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Journal of Clinical Orthopaedics and... Mar 2024Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between... (Review)
Review
PURPOSE
Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between 10 and 38%, a wide margin, and confounded by multiple factors including age, high energy mechanisms, pathological and periprosthetic fractures. The purpose of this study was to assess and determine all-cause mortality following geriatric native distal femur fractures at 30 days, six months and one year.
METHODS
- The databases Cochrane CENTRAL, MEDLINE, EMBASE and NHS NICE Healthcare Databases Advanced Search Interface were searched in accordance with PRISMA guidelines. Original research articles relevant to mortality outcomes in native geriatric distal femur fractures following low energy trauma were included. A time-to-event data meta-analysis model was used to estimate pooled 30-day, six month and one-year mortality. A random effects meta-regression model was performed to assess potential sources of heterogeneity when studies reported on factors affecting the mortality observed in patients with geriatric distal femur fractures.
RESULTS
- Thirteen studies were included in the meta-analysis with a mean age of 79.6 years. Eight studies reported the 30-day mortality of distal femur fractures in patients as a pooled estimate of 8.14%. Pooled estimate for 6-month mortality reported was 19.5% and the one-year mortality reported by ten studies was 26.10%. Time-to-event modelling showed that risk of mortality at one year in elderly patients with distal femur fractures was significantly higher HR = 4.31 (p < 0.001). When evaluating prognostic predictors, age and Type C fracture were predictive of highest mortality rates.
CONCLUSIONS
- This study is the first meta-analysis to evaluate the early and long-term mortality observed in elderly patients presenting with native distal femoral fractures. Through our results we have shown the quantifiable impact patient age and fracture configuration has on one-year mortality in this patient cohort.
PubMed: 38495682
DOI: 10.1016/j.jcot.2024.102375 -
Journal of Orthopaedics Jul 2024Posterior pilon variant ankle fractures (PPVF) are a unique subtype of posterior malleolar fractures which have been a source of controversy and confusion in recent... (Review)
Review
Posterior pilon variant ankle fractures (PPVF) are a unique subtype of posterior malleolar fractures which have been a source of controversy and confusion in recent years. There has not been a thorough literature review previously written on the topic. Database searches of PubMed and Embase were conducted from inception until June 2023. The key words included "pilon variant," "posterior pilon variant," and "posterior pilon" fractures. Outcomes were evaluated by union time, rates of delayed union, nonunion, malunion, and complication. A total of 15 articles relevant to surgical repair of pilon variant fractures were included in the literature review. The unique mechanism of injury has been reported to involve both rotational and axial forces, leading to involvement of the posterior and medial aspects of the distal tibia. Pilon variant fractures can be suspected by several characteristics on radiographs and have a high confirmation rate via CT images. Multiple systems have been proposed to classify this fracture pattern, but there is no consensus on the ideal classification system. Surgically, direct fixation has shown better short-term clinical outcomes versus indirect fixation or no fixation. PPVF have a distinct fracture pattern involving the posterior and medial columns of the distal tibial plafond, and results from a mechanism intermediate to rotational and axial forces. These fractures are more severe than tri-malleolar fractures due to increased rates of articular impaction and incongruity. Future classification systems should focus on joint surface area and the tibial pilon column involved to avoid confusion with less severe posterior malleolar fractures.
PubMed: 38476677
DOI: 10.1016/j.jor.2024.02.035 -
General Hospital Psychiatry 2024Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions.
METHODS
Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection.
FINDINGS
17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000).
CONCLUSIONS
Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
Topics: Adult; Humans; Post-Acute COVID-19 Syndrome; Mental Health; Prevalence; COVID-19; SARS-CoV-2; Mental Fatigue
PubMed: 38447388
DOI: 10.1016/j.genhosppsych.2024.02.009 -
BMC Musculoskeletal Disorders Mar 2024This meta-analysis aims to investigate the efficacy of early rehabilitation on patients who have undergone surgery for distal radius fractures (DRFs) with palmar... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis aims to investigate the efficacy of early rehabilitation on patients who have undergone surgery for distal radius fractures (DRFs) with palmar plating, focusing on multiple outcome measures including upper limb function, wrist function, back extension mobility, pain levels, and complications.
METHODS
A rigorous search strategy adhering to the PRISMA guidelines was employed across four major databases, including PubMed, Embase, Web of Science, and the Cochrane Library. Studies were included based on stringent criteria, and data extraction was performed independently by two reviewers. Meta-analysis was conducted employing both fixed-effect and random-effects models as dictated by heterogeneity, assessed by the I statistic and chi-square tests. A total of 7 studies, encompassing diverse demographic groups and timelines, were included for the final analysis.
RESULTS
The meta-analysis disclosed that early rehabilitation yielded a statistically significant improvement in upper limb function (SMD -0.27; 95% CI -0.48 to -0.07; P < 0.0001) and back extension mobility (SMD 0.26; 95% CI 0.04 to 0.48; P = 0.021). A notable reduction in pain levels was observed in the early rehabilitation group (SMD -0.28; 95% CI -0.53 to -0.02; P = 0.03). However, there were no significant differences in wrist function (SMD -0.13; 95% CI -0.38 to 0.12; P = 0.36) and complications (OR 0.99; 95% CI 0.61 to 1.61; P = 0.96).
CONCLUSIONS
Early rehabilitation post-DRF surgery with palmar plating has been found to be beneficial in enhancing upper limb functionality and back extension mobility, and in reducing pain levels. Nevertheless, no significant impact was observed regarding wrist function and complications.
Topics: Humans; Pain; Upper Extremity; Wrist; Wrist Fractures; Wrist Joint
PubMed: 38443916
DOI: 10.1186/s12891-024-07317-0 -
BMC Urology Mar 2024The forgotten ureteral stents (FUS) is one of the late complications of stent placement. This systematic review summarized different aspects of FUS and focused on the...
BACKGROUND
The forgotten ureteral stents (FUS) is one of the late complications of stent placement. This systematic review summarized different aspects of FUS and focused on the problems and solutions related to FUS.
METHODS
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. PubMed® and Embase® were searched from inception until October 1st, 2022. Eligible studies were those defining FUS as a stent unintentionally left in situ longer than at least 2 months.
RESULTS
Total 147 studies with 1292 patients were finally included. The mean indwelling time of FUS was 33.5 months (range from 3 months to 32 years). The most common initial cause for stent placement was adjunct treatment to urolithiasis (79.2%). The major forgetting reasons were patient-related (83.9%), which included poor compliance, lapse in memory, and misconceptions about the necessity of timely removal. Primary presenting complaints were flank pain (37.3%), lower urinary tract symptoms (33.3%), and hematuria (22.8%). Encrustation (80.8%) and urinary tract infections (40.2%) were the most common complications detected in patients with FUS. Computed tomography evolving as a preferred imaging test (76.1%) was indispensable for evaluating encrustation, migration, fracture and other complicated situations in patients with FUS. Besides, evaluation of kidney function and infection status was also of great importance. Multiple and multimodal procedures (59.0%) were often necessitated to achieve the stent-free status, and were mostly endoscopic procedures. Cystoscope was most commonly used (64.8%). Retrograde ureteroscopy (43.4%) and antegrade stent removal (31.6%) were often used when dealing with more complicated situations. Extracorporeal shockwave lithotripsy (30.4%) was often used as adjunctive to other endoscopic procedures, but it sometimes failed. The decision regarding the choice of treatment is based on the volume and site of encrustation, the direction of migration, the site of fracture, kidney function and other urinary comorbidities.
CONCLUSIONS
FUS not only pose hazard to patients' health, but also impose a huge economic burden on medical care. Thorough preoperative evaluation is fundamental to developing the treatment strategy. The management of FUS should be individualized using different treatment modalities with their advantages to minimize patients' morbidities. Prevention is better than cure. Strengthening health education and setting a tracking program are of great importance to the prevention of FUS.
Topics: Humans; Cystoscopes; Fractures, Bone; Hematuria; Lithotripsy; Ureteroscopy; Urolithiasis; Foreign Bodies; Stents
PubMed: 38443863
DOI: 10.1186/s12894-024-01440-9 -
Medicine Mar 2024This systematic review and meta-analysis aimed to evaluate the effects of Taohong Siwu Decoction (THSWD) combined with low molecular weight heparin (LMWH), as well as... (Meta-Analysis)
Meta-Analysis
Effectiveness of Taohong Siwu decoction in the prevention of deep vein thrombosis in hip surgery patients: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
This systematic review and meta-analysis aimed to evaluate the effects of Taohong Siwu Decoction (THSWD) combined with low molecular weight heparin (LMWH), as well as THSWD alone, on the incidence of Deep vein thrombosis (DVT), D-dimer levels, prothrombin time (PT), activated partial thromboplastin time (APTT), visual analogue scale (VAS) pain score, and calf swelling in patients undergoing hip fracture or replacement surgery, compared to LMWH.
METHODS
According to the predefined inclusion criteria, we conducted a comprehensive search for randomized controlled trials (RCTs) examining the efficacy of THSWD combined with LMWH or THSWD compared to LMWH in patients with hip fractures or undergoing replacement surgery. The search was performed across multiple databases including China National Knowledge Internet, WanFang, Sinomed, Duxiu, PubMed, Embase, Google Scholar, Cochrane, and Web of Science from their inception until December 2023. Additionally, relevant literature references were retrieved and hand searching of pertinent journals was conducted. The methodological quality assessment of the included trials was carried out following the guidelines outlined in the Cochrane Handbook. Review Manager 5.4 was applied in analyzing and synthesizing.
RESULTS
A total of 18 RCTs with 1353 patients were included. The results of meta-analysis showed that compared with the control group, the combined group had a better effect on the incidence of DVT [RR = 0.32, 95% CI(0.17, 0.58; P = .0002], D-dimer [SMD = -5.88, 95% CI(-7.66, -4.11); P < .00001], VAS [MD = -1.16, 95% CI(-1.81, -0.50); P = .0005], Calf circumference difference [MD = -0.56, 95% CI(-1.05, -0.08); P = .02]. There was no significant difference in PT and APTT between the combined group and the control group. Meta-analysis results show that the D-dimer, incidence of DVT, PT, and APTT did not significantly differ between the THSWD and the LMWH groups.
CONCLUSION
This meta-analysis shows that compared with LMWH, THSWD combined with LMWH has a better efficacy in the treatment of DVT after hip surgery, without a significant increase in the incidence of adverse events. Additionally, the combined therapy can also reduce D-dimer, VAS, and swelling. However, due to the limitations of the included studies (such as small sample size and low-quality evidence), the results need to be further verified in more rigorous multicenter clinical trials with a large sample size.
Topics: Humans; Anticoagulants; Randomized Controlled Trials as Topic; Heparin, Low-Molecular-Weight; Venous Thrombosis; Multicenter Studies as Topic; Drugs, Chinese Herbal
PubMed: 38428876
DOI: 10.1097/MD.0000000000037241 -
Actas Urologicas Espanolas Feb 2024Patients undergoing radical cystectomy with urinary diversions (UD) are at increased risk of bone fractures compared to the general population. Although a loss of bone... (Review)
Review
Why do patients with urinary diversions have an increased risk of bone fracture? A systematic review on risk factors for osteoporosis and bone mineral density loss in this group of patients.
INTRODUCTION
Patients undergoing radical cystectomy with urinary diversions (UD) are at increased risk of bone fractures compared to the general population. Although a loss of bone mineral density (BMD) has been described in patients with UD, we still do not know with certainty why these patients follow this tendency.
OBJECTIVE
We performed a systematic review of the available literature to analyze the prevalence of osteoporosis and bone alterations in patients with ileal UD and the possible associated risk factors.
EVIDENCE ACQUISITION
We systematically searched PubMed® and Cochrane Library for original articles published before December 2022 according to PRISMA guidelines.
EVIDENCE SYNTHESIS
A total of 394 publications were identified. We selected 12 studies that met the inclusion criteria with 496 patients included. Six of the twelve studies showed decreased BMD values. Prevalence of osteoporosis was specified in three articles, with values ranging from 0% to 36%. Risk factors such as age, sex, body mass index, metabolic acidosis and renal function appear to have an impact on bone tissue reduction, while type of UD, follow-up, 25-hydroxyvitamin D and parathormone had less evidence or contradictory data. The heterogeneity of the studies analyzed could led to interpretation bias.
CONCLUSIONS
UD are associated with multiple risk factors for osteoporosis and bone fractures. Identifying patients at highest risk and establishing diagnostic protocols in routine clinical practice are essential to reduce the risk of fractures and the resulting complications.
PubMed: 38365091
DOI: 10.1016/j.acuroe.2023.11.009 -
Current Medical Research and Opinion Mar 2024This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering... (Review)
Review
OBJECTIVE
This study aimed to critically assess existing risk prediction models for postoperative mortality in older individuals with hip fractures, with the objective of offering substantive insights for their clinical application.
DESIGN
A comprehensive search was conducted across prominent databases, including PubMed, Embase, Cochrane Library, SinoMed, CNKI, VIP, and Wanfang, spanning original articles in both Chinese and English up until 1 December 2023. Two researchers independently extracted pertinent research characteristics, such as predictors, model performance metrics, and modeling methodologies. Additionally, the bias risk and applicability of the incorporated risk prediction models were systematically evaluated using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
RESULTS
Within the purview of this investigation, a total of 21 studies were identified, constituting 21 original risk prediction models. The discriminatory capacity of the included risk prediction models, as denoted by the minimum and maximum areas under the subject operating characteristic curve, ranged from 0.710 to 0.964. Noteworthy predictors, recurrent across various models, included age, sex, comorbidities, and nutritional status. However, among the models assessed through the PROBAST framework, only one was deemed to exhibit a low risk of bias. Beyond this assessment, the principal limitations observed in risk prediction models pertain to deficiencies in data analysis, encompassing insufficient sample size and suboptimal handling of missing data.
CONCLUSION
Subsequent research endeavors should adopt more stringent experimental designs and employ advanced statistical methodologies in the construction of risk prediction models. Moreover, large-scale external validation studies are warranted to rigorously assess the generalizability and clinical utility of existing models, thereby enhancing their relevance as valuable clinical references.
Topics: Aged; Humans; Comorbidity; Hip Fractures; Risk Assessment
PubMed: 38323327
DOI: 10.1080/03007995.2024.2307346 -
The Journal of Hand Surgery... Feb 2024Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of...
Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire's ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature. An electronic search was carried out across multiple databases. Abstracts were screened by two independent reviewers against inclusion criteria and, where necessary, full texts were reviewed. Nine eligible papers were identified, and data regarding type of procedure, dressing choice and infection rate was extracted. The included studies were widely heterogenous, and the standard of the evidence was, in general, poor. In most, dressing choice and infection incidence were not the primary intervention/outcome under study. Based on the available literature, insufficient evidence exists to establish one dressing choice as having a lower infection rate. This highlights the need for further high-quality evidence in this area. Level III (Therapeutic).
Topics: Humans; Bone Wires; Wrist; Fractures, Bone; Wrist Injuries; Bandages
PubMed: 38299244
DOI: 10.1142/S2424835524500012 -
PLOS Digital Health Jan 2024Artificial Intelligence (AI), encompassing Machine Learning and Deep Learning, has increasingly been applied to fracture detection using diverse imaging modalities and...
Artificial Intelligence (AI), encompassing Machine Learning and Deep Learning, has increasingly been applied to fracture detection using diverse imaging modalities and data types. This systematic review and meta-analysis aimed to assess the efficacy of AI in detecting fractures through various imaging modalities and data types (image, tabular, or both) and to synthesize the existing evidence related to AI-based fracture detection. Peer-reviewed studies developing and validating AI for fracture detection were identified through searches in multiple electronic databases without time limitations. A hierarchical meta-analysis model was used to calculate pooled sensitivity and specificity. A diagnostic accuracy quality assessment was performed to evaluate bias and applicability. Of the 66 eligible studies, 54 identified fractures using imaging-related data, nine using tabular data, and three using both. Vertebral fractures were the most common outcome (n = 20), followed by hip fractures (n = 18). Hip fractures exhibited the highest pooled sensitivity (92%; 95% CI: 87-96, p< 0.01) and specificity (90%; 95% CI: 85-93, p< 0.01). Pooled sensitivity and specificity using image data (92%; 95% CI: 90-94, p< 0.01; and 91%; 95% CI: 88-93, p < 0.01) were higher than those using tabular data (81%; 95% CI: 77-85, p< 0.01; and 83%; 95% CI: 76-88, p < 0.01), respectively. Radiographs demonstrated the highest pooled sensitivity (94%; 95% CI: 90-96, p < 0.01) and specificity (92%; 95% CI: 89-94, p< 0.01). Patient selection and reference standards were major concerns in assessing diagnostic accuracy for bias and applicability. AI displays high diagnostic accuracy for various fracture outcomes, indicating potential utility in healthcare systems for fracture diagnosis. However, enhanced transparency in reporting and adherence to standardized guidelines are necessary to improve the clinical applicability of AI. Review Registration: PROSPERO (CRD42021240359).
PubMed: 38289965
DOI: 10.1371/journal.pdig.0000438