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Journal of Orthopaedic Surgery and... Aug 2023Internal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Internal fixation with cephalomedullary nails has been widely used in the treatment of intertrochanteric femoral fractures (IFF). Yet, the difference in efficacy and safety between the commonly used integrated dual-screw cephalomedullary nail (InterTAN) and single-screw cephalomedullary nail remains inconclusive. Thus we performed the present systematic review and meta-analysis.
METHODS
Randomized controlled trials (RCTs) or observational studies comparing InterTAN with proximal femoral nail anti-rotation (PFNA), the Asian PFNA (PFNA-II), or the Gamma3 nail in treating IFF were searched on PubMed, EMBASE, Web of Science and Cochrane Library from inception to April 30, 2023. The differences in perioperative parameters and clinical and radiological outcomes were evaluated by mean difference (MD) with 95% confidence interval (95%CI). The risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI.
RESULTS
Twenty-three studies comprising 3566 patients were included. Compared with single-screw cephalomedullary nails (PFNA/PFNA-II, Gamma3), InterTAN conferred significantly reduced risk of implant failures (RR = 0.37, 95%CI 0.26 to 0.51, P < 0.001), hip and thigh pain (RR = 0.70, 95%CI 0.55 to 0.90, P = 0.006) and all-cause revision/reoperation (RR = 0.38, 95%CI 0.26 to 0.57, P < 0.001). Moreover, patients treated with InterTAN had significantly higher 1-year Harris Hip Score (MD = 0.82, 95%CI 0.20-1.44, P = 0.010) and shorter time to union/healing (MD = - 0.66 days, 95%CI - 1.16 to - 0.16, P = 0.009). Femoral neck shortening, time to full bearing, and incidences of non-union, infection, deep venous thrombosis, and mortality were comparable between both groups.
CONCLUSIONS
The integrated dual-screw InterTAN construct has superior performance in reducing risks of complications and improving clinical and functional outcomes in the treatment of IFF. More well-designed, high-quality RCTs are warranted to confirm these findings.
Topics: Humans; Hip Fractures; Femur Neck; Wound Healing; Bone Screws; Femur
PubMed: 37599361
DOI: 10.1186/s13018-023-04103-x -
Neurosurgical Review Jul 2023Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or... (Meta-Analysis)
Meta-Analysis Review
Transpetrosal approaches are known to be associated with a significant risk of complications, including CSF leak, facial palsy, hearing impairment, venous injury, and/or temporal lobe injury. We aimed to evaluate the morbidity of the standard combined petrosal approach (CPA), defined as a combination of the posterior (retrolabyrinthine) and the anterior petrosal approach. We performed a systematic review and meta-analysis of articles reporting on clinical series of patients operated on for petroclival meningiomas through CPA. Studies that used the terminology "combined petrosal approach" without matching the aforementioned definition were excluded as well as clinical series that included less than 5 patients. A total of 8 studies were included involving 160 patients. The pooled complication rates were 3% (95% CI, 0.5-5.6) for CSF leak, 8.6% (95% CI, 4.1-13.2%) for facial palsy, 8.2% (95% CI, 3.9-12.6%) for hearing impairment, 2.8% (95% CI, 0.9-6.5%) for venous complications, and finally 4.8% (95%, 1.2-8.4%) for temporal lobe injury. Contrary to the general belief, CPA is associated with an acceptable rate of complications, especially when compared to alternative approaches to the petroclival area. In view of the major advantages like shorter trajectory, multiple angles of surgical attack, and early tumor devascularization, CPA remains an important tool in the armamentarium of the skull base surgeon.
Topics: Humans; Facial Paralysis; Neurosurgical Procedures; Meningioma; Meningeal Neoplasms; Hearing Loss; Petrous Bone
PubMed: 37439884
DOI: 10.1007/s10143-023-02072-7 -
International Journal of Infectious... Sep 2023Chorea following SARS-CoV-2 infection and vaccination, has been increasingly recognized. We aimed to synthesize clinical and paraclinical characteristics, treatment...
OBJECTIVES
Chorea following SARS-CoV-2 infection and vaccination, has been increasingly recognized. We aimed to synthesize clinical and paraclinical characteristics, treatment responses, and outcomes of this neurologic complication.
METHODS
We systematically reviewed LitCOVID, the World Health Organization database on COVID-19, and MedRxiv up to March 2023, following a published protocol.
RESULTS
We included 14 chorea cases in patients with SARS-CoV-2 infection and eight following COVID-19 vaccination. Acute or subacute chorea preceded COVID-19 symptoms within 1-3 days or developed up to 3 months after infection. Frequently it was generalized (85.7%), with associated neurological manifestations (encephalopathy 35.7%; other movement disorders 7.1%). After vaccination, chorea had a sudden onset (87.5%) within 2 weeks (75%); 87.5% of cases presented hemichorea, with hemiballismus (37.5%) or other movement disorders; 12.5% presented additional neurological findings. Cerebrospinal fluid was normal in 50% of infected individuals but abnormal in all vaccinated cases. Brain magnetic resonance imaging detected normal basal ganglia in 51.7% of infection cases and 87.5% following vaccination.
CONCLUSION
In SARS-CoV-2 infection, chorea may present several pathogenic mechanisms: autoimmune response to infection, direct infection-related injury, or an infection-related complication (i.e., acute disseminated encephalomyelitis, cerebral venous sinus thrombosis, hyperglycemia); also, previous Sydenham chorea may relapse. After COVID-19 vaccination, chorea could be due to an autoimmune reaction or other mechanisms (vaccine-induced hyperglycemia, stroke).
Topics: Humans; Chorea; COVID-19; COVID-19 Vaccines; Hyperglycemia; Movement Disorders; SARS-CoV-2; Vaccination
PubMed: 37423421
DOI: 10.1016/j.ijid.2023.07.001 -
European Journal of Orthopaedic Surgery... Oct 2023There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce further heterogeneity and bias to the evidence presented. This meta-analysis aims to present level I evidence by comparing functional outcomes, peri-operative parameters and complications of direct anterior approach (DAA) versus posterior approach (PA) or lateral approach (LA) in THA.
PATIENTS AND METHODS
A comprehensive multi-database search (PubMed, OVID Medline, EMBASE) was conducted from date of database inception to 1st December 2020. Data from randomised controlled trials comparing outcomes of DAA versus PA or LA in THA were extracted and analysed.
RESULTS
Twenty-four studies comprising 2010 patients were included in this meta-analysis. DAA has a longer operative time (MD = 17.38 min, 95%CI: 12.28, 22.47 min, P < 0.001) but a shorter length of stay compared to PA (MD = - 0.33 days, 95%CI: - 0.55, - 0.11 days, P = 0.003). There was no difference in operative time or length of stay when comparing DAA versus LA. DAA also had significantly better HHS than PA at 6 weeks (MD = 8.00, 95%CI: 5.85, 10.15, P < 0.001) and LA at 12 weeks (MD = 2.23, 95%CI: 0.31, 4.15, P = 0.02). There was no significant difference in risk of neurapraxia for DAA versus LA or in risk of dislocations, periprosthetic fractures or VTE between DAA and PA or DAA and LA.
CONCLUSION
The DAA has better early functional outcomes with shorter mean length of stay but was associated with a longer operative time than PA. There was no difference in risk of dislocations, neurapraxias, periprosthetic fractures or VTE between approaches. Based on our results, choice of THA approach should ultimately be guided by surgeon experience, surgeon preference and patient factors.
LEVEL OF EVIDENCE I
Meta-analysis of randomised controlled trials.
Topics: Humans; Arthroplasty, Replacement, Hip; Periprosthetic Fractures; Venous Thromboembolism; Treatment Outcome; Joint Dislocations
PubMed: 37010580
DOI: 10.1007/s00590-023-03528-8 -
Annals of Medicine Dec 2023The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those... (Meta-Analysis)
Meta-Analysis Review
Direct anterior approach versus posterolateral approach for total hip arthroplasty in the treatment of femoral neck fractures in elderly patients: a meta-analysis and systematic review.
OBJECTIVE
The purpose of this meta-analysis was to evaluate the postoperative clinical outcomes of elderly patients who underwent the direct anterior approach (DAA) versus those who received posterolateral approach (PLA) for total hip arthroplasty (THA) in the treatment of femoral neck fractures.
METHODS
An electronic search was conducted in databases including PubMed, Embase, Web of Science, the Cochrane Library, and CNKI from their inception to January 2022. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of DAA compared to PLA for the management of total hip arthroplasty (THA) in elderly patients using the dichotomous or continuous method with a random or fixed-effect model.
RESULTS
15 studies involving 1284 patients were included; 640 patients receiving DAA and 644 patients receiving PLA. DAA had a longer surgery duration than PLA [WMD = 9.41, 95% CI (4.64, 14.19), =95.5%]; The amount of postoperative drainage [WMD= -3.88, 95% CI (-5.59, -2.17), =98.3%], length of incision [WMD= -3.88, 95% CI (-5.59, -2.17), =98.3%], blood loss [WMD= -3.88, 95% CI (-5.59, -2.17), =98.3%], hospitalization time [WMD= -3.88, 95% CI (-5.59, -2.17), =98.3%], and postoperative bedtime [WMD = -5.56,95% CI (-7.11, -4.01), =99.0%], were similar between the two groups ( < 0.05). The HHS at 1 month, 12 months postoperatively [WMD = 7.58, 95%CI (5.70,9.46), =89.5%; WMD= 2.56, 95%CI 0.11,5.00, =93.2%] and the incidence of LFCN in patients were higher in the DAA group (OR = 2.91, 95% CI 1.26 to 6.71, =0.0%), while fewer patients in the DAA group suffered from postoperative dislocation than in the PLA group (OR = 0.26, 95% CI 0.11 to 0.60, =0.0%). No significant difference was observed in HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively at each time point, acetabular anteversion angle, acetabular abduction angle, wound infection, deep vein thrombosis, and intraoperative fracture ( > 0.05).
CONCLUSIONS
DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients than PLA. However, DAA was found to be associated with a high incidence of lateral femoral cutaneous nerve injury and a low incidence of postoperative dislocation.Key messagesThe present study aims to evaluate the clinical outcomes in elderly patients receiving DAA versus PLA for THA in the treatment of femoral neck fractures by mate-analysis.DAA offers a quicker functional recovery and is less invasive with an earlier return to daily activities in older THA patients. No significant difference was observed between the colchicine and comparators in terms of the need for HHS at 1 week, 3 months, and 6 months postoperatively, VAS postoperatively, acetabular anteversion angle, acetabular abduction angle, and complications (wound infection, deep vein thrombosis, and intraoperative fracture).
Topics: Aged; Humans; Arthroplasty, Replacement, Hip; Femoral Neck Fractures; Treatment Outcome; Venous Thrombosis
PubMed: 37000019
DOI: 10.1080/07853890.2023.2193424 -
Hip International : the Journal of... Nov 2023Hip fractures represent 1 of the most common injuries in older adults. They are associated with increased perioperative morbidity and mortality. Additionally, current... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Hip fractures represent 1 of the most common injuries in older adults. They are associated with increased perioperative morbidity and mortality. Additionally, current research suggests that SARS-COV-2 infection may worsen the prognosis of the hip fracture patients who undergo hip fixation. The aims of the present study were: (1) to determine the rate of specific adverse events including VTE (venous thromboembolism) and major adverse cardiovascular events (MACEs) in patients with hip fracture and concomitant SARS-CoV-2 infection undergoing surgery; and (2) to examine if the aforementioned population is at increased risk for VTE and MACEs, when compared to SARS-CoV-2 free patients with hip fracture.
METHODS
PubMed, EMBASE, Cochrane, Web of Science, Google scholar and medRxiv were searched from March 2020 to January 2021 for English language studies with patients suffering from hip fractures and SARS-COV-2 -CoV-2. 2 researchers were involved in the data extraction and the quality assessment of the studies respectively.
RESULTS
The literature search yielded a total of 1256 articles of which 14 were included in the systematic review and 7 in the meta-analysis respectively. The estimated pooled rate for VTE and MACE were 4.3% and 6.3% respectively. Patients with hip fracture and concomitant SARS-CoV-2 infection who undergo surgery are at increased risk for VTE, when compared to SARS-CoV-2 free patients (odds ratio 2.8 [95% CI, 1.1-7.1]). These patients are also at increased risk for MACE postoperatively as indicated by the odds ratio 2.4 (95% CI, 1.0-5.8). The quality of the studies was moderate.
CONCLUSIONS
Although there is a lack of high-quality data it seems that patients with hip fractures and concomitant SARS-CoV-2 infection are facing a 2.8 and 2.4 times increased risk for VTE and MACE.
Topics: Humans; Aged; Venous Thromboembolism; COVID-19; SARS-CoV-2; Arthroplasty, Replacement, Hip; Hip Fractures
PubMed: 36285337
DOI: 10.1177/11207000221132489