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Journal of Shoulder and Elbow Surgery Apr 2022To date, no meta-analysis has been performed on the efficacy of fibular allograft augmentation for the management of proximal humerus fractures. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients: a systematic review and meta-analysis.
BACKGROUND
To date, no meta-analysis has been performed on the efficacy of fibular allograft augmentation for the management of proximal humerus fractures. The purpose of this study was to evaluate the radiographic and clinical outcomes of proximal humerus fractures treated with a locking compression plate (LCP) with or without fibular allograft augmentation.
METHODS
The Cochrane Database of Systematic Reviews, the Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, and SCOPUS were queried in June of 2021 for literature comparing the radiographic and clinical outcomes for patients with proximal humerus fractures that were treated with an LCP only or an LCP augmented with a fibular allograft. Data describing study design, level of evidence, demographic information, final follow-up, radiographic changes in humeral head height (HHH), radiographic changes in neck shaft angle (NSA), final American Shoulder and Elbow Surgeons (ASES) scores, final Constant-Murley scores, and major complications were collected. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A meta-analysis was performed using pooled weighted mean differences (WMD) to compare changes in HHH, NSA, final ASES and final Constant-Murley scores between the 2 groups; a pooled odds ratio (OR) was used to compare complications between the groups.
RESULTS
Ten studies with a total of 802 patients were identified. There was a significant difference that favored patients augmented with a fibular allograft for change in HHH (WMD = -2.40; 95% confidence interval [CI], -2.49 to -2.31; P < .00001), change in NSA (WMD = -5.71; 95% CI, -6.69 to -4.72; P < .00001), final ASES scores (WMD = 5.08; 95% CI, 3.69-6.48; P < .00001), and OR for developing a major complication (OR = 0.37; 95% CI, 0.23-0.59; P < .0001). There was no significant difference in final Constant-Murley scores (WMD = 3.36; 95% CI, -0.21 to 6.93; P = .06) or revision surgery rate (P = .182) between the 2 groups.
CONCLUSION
The pooled WMD and prediction interval suggest that 95% of patients with proximal humerus fractures treated with an LCP augmented with a fibular allograft will have improved radiographic outcomes, improved ASES clinical outcome scores, and decreased odds of a major complication when compared with patients treated with an LCP alone. Limitations of this study include a relatively short average final follow-up time (<2 years) and a potential lack of standardization for radiographic outcomes among included studies.
Topics: Aged; Allografts; Bone Plates; Fracture Fixation, Internal; Humans; Humeral Head; Open Fracture Reduction; Retrospective Studies; Shoulder; Shoulder Fractures; Treatment Outcome
PubMed: 34906682
DOI: 10.1016/j.jse.2021.11.004 -
Journal of Shoulder and Elbow Surgery Aug 2018There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
Operative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials.
BACKGROUND
There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies.
METHODS
The databases of MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched on September 5, 2017, for studies comparing operative versus nonoperative treatment of proximal humeral fractures; both RCTs and observational studies were included. The criteria of the Methodological Index for Non-Randomized Studies, a validated instrument for methodologic quality assessment, were used to assess study quality. The primary outcome measure was physical function as measured by the absolute Constant-Murley score after operative or nonoperative treatment. Secondary outcome measures were major reinterventions, nonunion, and avascular necrosis.
RESULTS
We included 22 studies, comprising 7 RCTs and 15 observational studies, resulting in 1743 patients in total: 910 treated operatively and 833 nonoperatively. The average age was 68.3 years, and 75% of patients were women. There was no difference in functional outcome between operative and nonoperative treatment, with a mean difference of -0.87 (95% confidence interval, -5.13 to 3.38; P = .69; I = 69%). Major reinterventions occurred more often in the operative group. Pooled effects of RCTs were similar to pooled effects of observational studies for all outcome measures.
CONCLUSIONS
We recommend nonoperative treatment for the average elderly patient (aged > 65 years) with a displaced proximal humeral fracture. Pooled effects of observational studies were similar to those of RCTs, and including observational studies led to more generalizable conclusions.
Topics: Arthroplasty; Fracture Fixation; Fracture Healing; Fractures, Ununited; Humans; Immobilization; Osteonecrosis; Randomized Controlled Trials as Topic; Reoperation; Shoulder Fractures
PubMed: 29735376
DOI: 10.1016/j.jse.2018.03.009 -
Stroke Sep 2016After the demonstration of efficacy of bridging therapy, reliably predicting early recanalization (ER; ≤3 hours after start of intravenous thrombolysis) would be... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
After the demonstration of efficacy of bridging therapy, reliably predicting early recanalization (ER; ≤3 hours after start of intravenous thrombolysis) would be essential to limit futile, resource-consuming, interhospital transfers. We present the first systematic review on the incidence and predictors of ER after intravenous thrombolysis alone.
METHODS
We systematically searched for studies including patients solely treated by intravenous thrombolysis that reported incidence of ER and its association with baseline variables. Using meta-analyses, we estimated pooled incidence of ER, including according to occlusion site, and summarized the available evidence regarding predictors of no-ER.
RESULTS
We identified 26 studies that together included 2063 patients. The overall incidence of partial or complete ER was 33% (95% confidence interval, 27-40). It varied according to occlusion site: 52% (39-64) for distal middle cerebral artery, 35% (28-42) for proximal middle cerebral artery, 13% (6-22) for intracranial carotid artery, and 13% (0-35) for basilar occlusion. Corresponding rates for complete ER were 38% (22-54), 21% (15-29), 4% (1-8), and 4% (0-22), respectively. Proximal occlusion and higher National Institute of Health Stroke Scale were the most consistent no-ER predictors. Other factors, such as long or totally occlusive thrombus and poor collateral circulation, emerged as potential predictors but will need confirmation.
CONCLUSION
The overall incidence of ER after intravenous thrombolysis is substantial, highlighting the importance of reliably predicting ER to limit futile, interhospital transfers. Incidence of no-ER is particularly high for proximal occlusion and severe strokes. Given the scarcity of published data, further studies are needed to improve no-ER prediction accuracy.
Topics: Administration, Intravenous; Angiography, Digital Subtraction; Brain; Brain Ischemia; Fibrinolytic Agents; Humans; Magnetic Resonance Angiography; Neuroimaging; Stroke; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 27462117
DOI: 10.1161/STROKEAHA.116.014181 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Recently, there has been a series of clinical studies focusing on the perioperative administration of tranexamic acid (TXA) in geriatric trauma patients undergoing... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recently, there has been a series of clinical studies focusing on the perioperative administration of tranexamic acid (TXA) in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery. However, the safety and efficacy of TXA in these patients remains controversial. Therefore, we performed a systematic review to focus on two questions: (1) would TXA reduce perioperative blood loss in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery? and (2) would TXA increase the rate of perioperative complications in geriatric trauma patients undergoing proximal femoral intramedullary nail surgery?
PATIENTS AND METHODS
We systematically searched electronic databases (MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials) up to April 20, 2019. The perioperative blood loss and complication data were extracted and analysed by RevMan Manager 5.3.
RESULTS
Finally, five randomized controlled studies, involving 539 geriatric intertrochanteric fracture patients undergoing proximal femoral intramedullary nail surgery, were enrolled in this systematic review. Compared with the control group, the TXA group had significantly lower total perioperative blood loss (WMD=-172.84; 95% CI, -241.44 to -104.24; I=0%), intraoperative blood loss (WMD=-34.20; 95% CI, -46.04 to -22.36; I=0%), total perioperative hidden blood loss (WMD=-139.05; 95% CI, -213.67 to -64.43; I=0%), perioperative transfusion rates (RR =-0.16; 95% CI, -0.24 to -0.08; I=22%), length of hospital stay (WMD=-1.18; 95% CI, -1.91 to -0.46; p=0.001; I2=12%), and postoperative wound haematoma rates (RD=-0.05; 95% CI, -0.09 to 0.00; p=0.03; I=0%). In addition, there were no significant differences between TXA and control groups in the terms of surgical time, postoperative mortality, total thromboembolic events, wound infections, cerebrovascular accidents, respiratory infections, and renal failure.
DISCUSSION
TXA in geriatric trauma patients undergoing intramedullary nail surgery is effective for perioperative haemostasis without increasing the incidence of postoperative complications.
LEVEL OF EVIDENCE
II, Systematic review and Meta-analysis.
Topics: Aged; Antifibrinolytic Agents; Blood Loss, Surgical; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Tranexamic Acid
PubMed: 31928976
DOI: 10.1016/j.otsr.2019.10.015 -
Injury Apr 2011Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of specially contoured proximal humerus locking... (Review)
Review
PURPOSE
Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of specially contoured proximal humerus locking plates. The purpose of this study is to evaluate the short to medium term functional results and common complications associated with the fixation of proximal humerus fractures with locking plates.
METHODS
The PubMed and EMBASE databases were used to perform a systematic review of the English literature to assess the functional results and complications associated with proximal humerus locking plates. Our inclusion criteria were proximal humerus fracture due to trauma (excluding pathologic fractures), patients greater than 18 years of age, more than 15 patients in the study or subgroup of interest, at least 18 months follow-up, at least one relevant functional outcome score, and quality outcome score of at least 5/10. Studies that did not meet these criteria were excluded. All institutional, author, and journal information was concealed to minimize reviewer bias.
RESULTS
Twelve studies including 514 patients met the inclusion criteria. At most recent follow-up patients achieved a mean Constant score of 74 and a mean DASH score of 27. The overall rate of complications was 49% including varus malunion, 33% excluding varus malunion, and reoperation rate was 14%. The most common complications included varus malunion 16%, AVN 10%, screw perforation of the humeral head into the joint 8%, subacromial impingement 6%, and infection 4%.
DISCUSSION
Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. Further study is needed to determine what technical errors and patient characteristics are risk factors for failure of this now common fixation technique.
Topics: Adult; Bone Plates; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Postoperative Complications; Shoulder Fractures; Treatment Outcome
PubMed: 21176833
DOI: 10.1016/j.injury.2010.11.058 -
Orthopaedic Journal of Sports Medicine Jan 2023Characteristics regarding mechanism of injury, management, and return-to-play (RTP) rate and timing are important when treating and counseling athletes with rectus... (Review)
Review
BACKGROUND
Characteristics regarding mechanism of injury, management, and return-to-play (RTP) rate and timing are important when treating and counseling athletes with rectus femoris tears.
PURPOSE
To systematically review the literature to better understand the prevalence, sporting activity, injury mechanisms, and treatment of patients with rectus femoris injury and to provide prognostic information regarding the rate and timing of RTP.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we queried PubMed/MEDLINE, Cochrane, OVID, EMBASE, and Google Scholar in March 2022 for studies reporting on athletes sustaining isolated, full-thickness tearing, or bony avulsion injuries to the proximal rectus femoris during sporting activity. Excluded were studies without evidence of full-thickness tearing or avulsion, with athletes sustaining concomitant injuries, or with injuries occurring from nonsporting activities. The percentage of athletes sustaining injuries was calculated based on sport, injury mechanism, and management (nonoperative versus operative).
RESULTS
Of 132 studies initially identified, 18 were included, comprising 132 athletes (mean age, 24.0 ± 5.4 years; range, 12-43 years). The most common sporting activities were soccer (70.5%) and rugby (15.2%). The most reported mechanisms of injury were kicking (47.6%) and excessive knee flexion/forced hip extension (42.9%). Avulsion injuries were reported in 86% (n = 114) of athletes. Nonoperative management was reported in 19.7% of athletes, with operative management performed in 80.3%. The mean follow-up time was 21.4 ± 11.4 months (range, 1.5-48 months). The RTP rate was 93.3% (n = 14) in nonoperatively treated and 100% (n = 106) in operatively treated athletes, and the mean RTP time was 11.7 weeks (range, 5.5-15.2 weeks) in nonoperatively treated and 22.1 weeks (range, 14.0-37.6 weeks) in operatively treated athletes. Complications were reported in 7.7% (2/26) of nonoperatively treated and 18% (n = 19/106) of operatively treated athletes.
CONCLUSION
Full-thickness proximal rectus femoris injuries occurred most frequently in athletes participating in soccer and rugby secondary to explosive, eccentric contractions involved in kicking and sprinting. Operative management was performed in the majority of cases. Athletes who underwent operative repair had a 100% RTP rate versus 93.3% in athletes treated nonoperatively.
PubMed: 36743725
DOI: 10.1177/23259671221144984 -
Obstetrical & Gynecological Survey Jan 2015The objective of this study was to conduct a systematic review of studies comparing the pregnancy outcomes in hydrosalpinx patients treated with salpingectomy versus... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective of this study was to conduct a systematic review of studies comparing the pregnancy outcomes in hydrosalpinx patients treated with salpingectomy versus those treated with proximal tubal occlusion prior to in vitro fertilization (IVF).
DATA SOURCES
An extensive PubMed literature search was performed for the period from 1980 to December 2013 using combinations of the following keywords: "hydrosalpinx," "salpingectomy," and "tubal occlusion."
METHODS OF THE STUDY SELECTION
Initially, 204 relevant studies were identified from MEDLINE and screened for retrieval. All of the randomized controlled trials comparing ovarian response and the pregnancy outcome of salpingectomy and proximal tubal occlusion for hydrosalpinx patients prior to IVF were considered eligible for analysis.
TABULATION, INTEGRATION, AND RESULTS
Two investigators independently reviewed the studies. The data were pooled, and the mean standard difference (SD) was calculated. Eligible randomized controlled trials were selected for this meta-analysis. There were no differences in the response days to controlled ovarian hyperstimulation (SD = -1.112, SE = 0.973, Z = -1.14, P = 0.253), number of oocytes retrieved (SD = 0.404, SE = 0.311, Z = 1.300, P = 0.194), embryos transferred per cycle (SD = -0.757, SE = 0.568, Z = -1.332, P = 0.183), and fertilized oocytes (SD = -0.006, SE = 0.130, Z = -0.045, P = 0.964) between the patients receiving salpingectomy and proximal tubal occlusion. The pooled rates for clinical pregnancy (odds ratio, 0.864; 95% confidence interval, 0.534-1.398; Z = -0.596, P = 0.551) and implantation (odds ratio, 1.558; 95% confidence interval, 0.809-3.003; Z = 1.325, P = 0.185) were not significantly different between the hydrosalpinx patients with salpingectomy versus proximal tubal occlusion.
CONCLUSIONS
Similar responses to controlled ovarian hyperstimulation and pregnancy outcome were observed in patients treated with salpingectomy or proximal tubal occlusion.
Topics: Adult; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Ovulation Induction; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic; Salpingectomy; Sterilization, Tubal
PubMed: 25616345
DOI: 10.1097/OGX.0000000000000139 -
Journal of Orthopaedic Surgery and... Mar 2018Intertrochanteric hip fractures are common and devastating injuries especially for the elderly. Surgical treatment is the optimal strategy for managing intertrochanteric... (Comparative Study)
Comparative Study Meta-Analysis Review
Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures.
BACKGROUND
Intertrochanteric hip fractures are common and devastating injuries especially for the elderly. Surgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows early rehabilitation and functional recovery. The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain limited to relatively small studies which create uncertainty in attempts to establish evidence-based best practice.
METHODS
We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies to assess the clinical effectiveness of two commonly used intramedullary devices: a twin screw integrated cephalomedullary nail (InterTAN) versus a single screw cephalomedullary nail (proximal femoral nail antirotation) in patients with intertrochanteric fractures. The following outcomes were considered: revisions, implant-related failures, non-unions, pain, Harris Hip Score and intraoperative outcomes. Odds ratios or mean differences with 95% confidence intervals in brackets are reported.
RESULTS
Six studies met the inclusion criteria, two randomised controlled trials and four observational studies enrolling 970 patients with mean age of 77 years, and 64% of patients were female. There was a statistically significant difference (p value < 0.05) for revisions OR 0.27 (0.13 to 0.56), implant-related failures OR 0.16 (0.09 to 0.27) and proportion of patients complaining of pain OR 0.50 (0.34 to 0.74). There was no difference in non-unions and Harris Hip Score (p value > 0.05). There was a significant difference in blood loss and fluoroscopy usage in favour of PFNA, whilst no difference in operating times were observed between the two devices.
CONCLUSIONS
Our meta-analysis suggests that a twin screw integrated cephalomedullary nail InterTAN is clinically more effective when compared to a single screw cephalomedullary nail proximal femoral nail antirotation resulting in fewer complications, fewer revisions and fewer patients complaining of pain. No difference has been established regarding non-unions and Harris Hip Score. Intraoperative outcomes favour PFNA with less blood loss and fluoroscopy usage. Further studies are warranted to explore the cost-effectiveness of these and other implants in managing patients with intertrochanteric fractures.
Topics: Bone Nails; Bone Screws; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Prosthesis Design; Prosthesis Failure
PubMed: 29499715
DOI: 10.1186/s13018-018-0749-6 -
Journal of Dentistry Oct 2014The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth.
DATA
Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software.
SOURCES
A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013.
STUDY SELECTION
From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered "high" risk of bias, and four "low" risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I(2)=29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p=0.002) compared with Placebo.
CONCLUSION
Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence.
CLINICAL SIGNIFICANCE
Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth.
Topics: Dental Caries; Disease Progression; Follow-Up Studies; Humans; Pit and Fissure Sealants; Radiography, Bitewing; Tooth, Deciduous; Treatment Outcome
PubMed: 25066832
DOI: 10.1016/j.jdent.2014.07.015 -
Current Reviews in Musculoskeletal... Apr 2021Fractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials... (Review)
Review
The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis.
PURPOSE OF REVIEW
Fractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials support non-surgical treatment. Evidence behind the best non-surgical treatment strategy has been sparse and raises questions as to when and how to initiate exercises. The purpose of this systematic review and meta-analysis was to assess the benefits and harms of early mobilization versus late mobilization and supervised versus non-supervised exercises therapy after PHF and DRF.
RECENT FINDINGS
15 published and 5 unpublished trials were included. Early mobilization after PHF resulted in better function with a mean difference (MD) of 4.55 (95% CI 0.00-9.10) on the Constant Shoulder Score. However, the MD was not found to be clinically relevant. No clear evidence showed that early mobilization after PHF had a positive effect on range of motion or pain. Neither did it lead to more complications. Furthermore, no eligible evidence was found supporting early mobilization to be superior to late mobilization after DRF, or that supervised exercise therapy was superior to non-supervised exercise therapy after PHF and DRF. The quality of evidence on all outcomes was found to be low or very low. Early mobilization after PHF may have a beneficial effect on function. Due to the lack of clear evidence, there is an urgent need for future studies to determine the effect of early mobilization and supervised exercise therapy after PHF and DRF. Prospero ID number: CRD42020167656, date of registration 28.04.2020.
PubMed: 33689149
DOI: 10.1007/s12178-021-09697-5