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Plastic Surgery (Oakville, Ont.) May 2019Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the...
BACKGROUND
Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well.
OBJECTIVES
We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage.
METHODS
Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination.
RESULTS
There were no significant difference between the groups in regard with age ( = .463), follow-up period ( = .728), the ranges of flexion-extension ( = .431) and radio-ulnar deviation ( = .689), Q-DASH ( = .452), and MAYO scores ( = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy.
CONCLUSION
According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.
PubMed: 31106170
DOI: 10.1177/2292550319826099 -
Circulation Journal : Official Journal... Oct 2018We systematically reviewed the available literature on limb dysfunction after transradial access (TRA) or transfemoral access (TFA) cardiac catheterization....
BACKGROUND
We systematically reviewed the available literature on limb dysfunction after transradial access (TRA) or transfemoral access (TFA) cardiac catheterization. Methods and Results: MEDLINE and EMBASE were searched for studies evaluating any transradial or transfemoral procedures and limb function outcomes. Data were extracted and results were narratively synthesized with similar treatment arms. The TRA group included 15 studies with 3,616 participants and of these 3 reported nerve damage with a combined incidence of 0.16% and 4 reported sensory loss, tingling and numbness with a pooled incidence of 1.61%. Pain after TRA was the most common form of limb dysfunction (7.77%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or neuropathy was low at 0.49%. Although radial artery occlusion (RAO) was not a primary endpoint for this review, it was observed in 3.57% of the participants in a total of 8 studies included. The TFA group included 4 studies with 15,903,894 participants; the rates of peripheral neuropathy were 0.004%, sensory neuropathy caused by local groin injury and retroperitoneal hematomas were 0.04% and 0.17%, respectively, and motor deficit caused by femoral and obturator nerve damage was 0.13%.
CONCLUSIONS
Limb dysfunction post cardiac catheterization is rare, but patients may have nonspecific sensory and motor complaints that resolve over a period of time.
Topics: Arterial Occlusive Diseases; Cardiac Catheterization; Extremities; Female; Femoral Artery; Femoral Nerve; Hematoma; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Radial Artery; Radial Nerve; Retroperitoneal Space
PubMed: 30249925
DOI: 10.1253/circj.CJ-18-0389 -
Journal of the American Academy of... Apr 2018To compare the outcomes of tendon transfer and nerve transfer for radial nerve palsy.
PURPOSE
To compare the outcomes of tendon transfer and nerve transfer for radial nerve palsy.
METHODS
We performed a systematic review of the literature in EMBASE, PubMed, and Cochrane Database to include studies that address persistent traumatic radial nerve palsy treated with tendon transfer or nerve transfer surgery.
RESULTS
We identified 2,044 citations; 1,512 texts were excluded because of content, and 96 texts were screened for eligibility. Texts were excluded if they did not report the motor score (M0 to M5 as determined by the British Medical Research Council) or measurements of range of motion of the wrist. Sixteen texts were eligible for qualitative synthesis. Outcomes of these studies show heterogeneity with regard to the technique and functional restoration.
CONCLUSIONS
On the basis of the results of this systematic review, there does not seem to be a clearly superior technique; rather, there are advantages and disadvantages to each. Patient selection and surgeon experience are important when considering surgical interventions in this challenging clinical scenario. Nerve transfer surgery is an emerging technique that may offer patients meaningful functional gains with reduced donor site morbidity.
LEVEL OF EVIDENCE
Level III.
PubMed: 30211383
DOI: 10.5435/JAAOSGlobal-D-18-00001 -
Hand (New York, N.Y.) Nov 2017Posterior interosseous nerve neurectomies (PINN) are an option in the treatment of chronic dorsal wrist pain. However, the literature describing PINN consists primarily...
BACKGROUND
Posterior interosseous nerve neurectomies (PINN) are an option in the treatment of chronic dorsal wrist pain. However, the literature describing PINN consists primarily of small case series, and the procedure is typically done as an adjunct treatment; therefore, the outcomes of the PINN itself are not well known. We performed a systematic review of the literature to provide characteristics of patients following a PINN.
METHODS
A systematic review of the literature was performed. Papers published in the PubMed database in English on isolated PINN were included. Articles in which a PINN was performed as an adjunct were excluded. Primary outcomes were return to work, patient satisfaction, pain/function scores, wrist range of motion, complications, and pain recurrence. Weighted averages were used to calculate continuous data, whereas categorical data were noted in percentages.
RESULTS
The search yielded 427 articles including 6 studies and 135 patients (136 cases). The average age was 43.6 years (range, 17-75), and most patients were female (54.1%). At an average final follow-up of 51 months, 88.9% of patients were able to return to work. After initial improvement, a recurrence of pain occurred in 25.5% of patients at an average of 12.3 months. Excluding recurrence of pain, the complication rate was 0.9%, including 1 reflex sympathetic dystrophy. Overall, 88.4% of patients experienced a subjective improvement and were satisfied with the procedure.
CONCLUSIONS
Isolated PINN have shown excellent clinical outcomes, with few patients experiencing recurrent pain at long-term follow-up. PINN can provide relief in patient's chronic wrist pain.
Topics: Arthralgia; Denervation; Humans; Patient Satisfaction; Postoperative Complications; Radial Nerve; Return to Work; Wrist Joint
PubMed: 28720049
DOI: 10.1177/1558944717692093 -
Acta Ortopedica Brasileira 2017Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to... (Review)
Review
Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to summarize such methods. Eletronic searches related terms, held in databases (1980-2016): Pubmed (via Medline), Lilacs (via Scielo) and Google Scholar. Through pre-defined protocol, we identified relevant studies. We excluded case reports. Aspects of diagnosis and treatment were synthesized for analysis and tables. Quantitative analyzes were followed by their dispersion variables. Fourteen studies were included. All studies were considered as level IV evidence. Most studies consider aspects of clinical history and provocative maneuvers. There is no consensus on the use of electromyography, and methods are heterogeneous. Studies have shown that surgical treatment (muscle release and neurolysis) has variable success rate, ranging from 20 to 96.5%. Some studies applied self reported scores, though the heterogeneity of the population does not allow inferential analyzes on the subject. few complications reported. Most studies consider the diagnosis of compressive radial nerve syndromes essentially clinical. The most common treatment was combined muscle release and neurolysis, with heterogeneous results. There is a need for comparative studies
PubMed: 28642652
DOI: 10.1590/1413-785220172501164801 -
Plastic and Reconstructive Surgery Oct 2015Although contralateral C7 (CC7) transfer has been widely used for treating traumatic brachial plexus injury, the safety of the procedure is questionable. The authors... (Review)
Review
BACKGROUND
Although contralateral C7 (CC7) transfer has been widely used for treating traumatic brachial plexus injury, the safety of the procedure is questionable. The authors performed a systematic review to investigate the donor-site morbidity, including sensory abnormality and motor deficit, to guide clinical decision-making.
METHODS
A systematic review on (CC7) transfer for traumatic brachial plexus injury was performed for original articles in the PubMed and Embase databases. Patient demographic data and donor-site morbidity of (CC7) transfer, including incidence, recovery rate, and recovery time were extracted. The sensory abnormality areas and muscles involved in motor weakness were also summarized.
RESULTS
A total of 904 patients from 27 studies were reviewed. Overall, 74 percent of patients (668 of 897) experienced sensory abnormalities, and 98 percent (618 of 633) recovered to normal; the mean recovery time was 3 months. For motor function, 20 percent (118 of 592) had motor deficit after (CC7) transfer and 91 percent (107 of 117) regained normal motor function; the mean recovery time was 6 months. Sensory abnormality mainly occurred in the area of the hand innervated by the median nerve, whereas motor deficit most often involved muscles innervated by the radial nerve. There were 19 patients with long-term morbidity of the donor site in the studies.
CONCLUSIONS
The incidence of donor-site morbidity after (CC7) transfer was relatively high, and severe and long-term defects occurred occasionally. (CC7) transfer should be indicated only when other donor nerves are not available, and with a comprehensive knowledge of the potential risks.
Topics: Brachial Plexus; Humans; Motor Disorders; Nerve Transfer; Peripheral Nerve Injuries; Recovery of Function; Treatment Outcome
PubMed: 26397267
DOI: 10.1097/PRS.0000000000001616 -
Plastic and Reconstructive Surgery Oct 2015Contralateral C7 (CC7) transfer has been used for treating traumatic brachial plexus injury. However, the effectiveness of the procedure remains a subject of debate. The... (Review)
Review
BACKGROUND
Contralateral C7 (CC7) transfer has been used for treating traumatic brachial plexus injury. However, the effectiveness of the procedure remains a subject of debate. The authors performed a systematic review to study the overall outcomes of CC7 transfer to different recipient nerves in traumatic brachial plexus injuries.
METHODS
A literature search was conducted using PubMed and EMBASE databases to identify original articles related to CC7 transfer for traumatic brachial plexus injury. The data extracted were study/patient characteristics, and objective outcomes of CC7 transfer to the recipient nerves. The authors normalized outcome measures into a Medical Research Council-based (MRC) outcome scale.
RESULTS
Thirty-nine studies were identified. The outcomes were categorized based on the major recipient nerves: median, musculocutaneous, and radial/triceps. Regarding overall functional recovery, 11 percent of patients achieved MRC grade M4 wrist flexion and 38 percent achieved MRC grade M3. Grade M4 finger flexion was achieved by 7 percent of patients, whereas 36 percent achieved M3. Finally, 56 percent achieved greater than or equal to S3 sensory recovery in the median nerve territories. In the musculocutaneous nerve group, 38 percent regained to M4 and 37 percent regained to M3. In the radial/triceps nerve group, 25 percent regained elbow or wrist extension strength to a MRC grade M4 and to M3, respectively.
CONCLUSIONS
Outcome measures in the included studies were not consistently reported to uncover true patient-related benefits from the CC7 transfer. Reliable and validated outcome instruments should be applied to critically evaluate patients undergoing CC7 transfer.
Topics: Brachial Plexus; Humans; Nerve Transfer; Peripheral Nerve Injuries; Treatment Outcome
PubMed: 26397253
DOI: 10.1097/PRS.0000000000001494 -
Medicine Mar 2015Multiple meta-analyses have been published to compare intramedullary nail and plate for treating humeral shaft fractures; however, results are discordant.The purposes of... (Comparative Study)
Comparative Study Meta-Analysis Review
Multiple meta-analyses have been published to compare intramedullary nail and plate for treating humeral shaft fractures; however, results are discordant.The purposes of current study were to perform a systematic review of overlapping meta-analyses comparing intramedullary nail and plate fixation for the treatment of humeral shaft fractures, to appraise the methodological quality and the quality of reporting of meta-analyses, and to propose a guide through the currently discordant available evidence.This systematic review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis. The literature was systematically reviewed to identify meta-analyses comparing intramedullary nail and plate fixation for the treatment of humeral shaft fractures. Only meta-analyses exclusively including randomized clinical trials (RCTs) met eligibility criteria in this systematic review. Methodological quality for each included study was assessed using the Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews Instrument. We extracted all variables from the included studies and listed the results reported by them. Heterogeneity information of each variable was extracted for the included studies. An I of <60% is accepted in this systematic review. The Jadad algorithm was then applied to determine which meta-analyses provided the best evidence.Seven studies met the inclusion criteria in this study. All studies included RCTs or quasi-RCT and were Level II of evidence. Assessment of Multiple Systematic Reviews scores varied from 6 to 10 with a median of 7.86. Heterogeneity of each outcome was acceptable in those meta-analyses pooled results. The Jadad algorithm suggested that the meta-analyses can be selected based on the search strategies and application of selection. As a result, 2 meta-analyses with more RCTs were selected in this systematic review. The best available evidence suggested that the differences between intramedullary nail and plate fixation were not significant in fracture union, radial nerve injury, and infection. But intramedullary nail significantly increased the risk of shoulder complications (shoulder impingement and restriction of shoulder movement) and reoperation.We concluded that plate fixation is superior to intramedullary nail for the treatment of humeral shaft fractures.
Topics: Algorithms; Bone Nails; Bone Plates; Fracture Fixation, Intramedullary; Humans; Humeral Fractures
PubMed: 25789949
DOI: 10.1097/MD.0000000000000599 -
The Cochrane Database of Systematic... Nov 2014Radial head fracture is the most common fracture of the elbow. It usually results from a fall onto an outstretched arm. In 1954, Mason classified these fractures into... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Radial head fracture is the most common fracture of the elbow. It usually results from a fall onto an outstretched arm. In 1954, Mason classified these fractures into type 1 (undisplaced), type 2 (simple displaced), and type 3 (comminuted fractures). Aspiration of the elbow joint aims to relieve pressure in the elbow joint and has been used as an initial treatment option for radial head fractures. However, it is an invasive technique with the potential for complications such as infection and injury to nerves and vessels.
OBJECTIVES
To assess the effects (benefits and harms) of elbow joint aspiration for treating radial head fracture in adults.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (14 April 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (14 April 2014), MEDLINE (1946 to April Week 1 2014) and EMBASE (1980 to 2014 Week 15), trial registries, bibliographies and conference proceedings.
SELECTION CRITERIA
Randomised and quasi-randomised controlled clinical trials comparing aspiration versus no aspiration for treating radial head fractures in adults.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected articles, assessed risk of bias and extracted data. Disagreements were resolved by discussion. Where appropriate, we pooled results of comparable studies using fixed-effect meta-analysis.
MAIN RESULTS
We included two trials that involved 126 participants but provided results for only 108 participants. Most participants were adults, typically over 30 years of age. Both trials were at high risk of selection, performance, detection and reporting bias. Reflecting this high risk of bias, we downgraded the quality of evidence two levels for study limitations and a further level for imprecision. Thus we judged the evidence for all outcomes to be 'very low' quality, meaning that we are very uncertain about these estimates.One trial included participants with Mason type 1, 2 or 3 radial head fractures and also a few cases of traumatic elbow hemarthrosis without fracture. The other trial included participants with Mason type 1 and 2 fractures. All participants were managed non-surgically.Neither trial reported functional outcome based on validated patient-reported outcome measures of function or pain using validated measures such as a visual analogue scale. Very low quality evidence (108 participants, two trials) indicates little difference between aspiration and no aspiration in impaired function (unable to carry heavy loads; discomfort when carrying loads) at 12 months (9/51 in aspiration group versus 7/57 in the no aspiration group; risk ratio 1.43 favouring no aspiration, 95% confidence interval (CI) 0.57 to 3.58). Very low quality evidence (two trials) suggests a beneficial effect of aspiration on pain relief immediately after aspiration. Very low quality evidence (one trial, 28 participants) shows less pain after aspiration at three weeks, but it is unclear whether this applies subsequently. Neither trial reported on adverse events (for example, nerve and vascular injuries; deep or superficial infection) from the procedure, but aspiration was reported as being unsuccessful in three participants (7.9%) in one trial. Very low quality evidence indicates little difference in range of motion (based on elbow extension) between the two groups at six weeks (28 participants, one trial) or 12 months (108 participants, two trials). The report of adverse events was incomplete, but one trial (80 participants) reported the absence of three specific complications: myositis ossificans, joint instability or late displacement of the fracture.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine the effectiveness of joint aspiration for the initial treatment of radial head fracture in terms of function, pain and range of motion or to determine the safety of the procedure. An examination of current aspiration use, the prospective collection of adverse events and consultation with patients as to their preferences and values would be helpful in guiding decisions about the future design of a multicentre randomised trial aiming to obtain definitive evidence on the use of aspiration for treating radial head fractures.
Topics: Adult; Arthralgia; Drainage; Humans; Radius Fractures; Randomized Controlled Trials as Topic; Range of Motion, Articular; Treatment Outcome; Elbow Injuries
PubMed: 25416525
DOI: 10.1002/14651858.CD009949.pub2