-
European Journal of Trauma and... Oct 2022This study aimed to assess the efficacy of three-dimensional (3D) printing to conventional surgeries in proximal humerus fractures (PHFs). (Meta-Analysis)
Meta-Analysis Review
AIM
This study aimed to assess the efficacy of three-dimensional (3D) printing to conventional surgeries in proximal humerus fractures (PHFs).
METHODS
Eight databases were comprehensively searched for data on clinical characteristics and outcomes, including operation time, time to bone healing, blood loss volume, number of intraoperative fluoroscopies, the reduction rate of anatomic proximal humeri, Constant scores, Neer rating, loss of humeral head height, and complications. These data were compared between 3D printing-assisted versus conventional surgeries to learn the efficacy of 3D printing-assisted surgery.
RESULTS
3D printing-assisted surgery outperformed conventional procedures in operation time, blood loss volume, time to the union of PHFs, number of fluoroscopies, the reduction rate of anatomic proximal humeri, Constant scores, Neer rating, and complications.
CONCLUSION
3D printing-assisted surgery improves operation time, anatomic healing, pain, and motion, with less harm to patients.
Topics: Fluoroscopy; Fracture Fixation, Internal; Humans; Humerus; Printing, Three-Dimensional; Retrospective Studies; Shoulder Fractures; Treatment Outcome
PubMed: 34997257
DOI: 10.1007/s00068-021-01851-5 -
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 -
Journal of Shoulder and Elbow Surgery Aug 2023Reverse shoulder arthroplasty (RSA) has become an increasingly popular treatment option for proximal humerus fractures in the elderly. There is however contradictory... (Meta-Analysis)
Meta-Analysis Review
HYPOTHESIS
Reverse shoulder arthroplasty (RSA) has become an increasingly popular treatment option for proximal humerus fractures in the elderly. There is however contradictory evidence on the impact of timing of RSA on patient outcomes. It remains unclear if poor results after initial nonsurgical or surgical management can be improved with delayed RSA. The aim of this systematic review and meta-analysis is to compare the outcomes of acute RSA and delayed RSA for the treatment of proximal humerus fractures in the elderly.
MATERIALS AND METHODS
A systematic search was performed on 4 databases for studies that compared acute RSA with RSA used after prior nonoperative or operative treatment. Studies with a mean cohort age of <65 years were excluded. Demographical data, clinical outcome scores, range of motion measurements, and postoperative complications were collected from the included studies.
RESULTS
Sixteen studies were included for data analysis. Compared with delayed RSA cohorts, acute RSA cohorts had higher forward flexion (124.3° vs. 114.9°; P = .019), external rotation (24.7° vs. 20.2°; P = .041), and abduction (113.2° vs. 99.8°; P = .03). Compared with RSA after conservative management, acute RSA had greater external rotation (29.9° vs. 21.4°; P = .043). The acute RSA cohort had significantly higher American Shoulder and Elbow Surgeons (76.4 vs. 68.2; P = .025) and Constant-Murley scores (65.6 vs. 57.3; P = .002) compared with the delayed RSA cohort. Subgroup analyses showed significantly greater Constant-Murley (64.9 vs. 56.9; P = .020) and Simple Shoulder Test scores (8.8 vs. 6.8; P = .031) with acute RSA compared with RSA after conservative treatment. The American Shoulder and Elbow Surgeons score was higher in the acute RSA cohort compared with RSA after open reduction internal fixation (77.9 vs. 63.5; P = .008). The overall complication rate per 100 patient-years was 11.7 for the acute RSA cohort and 18.5 for the delayed RSA cohort (risk ratio: 0.55; P = .015).
CONCLUSION
Based on the current evidence, acute RSA presents better clinical outcome measures and range of motion measurements, with decreased complication rates than RSA performed after prior nonoperative or operative treatment.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Shoulder; Shoulder Joint; Shoulder Fractures; Treatment Outcome; Range of Motion, Articular; Humeral Fractures; Retrospective Studies
PubMed: 37024039
DOI: 10.1016/j.jse.2023.03.006 -
Journal of Neurosurgery. Spine Jul 2023Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK.
METHODS
A systematic literature search was performed using PubMed and Web of Science keywords of "Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]" AND "Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score.
RESULTS
A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of -0.69 (95% CI -0.88 to -0.50; I2 = 63.9%, p < 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference -32.35, 95% CI -46.05 to -18.65; I2 = 28.7%, p < 0.001).
CONCLUSIONS
This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.
Topics: Humans; Adult; Retrospective Studies; Bone Density; Thoracic Vertebrae; Spinal Fusion; Postoperative Complications; Kyphosis; Risk Factors
PubMed: 37029673
DOI: 10.3171/2023.2.SPINE221101 -
Journal of the National Cancer Institute Oct 2012Although there is convincing epidemiological evidence that physical activity is associated with a reduced risk of colon cancer, it is unclear whether physical activity... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although there is convincing epidemiological evidence that physical activity is associated with a reduced risk of colon cancer, it is unclear whether physical activity is differentially associated with the risks of proximal colon and distal colon cancers. We conducted a systematic review and meta-analysis to investigate this issue.
METHODS
MEDLINE and EMBASE were searched for English-language cohort and case-control studies that examined associations between physical activity and the risks of proximal colon and distal colon cancers. A random-effects meta-analysis was conducted to estimate the summary relative risks (RRs) for the associations between physical activity and the risks of the two cancers. All statistical tests were two-sided.
RESULTS
A total of 21 studies met the inclusion criteria. The summary relative risk of the main results from these studies indicated that the risk of proximal colon cancer was 27% lower among the most physically active people compared with the least active people (RR = 0.73, 95% confidence interval [CI] = 0.66 to 0.81). An almost identical result was found for distal colon cancer (RR = 0.74, 95% CI = 0.68 to 0.80).
CONCLUSION
The results of this systematic review and meta-analysis suggest that physical activity is associated with a reduced risk of both proximal colon and distal colon cancers, and that the magnitude of the association does not differ by subsite. Given this finding, future research on physical activity and colon cancer should focus on other aspects of the association that remain unclear, such as whether sedentary behavior and nonaerobic physical activity are associated with the risk of colon cancer.
Topics: Bias; Colonic Neoplasms; Female; Humans; Incidence; Male; Motor Activity; Physical Exertion; Risk Assessment; Risk Factors
PubMed: 22914790
DOI: 10.1093/jnci/djs354 -
Journal of Dentistry Aug 2015This systematic review aimed at evaluating the accuracy of radiographic caries detection for different lesions at different locations. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review aimed at evaluating the accuracy of radiographic caries detection for different lesions at different locations.
DATA
Studies reporting on the accuracy (sensitivity/specificity) of radiographic detection of natural primary caries lesions under clinical or in vitro conditions were included. Risk of bias was assessed using QUADAS-2. Pooled sensitivity, specificity and diagnostic odds ratios (DORs) were calculated using random-effects meta-analysis. Analyses were performed separately for occlusal and proximal lesions, with further discrimination between any kind of lesions, dentine lesions, and cavitated lesions.
SOURCES
Electronic databases (Medline, Embase, Cochrane Central) and grey literature were systematically searched, complemented by cross-referencing from bibliographies.
STUDY SELECTION
From 947 identified articles, 442 were analyzed full-text. 117 studies (13,375 teeth, 19,108 surfaces) were included, the majority of them reporting on permanent teeth and having high risk of bias. The detection of any kind (i.e. also initial) lesions had low sensitivities (pooled DOR [95% CI]: 0.24 [0.21/0.26] to 0.42 [0.31/0.34]), but moderate to high specificities (0.70 [0.76/0.84] to 0.97 [0.95/0.98]). For dentine lesions, sensitivities were higher (from 0.36 [0.24/0.49] for proximal to 0.56 [0.53/0.59] for occlusal lesions), and specificities ranged between 0.87 [0.85/0.89] and 0.95 [0.94/0.96]. No studies reported on cavitated occlusal lesions, whilst for cavitated proximal lesions, sensitivities increased above 0.60, whilst sensitivities remained high (above 0.90).
CONCLUSIONS
Radiographic caries detection is highly accurate for cavitated proximal lesions, and seems also suitable to detect dentine caries lesions. For detecting initial lesions, more sensitive methods could be considered in population with high caries risk and prevalence.
CLINICAL SIGNIFICANCE
Radiographic caries detection is especially suitable for detecting more advanced caries lesions, and has limited risks for false positive diagnoses. For groups with high caries risk and prevalence, alternative detection methods with higher sensitivity for initial lesions might be considered.
Topics: Dental Caries; Humans; Radiography, Dental; Sensitivity and Specificity
PubMed: 25724114
DOI: 10.1016/j.jdent.2015.02.009 -
BMC Oral Health Jan 2021Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.
METHODS
Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings.
RESULTS
In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15-0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18-0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20-0.45; permanent dentition: OR = 0.20, 95% CI 0.14-0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14-0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01-8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08-0.72; low to moderate risk: OR = 0.38, 95% CI 0.18-0.81; moderate to high risk: OR = 0.17, 95% CI 0.10-0.29; and high risk: OR = 0.14, 95% CI 0.07-0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01-8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08-0.72; low to moderate risk: OR = 0.38, 95% CI 0.18-0.81; moderate to high risk: OR = 0.20, 95% CI 0.10-0.39; and high risk: OR = 0.14, 95% CI 0.05-0.37).
CONCLUSION
Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.
Topics: Databases, Factual; Dental Caries; Dentition, Permanent; Humans; Pit and Fissure Sealants; Tooth, Deciduous
PubMed: 33413327
DOI: 10.1186/s12903-020-01364-4 -
Journal of Reconstructive Microsurgery Jun 2018Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed... (Review)
Review
BACKGROUND
Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed outcomes when performing anastomoses distal to the zone of injury. We investigated the impact of recipient vessel location on free flap outcomes.
METHODS
Retrospective review (1979-2016); 312 soft tissue free flaps for open tibia fractures met inclusion criteria. Flap characteristics and perioperative outcomes were examined. Systematic review identified articles evaluating anastomosis location and flap outcomes; pooled data analysis was performed.
RESULTS
More anastomoses were performed proximal to the zone of injury (80.7%) than distal (19.3%). Distal anastomoses were not associated with increased take back rates (19.6%) compared with proximal (23.8%) anastomoses ( = 0.356). Regression analysis comparing proximal and distal anastomoses found no difference in partial flap failures (7.4% vs 11.9%; = 0.978) or total flap failures (9.3% vs 9.3%; = 0.815) when controlling for the presence of arterial injury, flap type, and time from injury to coverage. Systematic review yielded 11 articles with 1,245 proximal and 127 distal anastomoses for comparison. Pooled analysis ( = 0.58) and weighted comparative analysis ( = 0.39) found no difference in flap failure rates between proximal and distal groups.
CONCLUSION
Our results are congruent with the current lower extremity literature and demonstrate no difference in perioperative complication rates between anastomoses performed proximal or distal to the zone of injury. These findings suggest that anastomotic location choice should be based primarily on recipient vessel quality/flow and ease of access/exposure rather than orientation relative to the zone of injury.
Topics: Adult; Aged; Anastomosis, Surgical; Female; Follow-Up Studies; Fractures, Open; Free Tissue Flaps; Graft Survival; Humans; Injury Severity Score; Leg Injuries; Limb Salvage; Male; Microsurgery; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Risk Assessment; Tibial Fractures; Wound Healing
PubMed: 29625505
DOI: 10.1055/s-0037-1621746 -
Journal of Shoulder and Elbow Surgery Oct 2022The treatment of proximal humerus fracture dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of... (Review)
Review
BACKGROUND
The treatment of proximal humerus fracture dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of devascularization of the humeral head often seen in these injuries. The purpose of this study is to undertake a systematic review of the literature on the functional outcomes, rate of revision, and short- and long-term complications for proximal humerus fracture dislocations treated with open reduction and internal fixation (ORIF).
METHODS
The PubMed and OVID Embase databases were queried for literature reporting on proximal humerus fracture dislocations treated with ORIF. Data including study design, patient demographics, functional outcomes, and complications were recorded.
RESULTS
Twelve studies including 294 patients with Neer type 2-, 3-, or 4-part proximal humerus fracture dislocations met the criteria for inclusion. The mean patient age was 53.4 years (19-89 years) with an average follow-up of 2.9 years (1.15-4.9 years). At the final follow-up, the mean Constant score was 73.2 (52-87.3) and the mean Disabilities of the Arm Shoulder and Hand score was 26.6 (17.5-32). Avascular necrosis was observed in 20.0% (0%-82.3%) and nonunion was observed in 3.0% (0%-7.7%) of patients. Conversion to arthroplasty was observed in 10.7% (5%-20%) and a total reoperation was observed in 35.6% (11.8%-89.1%) of patients in studies explicitly reporting these outcomes. In addition to conversion to arthroplasty, common causes of reoperation were revision ORIF (5.2%) and hardware removal (22.2%).
CONCLUSION
Patients undergoing ORIF for proximal humerus fracture dislocations have reasonable functional outcomes but relatively high avascular necrosis and reoperation rates. This information can be used to counsel patients and set expectations about the potential for further surgeries.
Topics: Fracture Dislocation; Fracture Fixation, Internal; Humans; Humerus; Joint Dislocations; Middle Aged; Necrosis; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 35605847
DOI: 10.1016/j.jse.2022.04.018 -
Orthopaedic Journal of Sports Medicine Dec 2023While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding... (Review)
Review
BACKGROUND
While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears.
PURPOSE
To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included "anterior closing wedge osteotomy,""anterior closing wedge tibial osteotomy,""anterior closing wedge proximal tibial osteotomy,""anterior cruciate ligament," and "revision anterior cruciate ligament." Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates.
RESULTS
A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears.
CONCLUSION
The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.
PubMed: 38107842
DOI: 10.1177/23259671231210549