free modality in detecting hand fractures, including phalanx and metacarpal fractures.
Topics: Finger Phalanges; Fractures, Bone; Humans; Metacarpal Bones; Ultrasonography
PubMed: 31689869
DOI: 10.1097/MD.0000000000017823 -
International Journal of Clinical... Dec 2021Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the...
OBJECTIVES
Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesise the evidence on these practices.
METHODS
We searched four databases for systematic reviews, randomised controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomised studies of interventions tool for observational studies. We summarised findings with measures of frequency and association for primary outcomes.
RESULTS
Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients <60 years of age, cast or splint immobilisation for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias.
CONCLUSION
In this review, we identified clinical practices in orthopaedic injury care which are not supported by current evidence and whose use may be questioned. In future research, we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.
Topics: Adult; Delivery of Health Care; Fractures, Bone; Humans; Orthopedics; Wrist Injuries
PubMed: 34816530
DOI: 10.1111/ijcp.15009 -
Plastic and Reconstructive Surgery Jan 2024The aim of this systematic literature review was to describe current indications and interventions for revisions after trapeziometacarpal joint (TMJ) resection...
BACKGROUND
The aim of this systematic literature review was to describe current indications and interventions for revisions after trapeziometacarpal joint (TMJ) resection arthroplasty.
METHODS
The literature search was conducted by an experienced librarian in the Medline, EMBASE, Cochrane Library, Web of Science and Scopus databases. We included all articles that investigated any TMJ arthroplasty procedure in which the trapezium was completely resected and if any subsequent revision procedure including joint-related and soft-tissue surgeries was mentioned. Two independent reviewers selected the articles and were involved in data extraction.
RESULTS
Sixty-two articles reporting on 5,284 operated thumbs and 434 revision surgeries were included. We extracted 24 indications for revision and 31 revision techniques. Most revisions were performed because of subsidence/impingement of the first metacarpal bone (n=194 thumbs) followed by unspecified pain (n=53), metacarpophalangeal joint problems (n=28) and scaphotrapezoidal osteoarthritis (n=17). Eleven treatment strategies were found for subsidence/impingement of the first metacarpal, the most frequent being revision of the existing interposition using autologous tendon (n=46) and soft tissue interposition with distraction pinning (n=28).
CONCLUSIONS
There are a wide variety of indications and even more surgical techniques described in the literature to treat persisting or recurrent pain after TMJ resection arthroplasty. Currently, there is no uniform treatment guideline available how to diagnose and treat such cases. Therefore, the results of this literature review will form the basis for a Delphi study aiming to develop recommendations for the diagnosis and treatment of persistent / recurrent pain after TMJ resection arthroplasty.
LEVEL OF EVIDENCE
IV.
PubMed: 38289903
DOI: 10.1097/PRS.0000000000011323 -
Hand (New York, N.Y.) Jan 2019Despite the proven efficacy and advantages of absorbable implants, their use for metacarpal shaft fixation has been limited. This is likely due to the high reported...
BACKGROUND
Despite the proven efficacy and advantages of absorbable implants, their use for metacarpal shaft fixation has been limited. This is likely due to the high reported complication rates in early studies with polyglycolic acid (PGA) implants, notably high rates of noninfectious inflammatory reaction (5%-25%), occurring up to 30 weeks after fixation. The objective of this study was to assess the clinical outcomes of newer absorbable plates and screws in the treatment of metacarpal shaft fractures.
METHODS
The authors performed a systematic search of the PubMed, Ovid MEDLINE, and EMBASE databases dating from 1946 to 2017. Primary outcome measures were the development of noninfectious inflammatory reaction and implant failure.
RESULTS
A total of 42 metacarpal shaft fractures in 35 patients were included. The average follow-up time was 20.4 months (n = 24; range: 3.6-61 months). Only 1 case (2.4%) of noninfectious inflammatory reaction was reported with polylactic acid (PLA) plates and PLA/PGA compounds. Noninfectious inflammatory reaction was observed in 4 out of the 9 patients (44.4%) with a trimethylene carbonate/PLA compound. Symptoms appeared after an average time of 15.8 months (range: 12-19 months) post-fixation. Painless prolonged inflammation that resolved spontaneously within 6 months was reported in 7.1% of cases (n = 3). Implant failure with loss of fracture reduction was reported in 9.5% of cases (n = 4).
CONCLUSIONS
Newer absorbable materials appear to have significantly lower rates of noninfectious inflammatory reaction than previously reported. When compared with metallic fixation of the metacarpal shaft, absorbable fixation appears to have comparable complication rates and biomechanical properties.
Topics: Absorbable Implants; Device Removal; Dioxanes; Disability Evaluation; Fracture Fixation, Internal; Fractures, Bone; Hand Strength; Humans; Inflammation; Metacarpal Bones; Polyesters; Polyglycolic Acid; Postoperative Complications
PubMed: 30239220
DOI: 10.1177/1558944718798856 -
Journal of Biological Regulators and... Dec 2017Osteoarthritis (OA) of the base of the thumb, also known as Trapezio-Metacarpal (TM) OA, is a disabling condition, which mainly affects women and manual workers. When TM...
Osteoarthritis (OA) of the base of the thumb, also known as Trapezio-Metacarpal (TM) OA, is a disabling condition, which mainly affects women and manual workers. When TM OA is not adequately treated, patients develop deformity and loss of function of the thumb. The surgical approach is a widespread strategy to treat this condition, but there is still no consensus on the most effective procedure. Therefore, several conservative strategies are commonly used, such as nonsteroidal anti-inflammatory drugs (NSAIDs) administration, thumb strengthening exercise, splinting, steroid (CS) and hyaluronic acid (HA) intrarticular injections. The present review of the literature aims to summarize the available scientific evidence on the treatment of TM OA with injections of HA. Thirteen studies were included: 7 randomized controlled trials, 5 case series and a case-control study. Among these, 5 studies compared HA versus CS injection. Results from most of them reported better outcomes with HA injections in terms of function (strength) and joint motion, while CS injections had greater effect on pain; moreover, CS action was faster but shorter, while HA required more time to obtain a therapeutic benefit and lasted longer. In non-comparative articles, this trend was also confirmed. Indeed, the authors reported an improvement in pain relief up to six months. Similarly, all studies indicated hand function improvement over time, measured though DASH score, pincher and grip strength tests. Available data from included studies show that there is no clear evidence to suggest a treatment with HA injections as the best advisable non-operative treatment for TM OA. However, promising potentials were shown by the randomized controlled trials, suggesting that there is some benefit and less comorbidities with the administration of HA. Further research, such as trials evaluating larger cohorts with validated scores for long-term follow-up, is still necessary.
Topics: Case-Control Studies; Humans; Hyaluronic Acid; Injections, Intra-Articular; Metacarpal Bones; Osteoarthritis; Randomized Controlled Trials as Topic; Superficial Back Muscles
PubMed: 29202562
DOI: No ID Found -
Plastic and Reconstructive Surgery Apr 2019Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intramedullary fixation of a comminuted subcapital metacarpal fracture using a headless compression screw was first described in 2010. The purpose of this study was to identify and evaluate all studies reporting clinical outcomes of intramedullary screw fixation of metacarpal fractures.
METHODS
A comprehensive search of the literature was performed under Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify all relevant studies. Outcome measures included mean follow-up, evidence of radiographic union, functional outcomes, and quality-of-life measures.
RESULTS
Nine articles for a total of 169 metacarpal fractures were identified. Average patient age was 32 years; 86.5 percent of the patients were men; and the majority of fractures occurred in the small finger (74 percent). Most fractures occurred in the neck (n = 66), followed by shaft (n = 31) and head (n = 10). The average follow-up was 11 months, with an average metacarpophalangeal joint flexion of 86 degrees (n = 83) and digit total active motion of 251 degrees (n = 72). Radiographic union was achieved in 100% of reported cases (n = 132) at or before the latest follow-up. Grip strength in four studies showed an average of 96 percent compared to the contralateral hand. No serious complications were reported. Nine minor complications were reported, including four cases of hardware removal in asymptomatic patients.
CONCLUSION
The review of the literature suggests intramedullary fixation of metacarpal neck and shaft fractures using headless compression screws has thus far proven to be a safe and successful surgical treatment option resulting in excellent clinical outcomes.
Topics: Adult; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Hand Injuries; Humans; Male; Metacarpal Bones; Metacarpophalangeal Joint
PubMed: 30676504
DOI: 10.1097/PRS.0000000000005478 -
Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review.The Journal of Hand Surgery, European... Jun 2018Fracture-dislocations of the carpometacarpal joint (CMCJ) of the little ray involve dorsal subluxation of the metacarpal base and they may be associated with injury of...
Fracture-dislocations of the carpometacarpal joint (CMCJ) of the little ray involve dorsal subluxation of the metacarpal base and they may be associated with injury of neighbouring CMCJs. Different treatment options are described, with no clear consensus on their management. This study presents a systematic review of comparative studies describing the management of these injuries. A bespoke search strategy was applied across multiple databases. Results were screened against specified stepwise inclusion criteria and data were extracted independently by two authors with discrepancy resolution by a third. Of 437 search results, six comparative studies were identified. Comparisons included non-operative or early mobilization versus fixation K-wires or open reduction and internal fixation. Conclusions were mixed; all studies had critical or significant risks of bias (using the ROBINS-I tool) and there was heterogeneity between studies.
Topics: Carpometacarpal Joints; Fracture Dislocation; Fracture Fixation, Internal; Humans
PubMed: 29411672
DOI: 10.1177/1753193417752317 -
The Journal of Hand Surgery, European... Jan 2021Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the...
Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.
Topics: Adult; Fracture Fixation, Internal; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones; Prospective Studies
PubMed: 33135525
DOI: 10.1177/1753193420968040