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Indian Journal of Orthopaedics Mar 2024Open debridement remains the gold standard for the clinical treatment of post-traumatic elbow stiffness. However, postoperative complications, such as re-contraction and...
BACKGROUND
Open debridement remains the gold standard for the clinical treatment of post-traumatic elbow stiffness. However, postoperative complications, such as re-contraction and heterotopic ossification of the elbow joint, are highly prevalent. Hinged external fixation appears to offer the potential for greater improvement of joint function and reduction of complications. The purpose of this article is to provide the latest evidence on the effectiveness and safety of hinged external fixation combined with open debridement for the treatment of post-traumatic elbow stiffness.
METHODS
We searched for randomized controlled trials (RCTs) from the China National Knowledge Infrastructure, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library databases until December 31, 2022. STATA 15.1 software was used to analyze all the data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3.
RESULTS
Finally, we selected 8 high-quality RCTs for our meta-analysis, which included 555 patients. The meta-analysis demonstrated that hinged external fixation combined with open debridement for post-traumatic elbow stiffness (treatment group) showed a significant increase in elbow flexion and extension mobility (WMD = 5.16, 95% CI 4.39-5.49, = 13.02, = 0.000), Mayo elbow function scores (WMD = 5.25, 95% CI 4.33-6.17, = 11.15, = 0.000), and Mayo excellent rate (RR = 1.25, 95% CI 1.14-1.37, = 4.87, = 0.000). Additionally, there was a significant decrease in the complication rate (RR = 1.11, 95% CI 1.02-1.20, = 2.54, = 0.011) compared to open debridement alone (control group). Furthermore, the results of the publication bias test showed no significant bias.
CONCLUSIONS
With the assistance of hinged external fixation, open debridement for post-traumatic elbow stiffness can lead to increased elbow mobility and a reduced complication rate. However, due to the small sample size, a multicenter randomized controlled trial with a larger sample size is still necessary to further confirm the effectiveness and safety of hinged external fixation combined with open debridement for post-traumatic elbow stiffness.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-023-01087-y.
PubMed: 38425820
DOI: 10.1007/s43465-023-01087-y -
Molecular Nutrition & Food Research Apr 2024Comprehensive assessment of l-carnitine's safety and effectiveness in reducing inflammatory markers in osteoarthritis (OA) patients. (Meta-Analysis)
Meta-Analysis
SCOPE
Comprehensive assessment of l-carnitine's safety and effectiveness in reducing inflammatory markers in osteoarthritis (OA) patients.
METHODS AND RESULTS
Journal articles on l-carnitine for OA are gathered using computer searches of PubMed, Embase, the Cochrane Library, and Web of Science. The kind of literature that is found is restricted to clinical randomized controlled trials (RCTs). The Cochrane Handbook risk of bias assessment tool RevMan 5.4 software is used to conduct a meta-analysis. The systematic assessment comprises eight trials totaling 619 patients; the included studies' quality is mediocre. The study's findings demonstrate that OA patients' Western Ontario and McMaster University (WOMAC) function improves and that treatment efficacy outperforms that of the control group (mean difference [MD] = -7.75, 95% CI [-14.63, -0.86]; Z = 2.21; p = 0.03), WOMAC total (MD = -10.24, 95% CI [-18.97, -1.51]; Z = 2.30; p = 0.02), and visual analogue scale (VAS) pain (MD = -14.01, 95% CI [-16.16, -11.85]; Z = 12.74; p < 0.00001). The studies that are methodically reviewed also discover heterogeneity, which may have resulted from the created pooled data and requires more analysis.
CONCLUSION
In patients with OA, l-carnitine effectively decreases clinical signs and symptoms, inflammatory markers, pain, and stiffness indicators, and significantly improves WOMAC and VAS scores.
Topics: Humans; Carnitine; Dietary Supplements; Osteoarthritis; Randomized Controlled Trials as Topic
PubMed: 38389158
DOI: 10.1002/mnfr.202300614 -
Hand (New York, N.Y.) Feb 2024Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal...
BACKGROUND
Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal management of these fractures can lead to the development of long-term complications such as stiffness and flexion contracture.
METHODS
MEDLINE (PubMed), Scopus, Embase, Google Scholar, and Cochrane CENTRAL databases were systematically searched, and additional studies were found through reference of articles up to June 15, 2023. Identified articles were assessed using predetermined inclusion/exclusion criteria.
RESULTS
Twenty-five articles were included, involving 268 patients with ages from 3 to 17 years. Fractures with less than 30% joint involvement, classified as Eaton type I or II, or designated as "Stable" in the Keifhaber-Stern classification, were treated through nonsurgical means. Surgical interventions, encompassing open reduction and internal fixation, were reserved for fractures with more than 30% joint involvement and/or meeting criteria such as Eaton type IIIa or IIIb and Keifhaber-Stern "Tenuous" or "Unstable." Positive outcomes were seen in 99.5% of patients receiving nonsurgical treatment, compared with 85.7% in the surgical cohort.
CONCLUSIONS
The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. In fractures with more than 30% joint involvement, surgical interventions yielded positive results. To further substantiate these findings, larger prospective studies with uniform measures are needed to validate the results of this study.
PubMed: 38380839
DOI: 10.1177/15589447241231308 -
Explore (New York, N.Y.) Feb 2024Osteoarthritis (OA) is a joint disease characterized by pain, inflammation, and physical disability. Boswellia serrata (BS) is widely studied for its effectiveness in OA... (Review)
Review
BACKGROUND AND PURPOSE
Osteoarthritis (OA) is a joint disease characterized by pain, inflammation, and physical disability. Boswellia serrata (BS) is widely studied for its effectiveness in OA condition. Our systematic review and meta-analysis study was aimed to evaluate BS extract efficacy in OA. A sub-group analysis was performed to compare the efficacy of a standardized BS extract (Aflapin) with other BS extracts.
METHODS
Randomized controlled trials, identified from three online databases, evaluating the effect of BS extracts in OA were included. Quality of studies was assessed using PEDro scale and risk of bias was assessed using Cochrane Risk of Bias tool. Pooled effect was reported as mean difference (MD) and 95% confidence interval. Study was conducted as per the Cochrane guidelines (PROSPERO registration ID: CRD42023411356).
RESULTS
Nine RCTs with 712 participants were included. All studies (except one) were good quality studies. BS supplementation significantly reduced VAS (MD: -10.71; p<0.00001), LFI (MD: -2.99; p<0.00001), WOMAC-pain (MD: -10.69; p<0.0001), WOMAC-stiffness (MD: -5.49; p<0.00001), and WOMAC-function (MD: -10.69; p<0.00001) scores compared to control therapy. By sub-group analysis, Aflapin supplementation showed greater reduction in VAS (MD: -16.09 vs -4.68), LFI (MD: -3.81 vs -2.01), WOMAC-pain (MD: -18.68 vs -7.07), WOMAC-stiffness (MD: -14.25 vs -3.78), and WOMAC-function (MD: -14.99 vs -8.41) scores as compared to other BS therapies.
CONCLUSIONS
BS supplementation is effective OA symptomatic management. Sub-group analysis revealed that Aflapin supplementation may be better in improving the symptoms of OA which needs to be confirmed by more comparative clinical studies.
PubMed: 38365549
DOI: 10.1016/j.explore.2024.02.001 -
Journal of Sports Sciences Dec 2023This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces.... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aims to compare physiological, perceptual and biomechanical outcomes between walking on a treadmill and overground surfaces. Five databases (CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science) were searched until September 2022. Included studies needed to be a crossover design comparing biomechanical, physiological, or perceptual measures between motorised-treadmill and overground walking in healthy adults (18-65 years) walking at the same speed (<5% difference). The quality of studies were assessed using a modified Downs and Black Quality Index. Meta-analyses were performed to determine standardised mean difference ± 95% confidence intervals for all main outcome measures. Fifty-five studies were included with 1,005 participants. Relative oxygen consumption (standardised mean difference [95% confidence interval] 0.38 [0.14,0.63]) and cadence (0.22 [0.06,0.38]) are higher during treadmill walking. Whereas stride length (-0.36 [-0.62,-0.11]) and step length (-0.52 [-0.98,-0.06]) are lower during treadmill walking. Most kinetic variables are different between surfaces. The oxygen consumption, spatiotemporal and kinetic differences on the treadmill may be an attempt to increase stability due to the lack of control, discomfort and familiarity on the treadmill. Treadmill construction including surface stiffness and motor power are likely additional constraints that need to be considered and require investigation. This research was supported by an Australian Government Research Training Program (RTP) scholarship. Protocol registration is CRD42020208002 (PROSPERO International Prospective Register of Systematic Reviews) in October 2020.
Topics: Adult; Humans; Australia; Biomechanical Phenomena; Exercise Test; Gait; Walking
PubMed: 38350022
DOI: 10.1080/02640414.2024.2312481 -
Diagnostics (Basel, Switzerland) Feb 2024Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave... (Review)
Review
Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.
PubMed: 38337859
DOI: 10.3390/diagnostics14030343 -
Prosthetics and Orthotics International Feb 2024Jumping is involved in a wide range of sports and activities, and foot orthoses (FO) are suggested to enhance performance and prevent injury. The aim of this systematic...
Jumping is involved in a wide range of sports and activities, and foot orthoses (FO) are suggested to enhance performance and prevent injury. The aim of this systematic review was to investigate whether using FO with different modifications affects jump landing biomechanics and improves performance in healthy individuals. The search strategy included 7 databases that identified 19 studies. The study quality was evaluated using a modified Downs and Black index. The primary outcome measures were joint kinematics, kinetics, muscle activity, vertical jump height, and horizontal jump distance. Our findings indicated that incorporating arch support with a rearfoot post and softer forefoot region into FO may improve several biomechanical variables during jump landing activities. Improvements in vertical ground reaction force loading rates, knee and ankle kinematics, and muscle cocontraction during jumping with FO could enhance jumping performance. In addition, improvements in hip, knee, ankle, and tibial kinematics and vertical ground reaction force loading rates during landing could reduce impact forces and related injuries. Although a limited number of studies have addressed the effects of FO on vertical jump height and horizontal jump distance, inserting such FO inside shoes with optimum bending stiffness could facilitate jumping performance. A rigorous exploration of the effect and mechanism of FO designs on jumping performance could benefit jumping-related activities and prevent ankle and knee injuries.
PubMed: 38330181
DOI: 10.1097/PXR.0000000000000335 -
The American Journal of Sports Medicine May 2024Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL.
PURPOSE
To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome).
RESULTS
Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], -1.99 N·m; 95% CI, -10.2 to 6.2 N·m; = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, -12.7 N·m; < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, -14.8 N·m; < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon ( < .001) and AugRepair ( = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, -0.30 to 0.95 N·m/deg; = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, -1.22 to 1.82 mm; = .70), AugRecon (MD, 0.57 mm; 95% CI, -0.70 to 1.84 mm; = .38), or Recon (MD, 1.02 mm; 95% CI, -0.02 to 2.05 mm; = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping.
CONCLUSION
AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear.
Topics: Humans; Collateral Ligament, Ulnar; Biomechanical Phenomena; Network Meta-Analysis; Ulnar Collateral Ligament Reconstruction; Suture Techniques; Elbow Injuries
PubMed: 38304942
DOI: 10.1177/03635465231188691 -
The Journal of Hand Surgery... Feb 2024Extra-articular proximal phalanx base fractures are common in adults and can lead to permanent finger stiffness and joint contractures. The purpose of this review is to...
Extra-articular proximal phalanx base fractures are common in adults and can lead to permanent finger stiffness and joint contractures. The purpose of this review is to summarise the evidence for operative and non-operative management of this fracture type. The MedLine, Embase, PubMed, Scopus and Cochrane Library databases were searched using the following key terms: 'proximal phalanx', 'base', 'fracture', 'repair' and 'fixation'. A total of 2,889 unique records were extracted. All studies with primary data on the management of extra-articular proximal phalangeal base fractures in adults were included for initial review. Eleven studies met inclusion criteria with a total of 441 extra-articular proximal phalanx base fractures. Outcomes were determined by final total active range of motion. 182 extra-articular proximal phalangeal base fractures were treated non-operatively, with excellent or good outcomes attained in 80% of cases. Another 259 extra-articular proximal phalangeal base fractures were treated operatively, including 236 with Kirschner wires (K-wires), 18 with plates, and five with intramedullary screws. Case-level data were available in 186 fractures managed by K-wire fixation, with excellent or good outcomes achieved in 79% of cases. Excellent or good outcomes were achieved in 35% of cases treated by plates, and 80% of five cases treated by intramedullary screw fixation. Three (1.6%) patients managed conservatively required surgery after reduction loss. No patients managed with K-wires required re-operation for reduction loss; tenolysis/capsulotomy was required in 11 (4.5%) cases for stiffness, and pin site infections occurred in eight (3.5%) cases. Complex regional pain syndrome occurred in five cases (28%) of plate fixation. In summary, excellent or good results may be achieved by K-wire pinning or conservative management. Current evidence is limited for plate or intramedullary screw fixation. Prospective trials and outcomes standardisation are needed to improve the evidence base. Level III (Therapeutic).
Topics: Adult; Humans; Prospective Studies; Range of Motion, Articular; Fractures, Bone; Fracture Fixation, Internal; Bone Wires
PubMed: 38299241
DOI: 10.1142/S2424835524500085 -
Recent Advances in Food, Nutrition &... 2024Osteoarthritis (OA) is a progressive degenerative joint disease. It basically impairs the structural integrity of articulate cartilage and imbalances the catabolic and... (Review)
Review
Osteoarthritis (OA) is a progressive degenerative joint disease. It basically impairs the structural integrity of articulate cartilage and imbalances the catabolic and anabolic signals in the joint. A degenerative disease is characterized by swelling, pain, and joint stiffness. The treatment and management of osteoarthritis are based on analgesic and anti-inflammatory agents, whereas the exact cause of OA is not known yet. The negative effects of synthetic medications have led to a daily rise in the usage of nutraceuticals and dietary supplements. Clinicians are aware of these treatments, and they also recommend nutraceuticals in addition to the currently preferred therapy. Many and experiments have been performed in past years to evaluate the function of these on osteoarthritis. The collection of articles was published on search engines like PubMed, Scopus, Google Scholar, ResearchGate, and ScienceDirect. The evaluation covers every potential nutraceutical utilized in osteoarthritis, together with its supporting data and mode of action. The present review discusses nutraceuticals, including devil's claw, vitamin D, boswellic acid, capsaicin, ginger, curcumin, krill oil, ginger, and avocado/soybean unsaponifiable.
Topics: Dietary Supplements; Osteoarthritis; Humans; Capsaicin; Animals; Curcumin; Zingiber officinale; Vitamin D; Persea; Triterpenes
PubMed: 38258782
DOI: 10.2174/012772574X270405231102054920