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Archives of Orthopaedic and Trauma... Nov 2020In adults, treatment of recalcitrant long bone non-union is extremely challenging, with poorly vascularised and atrophic defects unresponsive to standard...
INTRODUCTION
In adults, treatment of recalcitrant long bone non-union is extremely challenging, with poorly vascularised and atrophic defects unresponsive to standard non-vascularised bone graft treatment. Recent studies have documented the use of free vascularised periosteal flaps to achieve union in refractory long bone fracture non-union, yet its use is not well established. This systematic review aims to assess the evidence for free vascularised periosteal flaps in recalcitrant long bone non-union.
MATERIALS AND METHODS
The MEDLINE®/PubMed and Embase databases were searched for the Medical Subject Heading (MeSH) terms periosteal flap/vascularised flap/long bone/non-union/non united fracture in accordance with the PRISMA guidelines. Bibliographies were scrutinised for additional articles.
RESULTS
Pooled data from 14 studies met the inclusions criteria, comprising 137 cases of non-union, with 117 relating to long bone non-union. Pooled data indicated an overall 99% (116/117) successful union rate. All studies were of mid- to low-level evidence (Level III, IV and V). Only one study directly compared vascularised periosteal flaps to non-vascularised bone grafts, showing union rates of 100% versus 80% and faster time to union (2 versus 5.5 months).
CONCLUSIONS
Free vascularised periosteal flaps are promising with pooled data showing a 99% success rate in achieving union in refractory long bone non-union. This compares favourably with standard orthopaedic care consisting of revision fixation and non-vascularised bone graft union rates of approximately 80%. However, study design flaws should be addressed by validated outcome measures plus adequate blinding, and further comparative studies with greater patient numbers are required.
Topics: Bone Transplantation; Femur; Free Tissue Flaps; Humans
PubMed: 31974694
DOI: 10.1007/s00402-020-03354-1 -
International Journal of Oral and... Jul 2020The aim of this review was to determine the effect of cortical perforations in bone regeneration considering the surgical technique. An electronic search in the PubMed...
The aim of this review was to determine the effect of cortical perforations in bone regeneration considering the surgical technique. An electronic search in the PubMed (MEDLINE) and ScienceDirect databases and a hand search of the literature was conducted covering the period July 2008 to December 2018. Studies that specified the creation of perforations in the recipient area as a study variable associated with the regenerative technique were included. The quality of the randomized clinical trials included in this systematic review was also assessed. A total of 16 articles met both inclusion criteria and were eligible for analysis. Studies were grouped into three blocks according to the associated surgical technique. All studies were performed in an experimental model except for one. Qualitative assessment of the studies showed a moderate to high risk of bias of the overall studies. The evidence for creating perforations in guided bone regeneration and also in combination with autologous bone blocks in order to increase bone formation is limited according to the publications analysed. Although the number and size of perforations do not appear to interfere with the result, their effect in the upper maxilla and in the mandible should be evaluated separately due to the structural anatomical differences.
Topics: Bone Regeneration; Humans; Mandible; Maxilla
PubMed: 31718859
DOI: 10.1016/j.ijom.2019.10.011 -
BMC Public Health Nov 2019Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels....
BACKGROUND
Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults.
METHODS
Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles.
RESULTS
Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from - 3.13 to - 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain.
CONCLUSIONS
Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.
Topics: Aged; Analgesics, Opioid; Chronic Pain; Complementary Therapies; Female; Humans; Independent Living; Male; Pain Management; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31703654
DOI: 10.1186/s12889-019-7831-9 -
Revista Da Associacao Medica Brasileira... Jul 2019To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment.
OBJECTIVE
To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment.
METHODS
Identification of publications on pathological skeletal fractures previously exposed to ionizing radiation.
RESULTS
The incidence of fractures after irradiation varies from 1.2% to 25% with a consolidation rate of 33% to 75%, being more frequent in the ribs, pelvis, and femur. The time elapsed between irradiation and fracture occurs years after radiotherapy. Risk factors include age above 50 years, female gender, extensive periosteal detachment, circumferential irradiation, tumor size, and anterior thigh location. The etiology is still uncertain, but cellular disappearance, reduction of bone turnover and activity were observed hematopoietic as possible causes of failure of consolidation.
CONCLUSION
There is no consensus in the literature on the factors related to the development of fractures, with radiation dose, previous tumor size and periosteal detachment being suggested as potential factors.
Topics: Fractures, Bone; Humans; Radiation Injuries; Radiotherapy; Risk Factors
PubMed: 31340323
DOI: 10.1590/1806-9282.65.6.902 -
Journal of Oral and Maxillofacial... Oct 2019Controversy remains regarding the optimal degree of anatomic exposure, reduction, and fixation required during open reduction and internal fixation of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Controversy remains regarding the optimal degree of anatomic exposure, reduction, and fixation required during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures. We critically examined the reported data to compare the patient outcomes after various degrees of ZMC reduction and internal fixation.
MATERIALS AND METHODS
A systematic review and meta-analysis were designed to test the null hypothesis of no difference in outcomes between different degrees of fixation of ZMC fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method.
RESULTS
Of 1213 screened studies, 13 met the inclusion criteria. Fracture instability at 3 months was greater with 2-point fixation (61.1%) than with 3-point fixation (10.6%; relative risk, 2.5, 95% confidence interval [CI], 1.4 to 3.3). Less vertical orbital dystopia was seen with 3-point fixation than with 2-point fixation (mean difference, 0.9 mm; 95% CI, 0.6 to 1.3 mm). The incidence of infection and malar asymmetry did not differ between the groups. The quality of evidence was very low to low.
CONCLUSIONS
The reported data were limited by low quality, retrospective studies. However, the meta-analysis of randomized control trial data suggested a superiority of 3 points of exposure and fixation regarding fracture stability. When 2 points appear to provide stable fixation, the potential benefits of a third point should be weighed against the cost, operative time, and exposure/periosteal stripping on a case-by-case basis.
Topics: Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Humans; Open Fracture Reduction; Retrospective Studies; Zygomatic Fractures
PubMed: 31132344
DOI: 10.1016/j.joms.2019.04.025 -
The American Journal of Sports Medicine Jan 2020Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well...
BACKGROUND
Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood.
PURPOSE/HYPOTHESIS
The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost <$50,000 per quality-adjusted life-year over 10 years.
STUDY DESIGN
Systematic review.
METHODS
A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure.
RESULTS
Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm to 36.0 for OCA of bipolar lesions. Failure rates ranged from <5% for osteochondral autograft for defects requiring 1 or 2 plugs to 46% for OCA of bipolar defects. All treatments were cost-effective over 10 years in the baseline model if costs were increased 50% or if failure rates were increased an additional 15%. However, if efficacy was decreased by a minimum clinically important amount, then ACI (periosteal cover) of femoral condylar lesions ($51,379 per quality-adjusted life-year), OCA of bipolar lesions ($66,255) or the patella ($66,975), and microfracture of defects >3 cm ($127,782) became cost-ineffective over 10 years.
CONCLUSION
Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously.
Topics: Cartilage; Cartilage Diseases; Cost-Benefit Analysis; Humans; Knee Joint; Orthopedic Procedures; Patella; Reoperation; Treatment Outcome; United States
PubMed: 31038980
DOI: 10.1177/0363546519834557 -
Journal of Oral & Maxillofacial Research 2018To overview preclinical animal trials and quantify the effect size that stem cell therapy has on the regeneration of periodontal tissue complex. (Review)
Review
OBJECTIVES
To overview preclinical animal trials and quantify the effect size that stem cell therapy has on the regeneration of periodontal tissue complex.
MATERIAL AND METHODS
A systematic MEDLINE (PubMed) online library search was conducted for preclinical animal studies , using autologous periodontal ligament, dental pulp, cementum, alveolar periosteal, gingival margin or adipose stem cell types for periodontal tissue complex regeneration purposes. Studies had to be published between 2007.09.01 and 2017.09.01 in the English language.
RESULTS
Online library search yielded 2099 results. After the title, abstract and full-text screening ten studies fit inclusion criteria and were pooled into meta-analysis. Overall the stem cell regenerative therapy had a statistically significant positive influence on the periodontal tissue regeneration when compared to the control groups. The biggest influence was made to the regeneration of cementum (standardised mean difference [SMD] 2.25 [95% confidence interval (CI) = 1.31 to 3.2]) while the smallest influence was made to the alveolar bone (SMD 1.47 [95% CI = 0.7 to 2.25]) the effect size for periodontal ligament regeneration was (SMD 1.8 [95% CI = 1 to 2.59]). Subgroup analysis showed statistically significant (P < 0.05) differences between different cell types in the alveolar bone and cementum regeneration groups and in alveolar bone group in relation to scaffold materials.
CONCLUSIONS
Stem cell therapy has a positive impact on periodontal tissue complex regeneration. Such therapy has the biggest influence on cementum regeneration meanwhile alveolar bone regeneration is influenced by the least amount. However more and less diverse preclinical studies are needed to have a greater statistical power in future meta-analyses.
PubMed: 30116515
DOI: 10.5037/jomr.2018.9203 -
Foot and Ankle Surgery : Official... Apr 2018Talar osteochondral lesions (OLT) occur frequently in ankle sprains and fractures. We hypothesize that matrix-induced autologous chondrocyte implantation (MACI) will... (Review)
Review
BACKGROUND
Talar osteochondral lesions (OLT) occur frequently in ankle sprains and fractures. We hypothesize that matrix-induced autologous chondrocyte implantation (MACI) will have a low reoperation rate and high patient satisfaction rate in treating OLT less than 2.5cm.
METHODS
A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available free databases. Clinical outcome investigations reporting OLT outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared. Statistics were calculated using Student's t-tests, one-way ANOVA, chi-squared, and two-proportion Z-tests.
RESULTS
Nineteen articles met our inclusion criteria, which resulted in a total of 343 patients. Six studies pertained to arthroscopic MACI, 8 to open MACI, and 5 studies to open periosteal ACI (PACI). All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is low. In comparison of open and arthroscopic MACI, we found both advantages favoring open MACI. However, open MACI had higher complication rates.
CONCLUSIONS
No procedure demonstrates superiority or inferiority between the combination of open or arthroscopic MACI and PACI in the management of OLT less than 2.5cm. Ultimately, well-designed randomized trials are needed to address the limitation of the available literature and further our understanding of the optimal treatment options.
Topics: Ankle Injuries; Cartilage Diseases; Chondrocytes; Humans; Talus; Transplantation, Autologous
PubMed: 29409226
DOI: 10.1016/j.fas.2017.01.002 -
Journal of Periodontal Research Oct 2017This systematic review aims to evaluate mesenchymal stem cells (MSC) periodontal regenerative potential in animal models. MEDLINE, EMBASE and LILACS databases were... (Review)
Review
This systematic review aims to evaluate mesenchymal stem cells (MSC) periodontal regenerative potential in animal models. MEDLINE, EMBASE and LILACS databases were searched for quantitative pre-clinical controlled animal model studies that evaluated the effect of local administration of MSC on periodontal regeneration. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Twenty-two studies met the inclusion criteria. Periodontal defects were surgically created in all studies. In seven studies, periodontal inflammation was experimentally induced following surgical defect creation. Differences in defect morphology were identified among the studies. Autogenous, alogenous and xenogenous MSC were used to promote periodontal regeneration. These included bone marrow-derived MSC, periodontal ligament (PDL)-derived MSC, dental pulp-derived MSC, gingival margin-derived MSC, foreskin-derived induced pluripotent stem cells, adipose tissue-derived MSC, cementum-derived MSC, periapical follicular MSC and alveolar periosteal cells. Meta-analysis was not possible due to heterogeneities in study designs. In most of the studies, local MSC implantation was not associated with adverse effects. The use of bone marrow-derived MSC for periodontal regeneration yielded conflicting results. In contrast, PDL-MSC consistently promoted increased PDL and cementum regeneration. Finally, the adjunct use of MSC improved the regenerative outcomes of periodontal defects treated with membranes or bone substitutes. Despite the quality level of the existing evidence, the current data indicate that the use of MSC may provide beneficial effects on periodontal regeneration. The various degrees of success of MSC in periodontal regeneration are likely to be related to the use of heterogeneous cells. Thus, future studies need to identify phenotypic profiles of highly regenerative MSC populations.
Topics: Animals; Bone Regeneration; Bone Substitutes; Bone Transplantation; Cementogenesis; Databases, Factual; Dental Pulp; Disease Models, Animal; Guided Tissue Regeneration, Periodontal; Humans; Mesenchymal Stem Cells; Meta-Analysis as Topic; Osteogenesis; Periodontal Ligament; Regeneration; Stem Cell Transplantation; Tissue Scaffolds
PubMed: 28394043
DOI: 10.1111/jre.12455 -
Implant Dentistry Feb 2017Guided bone regeneration (GBR) procedures allow ridge augmentation before or at time of implant placement. GBR outcomes rely on primary passive tension-free wound...
PURPOSE
Guided bone regeneration (GBR) procedures allow ridge augmentation before or at time of implant placement. GBR outcomes rely on primary passive tension-free wound closure, which may be achieved by a variety of flap designs and surgical procedures. A comprehensive literature review of flap design and management is provided, including material types, incision design, reflection, releasing, and suturing techniques.
MATERIALS AND METHODS
Two reviewers completed a literature search using the PubMed database and a manual search of relevant journals. Relevant articles from January 1990 to September 2015 published in the English language were considered.
RESULTS
A variety of flap designs aim to achieve primary passive closure during GBR were introduced. To facilitate case selection and treatment planning, flap designs have been categorized based on their ability to achieve minor (<3 mm), moderate (3-6 mm), and major (≥7 mm) degrees of flap advancement.
CONCLUSIONS
Techniques such as vertical releasing incisions, periosteal releasing incisions, and split-thickness flaps may be used alone or combined to achieve passivity during GBR. GBR complications may be prevented by imaging and preoperative planning and careful surgical technique especially flap advancement.
Topics: Dental Implantation; Gingiva; Guided Tissue Regeneration, Periodontal; Humans; Preoperative Care; Surgical Flaps
PubMed: 27893512
DOI: 10.1097/ID.0000000000000510