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The Journal of the American Academy of... Jan 2023The aim was to compare surgical and nonsurgical management for adults with humeral shaft fractures in terms of patient-reported upper limb function, health-related... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The aim was to compare surgical and nonsurgical management for adults with humeral shaft fractures in terms of patient-reported upper limb function, health-related quality of life, radiographic outcomes, and complications.
METHODS
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, International Clinical Trials Registry, and OpenGrey (Repository for Grey Literature in Europe) were searched in September 2021. All published prospective randomized trials comparing surgical and nonsurgical management of humeral shaft fractures in adults were included. Of 715 studies identified, five were included in the systematic review and four in the meta-analysis. Data were extracted by two independent reviewers according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Pooled data were analyzed using a random-effects model.
RESULTS
The meta-analysis comprised 292 patients (mean age 41 [18 to 83] years, 67% male). Surgery was associated with superior Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley scores at 6 months (mean DASH difference 7.6, P = 0.01; mean Constant-Murley difference 8.0, P = 0.003), but there was no difference at 1 year (DASH, P = 0.30; Constant-Murley, P = 0.33). No differences in health-related quality of life or pain scores were found. Surgery was associated with a lower risk of nonunion (0.7% versus 15.7%; odds ratio [OR] 0.13, P = 0.004). The number needed to treat with surgery to avoid one nonunion was 7. Surgery was associated with a higher risk of transient radial nerve palsy (17.4% versus 0.7%; OR 8.23, P = 0.01) but not infection (OR 3.57, P = 0.13). Surgery was also associated with a lower risk of reintervention (1.4% versus 19.3%; OR 0.14, P = 0.04).
CONCLUSIONS
Surgery may confer an early functional advantage to adults with humeral shaft fractures, but this is not sustained beyond 6 months. The lower risk of nonunion should be balanced against the higher risk of transient radial nerve palsy.
LEVEL OF EVIDENCE
Level I.
Topics: Adult; Humans; Male; Female; Quality of Life; Radial Neuropathy; Prospective Studies; Randomized Controlled Trials as Topic; Humeral Fractures; Humerus
PubMed: 36580054
DOI: 10.5435/JAAOS-D-22-00432 -
The Journal of Hand Surgery... Dec 2022There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review...
There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level III (Therapeutic).
Topics: Humans; Wrist; Nerve Transfer; Fingers; Wrist Joint; Radial Neuropathy; Paralysis
PubMed: 36550081
DOI: 10.1142/S2424835522500953 -
Muscle & Nerve Mar 2023Nerve ultrasound is useful in the diagnosis and follow-up of peripheral nerve disorders in children. The aim of this study was to explore and analyze the current... (Meta-Analysis)
Meta-Analysis
INTRODUCTION/AIMS
Nerve ultrasound is useful in the diagnosis and follow-up of peripheral nerve disorders in children. The aim of this study was to explore and analyze the current literature on nerve cross-sectional area (CSA) in healthy children, with the goal of presenting reference values and discussing their implications.
METHODS
We performed a systematic review and meta-analysis of studies that reported ultrasound measurements of the upper or lower limb nerves in healthy children through a search of Web of Science, PubMed, Embase, and Scopus.
RESULTS
Sixteen studies with measurements of 10 nerves covering a total of 5149 nerves measured in 823 healthy children (445 boys and 378 girls) were included. Mean nerve CSA increased with age in the median nerve at the middle and lower third of the upper arm, mid-forearm, and distal wrist crease, the ulnar nerve at the middle third of the upper arm and elbow, the radial nerve at the spiral groove, and the tibial nerve at the popliteal fossa. Growth charts for nerve CSA for different age groups were developed.
DISCUSSION
This meta-analysis provides robust reference values for nerve CSA at different sites in children, and this can inform clinical practice and assist in identifying nerve enlargement. Moreover, it identifies the strength and quality of the current published data. We recommend future studies divide their samples into smaller age subgroups and standardize the anatomic site of measurement.
Topics: Male; Female; Humans; Child; Reference Values; Peripheral Nerves; Ultrasonography; Ulnar Nerve; Median Nerve
PubMed: 36533969
DOI: 10.1002/mus.27773 -
Neurological Research May 2023Dual nerve transfer of the spinal accessory nerve to the suprascapular nerve (SAN-SSN) and the radial nerve to the axillary nerve is considered to be the most feasible... (Meta-Analysis)
Meta-Analysis
Dual nerve transfer of the spinal accessory nerve to the suprascapular nerve (SAN-SSN) and the radial nerve to the axillary nerve is considered to be the most feasible method of restoration of shoulder abduction in brachial plexus injuries. Supraspinatus muscle plays an important role in the initiation of abduction and its functional restoration is crucial for shoulder movements. There are two possible approaches for the SAN-SSN transfer: the more conventional anterior approach and the posterior approach in the area of scapular spine, which allows more distal neurotization. Although the dual nerve transfer is a widely used method, it is unclear which approach for the SAN-SSN transfer results in better outcomes. We conducted a search of English literature from January 2001 to December 2021 using the PRISMA guidelines. Twelve studies with a total 142 patients met our inclusion criteria. Patients were divided into two groups depending on the approach used: Group A included patients who underwent the anterior approach, and Group B included patients who underwent the posterior approach. Abduction strength using the Medical Research Scale (MRC) and range of motion (ROM) were assessed. The average MRC grade was 3.57 ± 1.08 in Group A and 4.0 ± 0.65 (p = 0.65) in Group B. The average ROM was 114.6 ± 36.7 degrees in Group A and 103.4 ± 37.2 degrees in Group B (p = 0.247). In conclusion, we did not find statistically significant differences between SAN-SSN transfers performed from the anterior or posterior approach in patients undergoing dual neurotization technique for restoration of shoulder abduction.
Topics: Humans; Nerve Transfer; Accessory Nerve; Radial Nerve; Axilla; Scapula; Shoulder; Brachial Plexus
PubMed: 36526442
DOI: 10.1080/01616412.2022.2156721 -
The Archives of Bone and Joint Surgery Aug 2022The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN).... (Review)
Review
BACKGROUND
The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Although there have been multiple comparative clinical studies comparing outcomes for these two treatments, studies have not suggested one approach to be superior to the other. The purpose of this study is to perform a systematic literature review and meta-analysis of studies that evaluated the treatment of humeral shaft fractures with either ORIF or intramedullary nail.
METHODS
We conducted this meta-analysis utilizing stricter inclusion and broader exclusion criteria to examine these two common approaches. We examined those articles which have compared first-time, closed fractures of the humeral diaphysis in adults in fracture patterns that could be treated equivalently by intramedullary nail or plate fixation. The primary outcome of interest was nonunion, and studies that did not report nonunion rates were excluded.
RESULTS
There were a total of 1,926 abstracts reviewed and a total of three articles were included in the final analysis after screening. There was no significant difference in the incidence of nonunion between plating (2/111, 1.8%) and nailing (4/104, 3.9%) (). The mean difference in average time to union for plated fractures and nailed fractures was 1.11 weeks (95% CI 0.82 to 1.40) which was statistically significant (). There was a significant difference in the incidence of radial nerve palsy (12/111, 10.8%) for plating compared to nailing (0/104, 0%) (). There was no difference in incidence of post-operative infection between the two groups intramedullary nailing ().
CONCLUSION
The results of this analysis demonstrate an increased risk of iatrogenic radial nerve injury, and a significantly shorter time to union when treating humeral shaft fractures with plating as compared to intramedullary nailing. There was no difference in the rates of nonunion or delayed union. Based on the evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures.
PubMed: 36258745
DOI: 10.22038/ABJS.2021.59413.2947 -
Bulletin of the Hospital For Joint... Sep 2022The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the... (Meta-Analysis)
Meta-Analysis
PURPOSE
The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus dual-incision approach to distal biceps tendon repair.
METHODS
The literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant.
RESULTS
Twelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, LOE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24.1%, p < 0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p < 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01).
CONCLUSION
The dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.
Topics: Humans; Muscle, Skeletal; Ossification, Heterotopic; Rupture; Tendon Injuries; Tendons
PubMed: 36030447
DOI: No ID Found -
Injury Nov 2022Forearm fractures such as distal radius fractures are traditionally treated with a plaster or synthetic cast. Patients commonly report inconvenience of the cast, skin...
Forearm fractures such as distal radius fractures are traditionally treated with a plaster or synthetic cast. Patients commonly report inconvenience of the cast, skin problems, and occasionally radial sensory nerve numbness. A known issue with casting is that the rate of secondary dislocation is high. As an alternative to casts, personalized 3D-printed braces are increasingly used. This review provides an inventory of current developments and experience with 3D-printed forearm braces. Main focus was on the design requirements, materials used, technical requirements, and preclinical and clinical results. Review of 12 studies showed that all printed braces used an open design. Fused Deposition Modelling is most commonly used 3D-printing technique (seven studies) and polylactic acid is the most commonly used material (five studies). Clinical evaluation was done in six studies, mainly involving distal radius fractures, and generally showed a low complication rate and high patient satisfaction with the printed brace. Whether or not the results obtained with 3D-printed braces are superior to results after casting requires further studies.
Topics: Braces; Casts, Surgical; Forearm; Humans; Printing, Three-Dimensional; Radius Fractures; Splints
PubMed: 35858868
DOI: 10.1016/j.injury.2022.07.020 -
European Journal of Ophthalmology Jan 2023To summarize the evidence available on optical coherence tomography angiography (OCTA) in patients with anterior ischemic optic neuropathy (AION). (Meta-Analysis)
Meta-Analysis
PURPOSE
To summarize the evidence available on optical coherence tomography angiography (OCTA) in patients with anterior ischemic optic neuropathy (AION).
METHODS
Systematic searches were conducted on PubMed, Embase, Web of Science, Scopus, Cochrane, and Google Scholar Databases. The quality assessment of the included studies was performed using Newcastle -Ottawa Scale. The data were extracted to an Excel sheet. Vessel density (VD) data were pooled by random effects model, presented as pooled percentage change (PPC), and weighted mean differences (WMD). Additional subgroup analysis was also conducted.
RESULTS
In initial searches in online databases, we found 3535 citations, and after screening and checking the titles and abstracts, 26 articles were ultimately eligible for our meta-analysis. The overall PPC of Intra-optic-disc (IOD) VD (-10.73%; p = 0.017, I = 0.0%; p = 0.898) was lower than that of radial peripapillary (RP) VD (-17.57%; p < 0.001, I = 44.3%; p = 0.002). The overall PPC of peripapillary choroid VD (-6.99%; p < 0.001, I = 0.0%; p = 0.766) was significant, but noticeably lower than the pooled percentage change of RPVD and IOD VD. The WMD of RPVD was significant when non-affected fellow eyes were compared to the healthy subjects' eyes (-36.26; p < 0.001, I = 0.0%; p = 0.706).
CONCLUSIONS
The central retinal artery and its branches might be the main vessels which are affected in AION. The superficial retina was more affected than choroid layer in AION. Also, radial peripapillary retinal nerve fibre layer was more affected than the IOD area. OCTA might be a suitable tool for prediction of AION in susceptible eyes.
Topics: Humans; Tomography, Optical Coherence; Optic Neuropathy, Ischemic; Optic Disk; Angiography; Retina; Fluorescein Angiography; Retinal Vessels
PubMed: 35844139
DOI: 10.1177/11206721221113681 -
Computational and Mathematical Methods... 2022The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and safety of intramedullary nail (IMN) and locking compression plate (LCP) in the treatment of humeral shaft fractures.
METHODS
PubMed, Medline, Embase, Ovid, Cochrane Library, ISI Web of Science, Clinical Trials, and Chinese databases, including China National Knowledge Infrastructure Project, Wanfang database, and China biomedical abstracts database, were used to search the literature. Review Manager software was employed for statistical analysis and establishing forest and funnel maps. Categorical variables were measured by relative risk (RR), and standardized mean difference (SMD) was used to measure continuous variables. 95% confidence intervals were used for each variable. The modified Jadad scale, Newcastle-Ottawa scale, and Cochrane's bias risk tools were used to evaluate the bias and risk of eligible studies.
RESULTS
A total of 14 studies were included in the analysis with a total of 903 patients with humeral shaft fracture. Significant differences with regard to operation time (Std = -1.18, 95% CI: -2.14, -0.22, = 2.41, = 0.02), blood loss (Std = -2.97, 95% CI: -4.32, -1.63, = 4.34, < 0.001), and postoperative infection rate (RR = 0.32, 95% CI: -0.15, 0.68, = 2.98, = 0.003) were noted between the IMN group and LCP group. In addition, the American Shoulder and Elbow Surgeon (ASES) score (Std = -0.22, 95% CI: -0.44, 0.01, = 2.08, = 0.04) and the rate of shoulder and elbow function limitation (RR = 1.88, 95% CI: 1.06, 3.33, = 2.17, = 0.03) between the 2 groups were also statistically significant. There were no significant differences in the rate of radial nerve injury, nonunion, delayed healing, and secondary operation between the two groups.
CONCLUSION
IMN is superior than the LCP in terms of the operation time, intraoperative bleeding, and postoperative infection, suggesting its superiority in the humeral shaft fracture fixation. However, IMN is inferior to LCP in ASES score and shoulder elbow function limitation rate, indicating poor early postoperative functional recovery. More studies are required to evaluate and analyze the clinical efficacy between IMN and LCP regarding long-term function after artificial graft removal.
Topics: Humans; Bone Plates; Fracture Fixation, Intramedullary; Humeral Fractures; Humerus; Postoperative Complications; Treatment Outcome; Bone Nails
PubMed: 35799627
DOI: 10.1155/2022/5759233 -
Hand (New York, N.Y.) Nov 2023While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand... (Review)
Review
While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand and wrist. This paper seeks to characterize the safety of physical restraints by summarizing its effects on hand and wrist function and disability. Relevant studies were gathered through an independent double selection and extraction process using 3 electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to June 19, 2020. A total of 16 studies involving 807 participants were included. Lesion to the superficial branch of the radial nerve was the most commonly reported injury noted in 82% (42/55) of hands examined. A total of 6% (5/77) of examined hands had bony injury, including 3 radial styloid fractures and 2 scaphoid fractures. Both studies on zip ties noted presence of handcuff neuropathy, with 1 case report documenting severe rapidly progressing ischemic monomelic neuropathy. Overall, the use of handcuffs and zip ties is associated with entrapment neuropathies and bony injury to the hand and wrist. Further studies of higher quality evidence are necessary to understand the effects of physical restraint on hand function and disability.
Topics: Humans; Peripheral Nerve Injuries; Radius Fractures; Restraint, Physical; Wrist; Wrist Injuries
PubMed: 35778878
DOI: 10.1177/15589447221105548