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Medicine Aug 2022Surgical outcomes of the paratricipital approach (PT) and olecranon osteotomy (OO) for the treatment of distal humerus intra-articular fracture have been reported.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgical outcomes of the paratricipital approach (PT) and olecranon osteotomy (OO) for the treatment of distal humerus intra-articular fracture have been reported. However, there is no consensus regarding which approach is better in terms of functional outcomes and complications. This study aimed to compare the operation time, functional outcomes, and complications of OO and PT.
METHODS
The databases of MEDLINE, Embase, and Cochrane Library were systematically searched for studies published before June 1, 2021. We performed synthetic analysis of the operation time, functional outcomes, and incidence of complication after the conduct of OO group or PT group in patients with distal humerus intra-articular fractures.
RESULTS
Five studies were included representing a total of 243 patients who underwent surgery for distal humerus intra-articular fractures. A pooled analysis showed that there was a longer operation time in the OO group compared with the PT group (mean difference [MD] = 13.32, 95% CI: 3.78-22.87; P = .006). There was no significant difference between the functional outcomes of the OO and PT groups (elbow flexion: MD = 2.4, 95% CI: -0.82 to 5.79, P = .14; elbow extension: MD = 0.36, 95% CI: -2.20 to 2.92, P = .78; elbow arc of motion: MD = 0.40, 95% CI: -4.05 to 4.84, P = .86; Mayo Elbow Performance score: MD = -1.37, 95% CI: -4.73 to 1.98, P = .42). The incidence of infection was significantly higher in the OO group compared with that of the PT group (odds ratio [OR] = 3.82, 95% CI: 1.03-14.16, P = .04). There was no significant difference between the 2 groups in terms of the heterotopic ossification and ulnar neuropathy (OR = 1.85, 95% CI: 0.51-6.71, P = .35 and OR = 2.74, 95% CI: 0.60-12.48, P = .19, respectively).
CONCLUSIONS
Since the choice of surgical approach does not influence outcomes, surgeons can base their choice of approach on the basis of their own experience and familiarity with the procedure and the need to visualize the entire articular surface in complex intra-articular fracture patterns.
Topics: Elbow Joint; Fracture Fixation, Internal; Humans; Humeral Fractures; Humerus; Intra-Articular Fractures; Olecranon Process; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 36042686
DOI: 10.1097/MD.0000000000030289 -
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 -
Journal of Orthopaedics and... Jul 2022Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are used as prophylaxis for HO following THA. This meta-analysis compared selective versus non-selective NSAIDs as prophylaxis for HO following THA.
MATERIAL AND METHODS
The present study was conducted according to the PRISMA 2020 guidelines. All the clinical investigations comparing selective versus non-selective NSAIDs as prophylaxis for HO following THA were accessed in February 2022. An assessment of the methodological quality and statistical analyses were performed through the risk of bias summary tool of the Review Manager 5.3 software (Cochrane Collaboration, Copenhagen). The modified Brooker staging system was used to rate the efficacies of the interventions.
RESULTS
Data from 8 studies and 1526 patients were collected. 60.8% were female. No difference was found in the sample size, mean age, and percentage of females between the two groups at baseline. No statistically significant difference was found between selective and non-selective NSAIDs in term of efficacy. 72% (1078 of 1502) of the patients were classified as Brooker 0, 21% (322 of 1502) as Brooker I, 5% (80 of 1502) as Brooker II, 1% (16 of 1502) as Brooker III, and 0.1% (2 of 1502) as Brooker IV.
CONCLUSION
Selective and non-selective NSAIDs were equally effective when used as prophylaxis for HO following THA.
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthroplasty, Replacement, Hip; Female; Humans; Male; Ossification, Heterotopic; Treatment Outcome
PubMed: 35809109
DOI: 10.1186/s10195-022-00646-7 -
Journal of Clinical Orthopaedics and... Jun 2022The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment...
Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis.
PURPOSE
The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures.
MATERIAL AND METHODS
The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article.
RESULTS
A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups.
CONCLUSION
Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis.
PubMed: 35515344
DOI: 10.1016/j.jcot.2022.101876 -
Acta Orthopaedica Belgica Mar 2022The management of elbow fracture-dislocations is challenging. The internal joint stabiliser (IJS) (Skeletal Dynamics, Miami, FL) has been advocated as an alternative to...
The management of elbow fracture-dislocations is challenging. The internal joint stabiliser (IJS) (Skeletal Dynamics, Miami, FL) has been advocated as an alternative to traditional techniques. This article shares our initial clinical experience and provide a systematic review analysing the ability of the IJS to maintain radiographic joint reduction and the associated complication profile. Two cases of elbow fracture-dislocations treated at our centre using the IJS are presented. A systematic review of the literature was conducted using the online databases Medline, Scopus and EMBASE. Clinical studies reporting the maintenance of joint reduction after the use of IJS in patients with acute or chronic elbow instability were included. The two cases reported remained radiographically concentric at 6 months follow up without complications. 5 studies met the inclusion criteria and were included in the systematic review (total n=65). Only two patients across the studies had ongoing radiological instability (3%) and both were associated with coronoid insufficiency. The mean flexion-extension arc ranged from 106° to 135° and pronation- supination arc ranged from 138° to 151°. The mean DASH scores ranged from 16 to 37.3 and the mean Broberg and Morrey Functional score from 68.2 to 93. Complication rates in the case series ranged from 21% to 40%, the commonest complications were heterotopic ossification, neuropathy and infections. Initial reports into the use of the Internal Joint Stabiliser for elbow instability have shown a low incidence of residual radiological joint incongruency.
Topics: Elbow; Elbow Joint; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Joint Instability; Radius Fractures; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 35512168
DOI: 10.52628/88.1.21 -
American Journal of Physical Medicine &... Feb 2023The role of kinesiotherapy in heterotopic ossification remains unclear. The goal of this study was to revisit the literature on the preventive role of kinesiotherapy...
OBJECTIVE
The role of kinesiotherapy in heterotopic ossification remains unclear. The goal of this study was to revisit the literature on the preventive role of kinesiotherapy against heterotopic ossification formation and maturation.
DESIGN
A systematic review was performed in MEDLINE, OVID, Scopus, and Cochrane databases.
RESULTS
A high-quality clinical trial is missing from the literature. Of 9617 studies primarily identified, nine studies offered the proper data and were included. They infer that satisfactory results on neurogenic heterotopic ossification prevention were achieved with passive exercises, including continuous passive motion, that were initiated early and at a painless range of motion. On the contrary, for elbow posttraumatic heterotopic ossification and major joints burn-associated heterotopic ossification, active range of motion is indicated as early as possible.
CONCLUSIONS
Because of the very low quality of the studies included in this review, firm conclusions cannot be drawn about the effectiveness of kinesiotherapy. Nevertheless, it is recommended that controlled passive range of motion exercises (especially continuous passive motion) be applied early and pain-free especially in the neurogenic heterotopic ossification patients while active range of motion in painless limits is beneficial in the heterotopic ossification prevention of traumatic elbows or burn joints.
Topics: Humans; Elbow; Elbow Joint; Ossification, Heterotopic; Elbow Injuries; Burns; Range of Motion, Articular
PubMed: 35512120
DOI: 10.1097/PHM.0000000000002043 -
BMC Musculoskeletal Disorders Apr 2022Lumbar total disc replacement (TDR) is an alternative to lumbar fusion in the treatment of lower back pain and reduces the risk of adjacent segment degeneration....
BACKGROUND CONTEXT
Lumbar total disc replacement (TDR) is an alternative to lumbar fusion in the treatment of lower back pain and reduces the risk of adjacent segment degeneration. Heterotopic ossification (HO) has been identified as a common complication following lumbar TDR.
PURPOSE
This systematic review aims to determine the prevalence, risk factors and clinical and radiological impact of HO following lumbar TDR.
STUDY DESIGN
Systematic Review.
METHODS
MEDLINE, Scopus, PubMed and Cochrane Central were searched for articles that referred to lumbar TDR and HO. The hits were assessed against inclusion and exclusion criteria. Data from each included study was extracted and analysed with respect to the study aims.
RESULTS
Twenty-six studies were included in this review and the pooled prevalence of HO was estimated to be between 13.2% (participants) and 15.3% (vertebral levels). TDR clinical outcomes were not found to be reduced by HO and there was insufficient data to identify a given impact upon radiological outcomes. Age and follow up time were identified as potential risk factors for HO.
CONCLUSIONS
This review was hampered by inconsistencies in the reporting of HO across the studies. We therefore recommend that a set of guidelines should be produced to aid future researchers and reduce the risk of bias.
Topics: Humans; Intervertebral Disc Degeneration; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Ossification, Heterotopic; Total Disc Replacement; Treatment Outcome
PubMed: 35461244
DOI: 10.1186/s12891-022-05322-9 -
Revista Espanola de Cirugia Ortopedica... 2022Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity....
BACKGROUND
Lateral humeral condyle fractures are the second most common fracture around the elbow in children. However, the association of an elbow dislocation is a rare entity. Therefore, literature on young patients with this uncommon combination is sparse. We aimed to perform a systematic review of the literature searching for pediatric lateral condyle humerus fractures associated to elbow dislocation.
METHODS
A systematic review of the PubMed and Embase databases was conducted for peer-reviewed literature between 1960 and 2020. Two reviewers filtered the results, looking for articles in English and Spanish that reported fractures of the lateral condyle of the humerus associated to elbow dislocation in skeletally immature patients. Outcomes included patient and injury characteristics, treatment strategies, complications, and final outcomes including range of motion.
RESULTS
The initial search yielded a total of 851 studies. After initial screening, 16 studies were included, with 67 patients available for review. Age reported at the time of injury ranged from 2 to 12 years. The lesion occurred more commonly in males (60%) with Milch II, and Jakob type 3 fractures. The direction of the dislocation was posteromedial in most cases. Open reduction by lateral approach and Kirschner pin placement was the most performed treatment. The reported follow-up ranged from 3 to 156 months. Fourteen studies reported complications in 1/3 of the patients including: limited range of motion, cubitus varus, instability, hardware prominence, delayed union, nonunion, malunion, heterotopic ossification, neurological injury, and hardware failure. Thirteen studies reported clinical outcomes, which were rated as fair or poor in 2out of 10patients.
CONCLUSIONS
Current evidence is level IV and suggests that the complication rate after surgical management of lateral condyle fractures is substantial in the context of an associated elbow dislocation, with an elevated percentage of suboptimal results. The most frequent complications in this series were elbow stiffness and cubitus varus.
PubMed: 35404796
DOI: 10.1016/j.recot.2021.07.008 -
Journal of Shoulder and Elbow Surgery Jul 2022In patients with distal humerus fractures that are unreconstructible, total elbow arthroplasty is an established alternative to open reduction-internal fixation. Distal... (Review)
Review
BACKGROUND
In patients with distal humerus fractures that are unreconstructible, total elbow arthroplasty is an established alternative to open reduction-internal fixation. Distal humerus hemiarthroplasty is a further alternative to avoid the significant lifestyle limitations associated with total elbow arthroplasty. Distal humerus hemiarthroplasty is an increasingly popular treatment option for unreconstructible distal humeral fractures not amenable to reconstruction. The aim of this systematic review was to assess the literature regarding the functional outcomes and complications of the use of distal humerus hemiarthroplasty for acute trauma.
METHODS
A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "distal humerus fracture" OR "elbow fracture" AND "hemiarthroplasty" OR "arthroplasty" OR "replacement." Studies were limited to those published in the English language with reported functional outcome measures and complications. Patient demographic characteristics, implant systems, clinical outcomes (range of motion and functional outcome scores), and complications were extracted.
RESULTS
Thirteen studies with a total of 207 patients met the inclusion criteria. The average age ranged from 44 to 79 years, with the mean length of follow-up ranging from 11 to 82 months postoperatively. A mean range-of-motion arc ≥ 93° was achieved in all studies, with 11 of 13 studies achieving mean functional range of motion ≥ 100°. All studies reported good to excellent mean outcome scores. Heterotopic ossification, ulnar cartilage wear, stiffness, and ulnar neuropathy were the most commonly encountered complications. The reoperation rate and revision rate were 17% and 3%, respectively.
CONCLUSIONS
Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures, with good to excellent outcomes expected. Long-term outcome data and the use of distal humerus hemiarthroplasty in younger patients are yet to be fully defined.
Topics: Child; Child, Preschool; Elbow Joint; Fracture Fixation, Internal; Hemiarthroplasty; Humans; Humeral Fractures; Humerus; Range of Motion, Articular; Treatment Outcome
PubMed: 35337953
DOI: 10.1016/j.jse.2022.02.015 -
Shoulder & Elbow Apr 2022This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. (Review)
Review
PURPOSE
This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes.
METHODS
Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations.
RESULTS
Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols.
CONCLUSION
Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period.
PubMed: 35265188
DOI: 10.1177/1758573220957631