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The Cochrane Database of Systematic... Oct 2022Fractures of the distal femur (the far end of the thigh bone just above the knee) are a considerable cause of morbidity. Various different surgical and non-surgical... (Review)
Review
BACKGROUND
Fractures of the distal femur (the far end of the thigh bone just above the knee) are a considerable cause of morbidity. Various different surgical and non-surgical treatments have been used in the management of these injuries but the best treatment remains unknown.
OBJECTIVES
To evaluate the benefits and harms of interventions for treating fractures of the distal femur in adults.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was October 2021.
SELECTION CRITERIA
We included randomised and quasi-randomised controlled trials in adults comparing interventions for treating fractures of the distal femur. Interventions included surgical implants (retrograde intramedullary nail (RIMN), fixed-angle devices, non-locking plate fixation, locking plate, internal fixation, distal femoral replacement, mono-axial plates, poly-axial plates and condylar buttress plates) and non-surgical management.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our critical outcomes were validated patient-reported outcome measures (PROMs), direct adverse events, participant-reported quality of life (QoL) and pain scores. Our other important outcomes were adverse events indirectly related to intervention, symptomatic non-union, malunion and resource use. We used GRADE to assess certainty of evidence for each outcome.
MAIN RESULTS
We included 14 studies with 753 participants: 13 studies compared different surgical interventions, and one study compared surgical with non-surgical management. Here, we report the effects for RIMN compared with locking plates. Three studies (221 participants) reported this comparison; it included the largest study population and these are the two most commonly used devices in contemporary orthopaedic trauma practice. Studies used three different tools to assess PROMs. We found very-low certainty evidence for lower Disability Rating Index scores after RIMN at short-term follow-up favouring RIMN (mean difference (MD) -21.90, 95% confidence interval (CI) -38.16 to -5.64; 1 study, 12 participants) and low-certainty evidence of little or no difference at long-term follow-up (standardised mean difference (SMD) -0.22, 95% CI -0.50 to 0.06; 2 studies, 198 participants). Re-expressing the SMD of the long-term follow-up data to Knee Society Score (KSS) used by one study found no clinical benefit of RIMN, based on a minimal clinically important difference of 9 points (MD 2.47, 95% CI -6.18 to 0.74). The effect on QoL was very uncertain at four months (MD 0.01, 95% CI -0.42 to 0.44; 1 study, 14 participants) and one year (MD 0.10, 95% CI -0.01 to 0.21; 1 study, 156 participants); this evidence was very low certainty. For direct adverse events, studies reported reoperation, loss of fixation, superficial and deep infection, haematoma formation and implant loosening. Effects for all events were imprecise with the possibility of benefit or harm for both treatments. We considered reoperation the most clinically relevant. There was very low-certainty evidence of little or no difference in reoperation between the two implants (risk ratio (RR) 1.48, 95% CI 0.55 to 4.00; 1 study, 104 participants). No studies reported pain. For other important outcomes, we noted that people treated with RIMN may be more likely to have varus/valgus deformity (RR 2.18, 95% CI 1.09 to 4.37; 1 study, 33 participants; low-certainty evidence). However, we found no evidence of any important differences between treatments in terms of bony union, indirect adverse events, or resource use. Other comparisons of surgical interventions included in the review were: RIMN versus single fixed-angle device (3 studies, 175 participants); RIMN versus non-locking plate fixation (1 study, 18 participants); locking plate versus single fixed-angle device (2 studies, 130 participants); internal fixation versus distal femoral replacement (1 study, 23 participants); mono-axial plates versus poly-axial plates (2 studies, 67 participants); mono-axial plate versus condylar buttress plate (1 study, 78 participants). The certainty of the evidence for outcomes in these comparisons was low to very low, and most effect estimates were imprecise.
AUTHORS' CONCLUSIONS
This review highlights the major limitations of the available evidence concerning current treatment interventions for fractures of the distal femur. The currently available evidence is incomplete and insufficient to inform clinical practice. Priority should be given to randomised controlled trials comparing contemporary treatments for people with fractures of the distal femur. At a minimum, these should report validated patient-reported functional and quality-of-life outcomes at one and two years, with an agreed core outcome set. All trials should be reported in full using the CONSORT guidelines.
Topics: Adult; Femur; Fracture Fixation; Fractures, Bone; Humans; Pain; Quality of Life
PubMed: 36197809
DOI: 10.1002/14651858.CD010606.pub3 -
Seminars in Arthritis and Rheumatism Dec 2022The aim of this study was to systematically review the clinical and paraclinical findings in patients with reactive arthritis (ReA) caused by giardiasis. (Review)
Review
INTRODUCTION
The aim of this study was to systematically review the clinical and paraclinical findings in patients with reactive arthritis (ReA) caused by giardiasis.
METHODS
In this study, papers describing ReA in patients with giardiasis were found after searching in international databases including MEDLINE/PubMed, Web of Science, Scopus, and ScienceDirect up to 2021. Google Scholar was also searched to find more articles.
RESULTS
Finally, 16 studies met the inclusion criteria with reporting 115 patients, ranging in age from 19 months to 49 years. This disease was more reported in children and adolescents than adults. The most frequently involved joints with arthritis were the knee and ankle followed by the hip, wrist, elbow, shoulder, axial skeleton, metatarsophalangeal, and proximal interphalangeal. The most common extra-articular symptoms included diarrhea, allergic symptoms, and abdominal pain.
CONCLUSION
The signs and symptoms of ReA caused by giardiasis can be various, from moderate to severe manifestations. Also, they can be similar to some other diseases, so it is recommended that physicians and specialists have more knowledge about this disease to treat patients with a correct diagnosis.
Topics: Child; Adolescent; Adult; Humans; Arthritis, Reactive; Giardiasis; Knee Joint; Elbow Joint; Ankle Joint
PubMed: 36174478
DOI: 10.1016/j.semarthrit.2022.152094 -
The International Journal of Oral &... 2022To evaluate the performance of fixed complete dental prostheses supported by axial and tilted implants after at least 3 years of follow-up. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the performance of fixed complete dental prostheses supported by axial and tilted implants after at least 3 years of follow-up.
MATERIALS AND METHODS
An electronic search plus a hand search up to April 2021 was undertaken. Clinical studies were selected using specific inclusion criteria, independent of the study design. The main outcomes were cumulative implant survival rate, marginal bone level changes, and complications, after ≥ 3 years of follow-up. The difference in outcomes between axial and tilted implants and between the maxilla and mandible was evaluated using meta-analysis and the Mantel-Cox test.
RESULTS
Out of 824 articles retrieved, 24 were included. In total, 2,637 patients were rehabilitated with 2,735 full prostheses (1,464 maxillary, 1,271 mandibular), supported by 5,594 and 5,611 tilted and axial implants, respectively. In a range between 3 and 18 years of follow-up, 274 implants failed. The cumulative implant survival rate was 93.91% and 99.31% for implants and prostheses, respectively. The mean marginal bone level change was moderate, exceeding 2 mm in only two studies. Marginal bone loss was significantly lower around axial compared with tilted implants (P < .0001), whereas it was not affected by arch (maxilla vs mandible; P = .17).
CONCLUSION
Fixed complete dental prostheses supported by tilted and axially placed implants represent a predictable option for the rehabilitation of edentulous arches. Further randomized trials are needed to determine the efficacy of this surgical approach and the remodeling pattern of marginal bone in the long term.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Follow-Up Studies; Humans; Jaw, Edentulous; Maxilla; Treatment Outcome
PubMed: 36170316
DOI: 10.11607/jomi.9710 -
World Neurosurgery Nov 2022The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development.
METHODS
A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate.
RESULTS
This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications.
CONCLUSIONS
The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.
Topics: Humans; Spinal Fusion; Atlanto-Axial Joint; Cervical Vertebrae; Bone Screws; Postoperative Complications; Joint Instability
PubMed: 36089281
DOI: 10.1016/j.wneu.2022.09.016 -
Journal of Clinical Neuroscience :... Sep 2022Burst fractures of the fifth lumbar vertebra (L5) are rare injuries and typically occur because of high-energy axial compressive load. Their unique anatomy and... (Review)
Review
BACKGROUND
Burst fractures of the fifth lumbar vertebra (L5) are rare injuries and typically occur because of high-energy axial compressive load. Their unique anatomy and biomechanical characteristics distinguish them from other lumbar spine injuries. To the best of our knowledge, the treatment strategies for L5 burst fractures have not been thoroughly described. The aims of this case series and systematic review were to highlight the treatment strategies and outcomes of the L5 burst fractures.
METHODS
We performed a retrospective case series of 8 patients treated for burst L5 fractures in our institution between 2005 and 2020. Additionally, a systematic review via PubMed and Cochrane Library databases according to PRISMA guidelines was performed to review L5 burst fractures treatment strategies. Only Articles in English with full text available were included. The references of the selected studies were checked to find all possible related articles. Treatment strategies were conservative, posterior segmental instrumentation and fixation (PSIF), PSIF with anterior corpectomy (AC), and PSIF with posterior corpectomy (PC). Outcomes measures included neurological status, radiological regional alignment, and complications.
RESULTS
A total of 1449 publications were found, and 29 articles were finally selected for analysis. Of those, 15 were retrospective case reports, and 14 were retrospective case series. One hundred and sixty-nine patients were found in the review. The author's eight cases were added to the found in the literature for a methodological quality assessment. There were 52 (29%) patients managed non-operative, and 125 (71%) underwent surgery. One-hundred-two patients were neurologically intact, of whom 46 were managed non-operative. Canal compromise in intact patients ranged between 20 and 90%. Posterior segmental fixation and instrumentation with decompression was the preferred surgical strategy in patients with neurological deficits. Patients with combined anterior column restoration and anterior approach showed vertebral height and lordosis restoration. A 79% of the operative treated group reported neurological improvement. Patients with pre-operative neurological deficit managed non-operative reported the highest rate of complications (33.3%).
CONCLUSION
In the setting of L5 burst fractures, neurological injuries have a promising prognosis after surgery and are not correlated with the degree of canal stenosis. The compromise of the L5 vertebra affects the sagittal balance and its restoration can be achieved with an anterior corpectomy. Nonoperative management can be considered in cases of reasonable alignment, and no neurologic deficit.
Topics: Decompression, Surgical; Fractures, Compression; Humans; Lumbar Vertebrae; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Treatment Outcome
PubMed: 35907351
DOI: 10.1016/j.jocn.2022.07.017 -
Knee Surgery, Sports Traumatology,... Jan 2023The aim of this meta-analysis was to evaluate complete transphyseal (CTP), partial transphyseal (PTP), and physeal-sparing (PS) techniques for anterior cruciate ligament... (Meta-Analysis)
Meta-Analysis
Physeal-sparing ACL reconstruction provides better knee laxity restoration but similar clinical outcomes to partial transphyseal and complete transphyseal approaches in the pediatric population: a systematic review and meta-analysis.
PURPOSE
The aim of this meta-analysis was to evaluate complete transphyseal (CTP), partial transphyseal (PTP), and physeal-sparing (PS) techniques for anterior cruciate ligament (ACL) reconstruction.
METHODS
A systematic literature search of the PubMed, Web of Science, Cochrane Library, and Scopus literature databases was performed on 10.05.2021. All human studies evaluating the outcomes of CTP, PTP, and PS techniques were included. The influence of the selected approach was evaluated in terms of rates of retears, return to previous level of sport competition, IKDC subjective and objective scores, Lysholm score, rate of normal Lachman and pivot-shift tests, limb length discrepancy, and hip-knee angle (HKA) deviation. Risk of bias and quality of evidence were assessed following the Downs and Black checklist.
RESULTS
Forty-nine out of 425 retrieved studies (3260 patients) met the inclusion criteria. The results of the meta-analysis comparing CTP, PTP, and PS approaches for ACL reconstruction in the under 20-year-old population showed a significant difference in terms of differential laxity (CTP 1.98 mm, PTP 1.69 mm, PS 0.22 mm, p < 0.001). No significant differences were seen in terms of growth malalignment, rate of normal Lachman and pivot-shift tests, and rate of normal/quasi-normal IKDC objective score.
CONCLUSIONS
The present meta-analysis found overall similar results with the three ACL reconstruction approaches. The PS technique showed better results in terms of knee laxity than the PTP and CTP approaches, but this did not lead to a significant difference in terms of subjective and objective scores. No clear superiority of one technique over the others was found with respect to re-ruptures, growth disturbances, and axial deviations. While the argument for avoiding growth malalignment does not seem to be a crucial point, the PS technique should be the preferred approach in a young population to ensure knee laxity restoration.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Child; Young Adult; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint; Knee; Growth Plate; Treatment Outcome
PubMed: 35838794
DOI: 10.1007/s00167-022-07032-0 -
Annals of the Rheumatic Diseases Jun 2023To define the instruments for the Assessment of SpondyloArthritis international Society-Outcomes Measures in Rheumatology (ASAS-OMERACT) core domain set for axial...
OBJECTIVES
To define the instruments for the Assessment of SpondyloArthritis international Society-Outcomes Measures in Rheumatology (ASAS-OMERACT) core domain set for axial spondyloarthritis (axSpA).
METHODS
An international working group representing key stakeholders selected the core outcome instruments following a predefined process: (1) identifying candidate instruments using a systematic literature review; (2) reducing the list of candidate instruments by the working group, (3) assessing the instruments' psychometric properties following OMERACT filter 2.2, (4) selection of the core instruments by the working group and (5) voting and endorsement by ASAS.
RESULTS
The updated core set for axSpA includes seven instruments for the domains that are mandatory for all trials: Ankylosing Spondylitis Disease Activity Score and Numerical Rate Scale (NRS) patient global assessment of disease activity, NRS total back pain, average NRS of duration and severity of morning stiffness, NRS fatigue, Bath Ankylosing Spondylitis Function Index and ASAS Health Index. There are 9 additional instruments considered mandatory for disease-modifying antirheumatic drugs (DMARDs) trials: MRI activity Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joints and SPARCC spine, uveitis, inflammatory bowel disease and psoriasis assessed as recommended by ASAS, 44 swollen joint count, Maastricht Ankylosing Spondylitis Enthesitis Score, dactylitis count and modified Stoke Ankylosing Spondylitis Spinal Score. The imaging outcomes are considered mandatory to be included in at least one trial for a drug tested for properties of DMARD. Furthermore, 11 additional instruments were also endorsed by ASAS, which can be used in axSpA trials on top of the core instruments.
CONCLUSIONS
The selection of the instruments for the ASAS-OMERACT core domain set completes the update of the core outcome set for axSpA, which should be used in all trials.
Topics: Humans; Spondylitis, Ankylosing; Spondylarthritis; Spine; Antirheumatic Agents; Outcome Assessment, Health Care
PubMed: 35680390
DOI: 10.1136/annrheumdis-2022-222747 -
Scientific Reports Jun 2022To determine whether smoking has adverse effects on postoperative complications following spine cervical surgery (PROSPERO 2021: CRD42021269648). We searched PubMed,... (Meta-Analysis)
Meta-Analysis
To determine whether smoking has adverse effects on postoperative complications following spine cervical surgery (PROSPERO 2021: CRD42021269648). We searched PubMed, Embase, Cochrane Library, and Web of Science through 13 July 2021 for cohort and case-control studies that investigated the effect of smoking on postoperative complications after cervical spine surgery. Two researchers independently screened the studies and extracted data according to the selection criteria. The meta-analysis included 43 studies, including 27 case-control studies and 16 cohort studies, with 10,020 patients. Pooled estimates showed that smoking was associated with overall postoperative complications (effect estimate [ES] = 1.99, 95% confidence interval [CI]: 1.62-2.44, p < 0.0001), respiratory complications (ES = 2.70, 95% CI: 1.62-4.49, p < 0.0001), reoperation (ES = 2.06, 95% CI: 1.50-2.81, p < 0.0001), dysphagia (ES = 1.49, 95% CI: 1.06-2.10, p = 0.022), wound infection (ES = 3.21, 95% CI: 1.62-6.36, p = 0.001), and axial neck pain (ES = 1.98, 95% CI: 1.25-3.12, p = 0.003). There were no significant differences between the smoking and nonsmoking groups in terms of fusion (ES = 0.97, 95% CI: 0.94-1.00, p = 0.0097), operation time (weighted mean difference [WMD] = 0.08, 95% CI: -5.54 to 5.71, p = 0.977), estimated blood loss (WMD = -5.31, 95% CI: -148.83 to 139.22, p = 0.943), length of hospital stay (WMD = 1.01, 95% CI: -2.17 to 4.20, p = 0.534), Visual Analog Scale-neck pain score (WMD = -0.19, 95% CI: -1.19 to 0.81, p = 0.707), Visual Analog Scale-arm pain score (WMD = -0.50, 95% CI: -1.53 to 0.53, p = 0.343), Neck Disability Index score (WMD = 11.46, 95% CI: -3.83 to 26.76, p = 0.142), or Japanese Orthopedic Association Scores (WMD = -1.75, 95% CI: -5.27 to 1.78, p = 0.332). Compared with nonsmokers, smokers seem to be more significantly associated with overall complications, respiratory complications, reoperation, longer hospital stay, dysphagia, wound infection and axial neck pain after cervical spine surgery. It is essential to provide timely smoking cessation advice and explanation to patients before elective cervical spine surgery.
Topics: Cervical Vertebrae; Deglutition Disorders; Humans; Neck Pain; Postoperative Complications; Smoking; Wound Infection
PubMed: 35654928
DOI: 10.1038/s41598-022-13198-x -
World Neurosurgery Aug 2022Both transarticular screw fixation (TAS) and segmental screw-rod fixation (SF) have been widely performed for C1-2 fusion; however, just only small clinical studies and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Both transarticular screw fixation (TAS) and segmental screw-rod fixation (SF) have been widely performed for C1-2 fusion; however, just only small clinical studies and a few meta-analyses comparing the 2 surgical techniques for C1-2 posterior fusion have been reported.
METHODS
We searched the Cochrane, Embase, and Medline databases for articles comparing the intraoperative and postoperative outcomes of TAS and SF for C1-2 posterior fusion with April 14, 2022, as the publication cutoff date. The odds ratio (OR) and standardized mean difference were used to analyze differences in outcomes between the 2 abovementioned surgical techniques. A P value < 0.05 was considered statistically significant.
RESULTS
A total of 5101 publications were assessed, and 6 studies were finally included in the study. In terms of the fusion rate, SF produced significantly better outcomes than TAS did (OR = 2.96, P = 0.02). With respect to surgical outcomes, blood loss and operation times were significantly lower in the TAS group than those in the SF group (P = 0.008 and P < 0.00001, respectively). The rate of vertebral artery injury was significantly lower in the SF group than that in the TAS group (OR = 3.95, P = 0.04). However, other complications, such as screw malposition, infection, hardware failure, and nonunion, were not significantly different between the 2 groups.
CONCLUSIONS
SF showed a greater fusion rate and lower risk of vertebral artery injury than TAS did, but TAS showed less blood loss and lower operation times than SF.
Topics: Atlanto-Axial Joint; Bone Screws; Cervical Vertebrae; Humans; Joint Instability; Neck Injuries; Spinal Cord; Spinal Fusion
PubMed: 35643403
DOI: 10.1016/j.wneu.2022.05.086 -
BioMed Research International 2022Rheumatoid arthritis (RA) can cause deformity in particularly the craniocervical but also in the lower cervical region. (Review)
Review
BACKGROUND
Rheumatoid arthritis (RA) can cause deformity in particularly the craniocervical but also in the lower cervical region.
OBJECTIVES
The aim of this study is to give an overview of current literature on the association of disease activity score (DAS) and the prevalence and progression of rheumatoid arthritis-associated cervical spine deformities.
METHODS
A literature search was done in PubMed, Embase, and Web of Science using a sensitive search string combination (Supplemental File). Studies describing the association between DAS and the incidence and progression of atlantoaxial subluxation, vertical subluxation, and subaxial subluxation were selected by predefined selection criteria, and risk of bias was assessed using a Cochrane checklist adjusted for this purpose.
RESULTS
Twelve articles were retrieved, and risk of bias on study level was low to moderate. In the eight longitudinal studies, patients demonstrated high DAS at baseline, which decreased upon treatment with medication: cervical deformity at the end of follow-up was associated with higher DAS values. The four cross-sectional studies did not demonstrate a straightforward correlation between DAS and cervical deformity. Deformity progression was evaluated in three studies, but no convincing association with DAS was established.
CONCLUSION
A positive association between prevalence of cervical spine deformities and high disease activity was demonstrated, but quality of evidence was low. Progression of cervical deformity in association with DAS control over time is only scarcely studied, and future investigations should focus on halting of deformity progression.
Topics: Arthritis, Rheumatoid; Atlanto-Axial Joint; Cervical Vertebrae; Cross-Sectional Studies; Humans; Joint Dislocations
PubMed: 35463987
DOI: 10.1155/2022/9403883