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Journal of Clinical Neuroscience :... May 2022Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine.... (Meta-Analysis)
Meta-Analysis Review
The Prevalence of Degenerative Cervical Myelopathy-Related Pathologies on Magnetic Resonance Imaging in Healthy/Asymptomatic Individuals: A Meta-Analysis of Published Studies and Comparison to a Symptomatic Cohort.
Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms and examination findings together with MRI findings. In this study, we explore the significance of these degenerative pathology to onset of DCM by performing the first meta-analysis on the prevalence of degenerative features reported on MRI amongst healthy and asymptomatic populations and compare this to the prevalence of degenerative features reported on MRI amongst a symptomatic population calculated in a previous review. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to present day. The search yielded a total of 1098 studies of which 17 were included in this meta-analysis covering a total of 5059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%, 95% Confidence Interval [0.1%, 0.8%]), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%, 95% Confidence Interval [5.3%, 18.4%]) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, 95% Confidence Interval [48.3%, 80.8%], I 100%) were found to be significantly lower in asymptomatic populations. Symptomatic populations have a prevalence of 10.5% (95% Confidence Interval [7.7%, 13.3%]) for ossification of posterior longitudinal ligament, 56.8% (95% Confidence Interval [52.3%, 61.3%]) for enlargement of ligamentum flavum and 89.7% (95% Confidence Interval [86.9%, 92.5%]) for degenerative multilevel disc pathology [18]. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significant relevance to the evolving biomechanical understanding of the disease.
Topics: Cervical Vertebrae; Humans; Hypertrophy; Magnetic Resonance Imaging; Ossification of Posterior Longitudinal Ligament; Prevalence; Spinal Cord Diseases
PubMed: 35255357
DOI: 10.1016/j.jocn.2022.03.002 -
Journal of Clinical Neuroscience :... Apr 2022Neuritis ossificans is a rare disease described as heterotopic calcification that occurs in neural tissue such as nerves. (Review)
Review
BACKGROUND
Neuritis ossificans is a rare disease described as heterotopic calcification that occurs in neural tissue such as nerves.
METHOD
A systematic review of the literature was done in accordance with PRISMA guidelines. An illustrative case of neuritis ossificans of the sciatic nerve in an 18 year old man was also reported.
RESULTS
The review yielded 17 previously reported cases of neuritis ossificans. There was a male predominance and the most common locations were the median and tibial nerves. Only 2 previous cases involved the sciatic nerve. Most were treated with excision with positive outcomes. Our case was treated initially with a biopsy, then partial excision and symptomatic management with NSAIDs and GABA inhibitors. He had a good outcome at 13 months follow-up.
CONCLUSION
Neuritis ossificans is a rare disease with unclear pathophysiology that has been theorized to involve neuroinflammation. Treatment consists of excision, if deemed possible, and symptom control.
Topics: Adolescent; Female; Humans; Male; Neuritis; Ossification, Heterotopic; Rare Diseases; Sciatic Nerve; Tibial Nerve
PubMed: 35202993
DOI: 10.1016/j.jocn.2022.02.021 -
Surgical Technology International May 2022Heterotopic ossification (HO) is a well-recognized complication following operative fixation of acetabular fractures with a range of severity and clinical consequences....
INTRODUCTION
Heterotopic ossification (HO) is a well-recognized complication following operative fixation of acetabular fractures with a range of severity and clinical consequences. The purpose of this review was to: (1) report the incidence of heterotopic ossification (HO) formation following operative fixation of acetabular fractures; (2) determine the effectiveness of prophylactic treatments for HO; and (3) assess the radiographic severity of HO with and without prophylactic treatment.
MATERIALS AND METHODS
A literature search for peer-reviewed articles was conducted utilizing a variety of research databases. PRISMA guidelines were followed and included in this review were full-length, English language manuscripts published before September 2019, using the following search criteria: "heterotopic ossification AND acetabulum OR acetabular." Studies that reported HO as one of the reported outcomes were included. Articles were excluded if radiographic HO was not reported and if it was evaluated in surgeries other than those involved in acetabular fractures. Extracted data included, but was not limited to: type of prophylaxis; incidence of HO; severity of HO based on the Brooker classification; and statistical significance. A methodologic quality appraisal of the included studies was also conducted. A total of 54 full-text studies with 5,890 patients with operatively fixed acetabular fractures met inclusion criteria. There were four level I studies, four level II study, 26 level III studies, and 20 level IV studies.
RESULTS
The overall incidence of HO after acetabular fracture surgery was 28.4%. The rate of HO formation was: 34.9% without prophylaxis, 28.3% with non-steroidal anti-inflammatory drugs (NSAID) prophylaxis, and 21.2% with radiation therapy (RT). Patients receiving a combination of both RT and NSAIDs developed HO 21.8% of the time. The rate of radiographic severe HO was 13.9% (range, 0-75%) in patients without prophylaxis, 9.4% (range, 0-50%) with NSAID prophylaxis, 5.7% (range, 0-12.8%) with RT prophylaxis, and 11.7% (range, 0-18.5%) with the combination of RT and NSAIDs.
CONCLUSION
With the current literature collected in this systematic review, there was a lower incidence and severity of heterotopic bone formation following acetabular fracture fixation using radiation prophylaxis compared to NSAIDs or no treatment. The available literature is heterogeneous in fracture characteristics, surgical approaches, and prophylactic regimens with a general lack of randomized control trials. Further prospective studies are required to make definitive claims on the optimal prophylactic strategy to prevent heterotopic ossification.
Topics: Acetabulum; Anti-Inflammatory Agents, Non-Steroidal; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Ossification, Heterotopic; Postoperative Complications; Retrospective Studies; Spinal Fractures
PubMed: 35157298
DOI: 10.52198/22.STI.40.OS1543 -
Archives of Orthopaedic and Trauma... Feb 2023Acetabulum fracture is one of the most challenging fractures to manage and operate for orthopaedic surgeons; anatomical reduction of fractures and reconstruction of the... (Meta-Analysis)
Meta-Analysis Review
Ilioinguinal versus modified Stoppa approach for open reduction and internal fixation of displaced acetabular fractures: a systematic review and meta-analysis of 717 patients across ten studies.
BACKGROUND
Acetabulum fracture is one of the most challenging fractures to manage and operate for orthopaedic surgeons; anatomical reduction of fractures and reconstruction of the joint is of utmost importance. These factors in turn are dependent on the appropriate surgical approach used to improve the clinical outcomes and reduce associated complications. Hence, this meta-analysis aims to compare the outcomes of ilioinguinal versus modified Stoppa approach for open reduction and internal fixation (ORIF) of displaced acetabular fractures.
METHODS
Medline (PubMed), Embase, Scopus, and Cochrane Library databases were searched from their inception to 10th of June 2021 for both randomized clinical trials (RCTs) and or non-randomized studies comparing the outcomes of ilioinguinal approach and modified Stoppa approach for the ORIF of acetabular fractures. The estimates of treatment effects were described by mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous variables with corresponding 95% confidence (95% CI) intervals. The risk of bias was assessed by MINORS tool for the non-randomized, and the Cochrane Collaboration's risk of bias tool for RCTs.
RESULT
A total of ten studies (717 patients), three RCTs and seven retrospective studies, were included. Modified Stoppa approach showed shorter mean duration of surgery (MD 47.13, 95% CI: 27.30-66.96), lesser number of overall complications (OR 2.14, 95% CI: 1.46-3.13), less intraoperative blood loss (MD 259.65, 95% CI: 152.66-366.64), and lower rates of infection (OR 2.17, 95% CI: 1.14-4.15). However, ilioinguinal approach showed a better quality of fracture reduction (OR 0.59, 95% CI: 0.42-0.82). Results were equivocal in terms of vascular injuries (OR 1.88 (95% CI: 0.86-4.09), nerve injuries (OR 1.77, 95% CI: 0.99-3.17), heterotopic ossification (OR1.74, 95% CI: 0.63-4.82), and clinical outcome (OR 0.81, 95% CI: 0.45-1.47) between the two groups.
CONCLUSION
Modified Stoppa approach carries a lesser duration of surgery, lesser intraoperative blood loss, fewer overall complications, and lesser postoperative infection rates compared to ilioinguinal approach. Although a better anatomical reduction is achieved by ilioinguinal approach, however, this does not translate into better clinic functional outcomes which remain comparable between the two approaches. So overall, modified Stoppa approach seems a better alternative for managing these fractures.
Topics: Humans; Fracture Fixation, Internal; Blood Loss, Surgical; Acetabulum; Fractures, Bone; Hip Fractures; Spinal Fractures; Neck Injuries; Treatment Outcome
PubMed: 35138428
DOI: 10.1007/s00402-022-04369-6 -
Orthopaedics & Traumatology, Surgery &... Apr 2022The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach and three meta-analyses comparing these two approaches for the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The modified Stoppa (MS) approach is an alternative to the ilioinguinal (IL) approach and three meta-analyses comparing these two approaches for the treatment of acetabular fractures were published previously. The aim of this study was to provide an updated systematic review and meta-analysis comparing the MS approach with the IL approach for the treatment of acetabular fractures and to answer the following question: are the results of the MS approach superior to those of the IL approach in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures?
PATIENTS AND METHODS
An updated systematic literature review was conducted using relevant original studies from various databases (PubMed, Web of Science and the Cochrane Library). Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value of<0.05 was considered to be significant. We calculated the mean differences (MDs) for continuous data and odds ratio (OR) for dichotomous data with 95% confidence intervals (CIs) for each outcome. Statistical heterogeneity was assessed based on I using the standard Chi test. When I>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity.
RESULTS
Six studies were included in this meta-analysis. The findings demonstrated that the rate of anatomical reduction was significantly higher in the MS approach than in the IL approach (I=0%, OR=1.75, 95% CI: 1.13-2.69, p=0.01), the operative time was significantly shorter in the MS approach than in the IL approach (I=88%, MD=-63.60, 95% CI: -93.01 - (-34.20), p<0.0001) and operative blood loss was significantly lower in the MS approach than in the IL approach (I=75%, MD=-350.51, 95% CI: -523.45 - (-177.58), p<0.0001). There was no significant difference in the rate of nerve injury (I=0%, OR=0.47, 95% CI: 0.16-1.39, p=0.17), the rate of vascular injury (I=0%, OR=0.51, 95% CI: 0.17-1.49, p=0.22), the rate of infection (I=0%, OR=0.53, 95% CI: 0.25-1.12, p=0.10), the rate of heterotopic ossification (I=45%, OR=0.63, 95% CI: 0.22-1.85, p=0.40), and the rate of excellent or good clinical score (I=21%, OR=1.15, 95% CI: 0.56-2.38, p=0.70) between the two approaches.
DISCUSSION
The MS approach provided better reduction quality, shorter operative time, lower operative blood loss, although there were no significant differences in the rate of complications, and excellent or good clinical score between the two approaches.
LEVEL OF EVIDENCE
III.
Topics: Acetabulum; Blood Loss, Surgical; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Spinal Fractures; Treatment Outcome
PubMed: 35066214
DOI: 10.1016/j.otsr.2022.103204 -
Life (Basel, Switzerland) Jan 2022: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe... (Review)
Review
: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. : We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle' d Augine and Postel Score). We performed a meta-analysis with the available data. : Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2-79%), HO was 20% (95% CI, 2-45%), and AVN was 3% (95% CI, 0-16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0-27%) and Merle d' Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3-38%); ORIF group had the highest AVN rate (11%; 95% CI, 0-92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0-100%) and lowest HO rate (2%; 95% CI, 0-28%). : This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.
PubMed: 35054465
DOI: 10.3390/life12010071 -
Journal of Shoulder and Elbow Surgery May 2022Elbow arthroplasty (EA) is an established technique for the treatment of select distal humeral fractures, yet little data exists regarding the safety and outcome of EA...
BACKGROUND
Elbow arthroplasty (EA) is an established technique for the treatment of select distal humeral fractures, yet little data exists regarding the safety and outcome of EA in the presence of an open distal humeral fracture where the risk of periprosthetic infection is an even greater concern. We hypothesized that EA does not carry an increased risk of infection or other postoperative complications when performed for simple open distal humeral fractures.
METHODS
Seventeen patients underwent total EA (n = 9) or hemiarthroplasty (n = 8) for an open distal humeral fracture. The open fracture component was classified according to the Orthopaedic Trauma Society system as "simple" or "complex." Outcome measures collected included the Mayo Elbow Performance Score (MEPS), range of motion, complications, and reoperations. Patients who underwent primary débridement and implantation were compared with those who underwent preliminary débridement procedures and subsequent staged arthroplasty. A systematic review of the existing literature was performed to analyze other reported cases and contextualize our findings.
RESULTS
The mean follow-up was 46 months (range, 12-138 months). All fractures were multifragmentary and intra-articular. Sixteen patients had a "simple" open fracture and 1 had a "complex" fracture. The overall mean MEPS was 83 (range, 30-100; standard deviation ± 17), with a mean flexion-extension arc of 96°. Patients who underwent primary débridement and implantation demonstrated a higher mean flexion arc (116° vs. 79°, P = .02) than those who underwent staged arthroplasty. The mean MEPS was not significantly different between the groups (90 vs. 78, P = .12). Complications included asymptomatic ulna component loosening (n = 1), joint instability (n = 1), and symptomatic heterotopic ossification (n = 3). There were no deep or superficial infections recorded.
CONCLUSION
EA is safe and effective when performed for simple open distal humeral fractures. Primary débridement and implantation may offer functional benefits over a staged approach.
Topics: Arthroplasty, Replacement, Elbow; Elbow; Elbow Joint; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Open; Humans; Humeral Fractures; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 35017081
DOI: 10.1016/j.jse.2021.12.005 -
International Journal of Oral and... Aug 2022The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to evaluate the revision rate after total alloplastic temporomandibular joint replacement (TMJR) and determine whether there is a higher risk of revision surgery with stock or custom-fitted prostheses (the two most current TMJR prosthesis types). A systematic review was performed, with a search of PubMed, Google Scholar, and the Cochrane Library in November 2020. Overall, 27 articles were included in this study, describing Biomet and TMJ Concepts prostheses and including postoperative data on complications requiring a return to the operating room. A total of 2247 prostheses were analysed: 1350 stock Biomet prostheses and 897 custom-fitted TMJ Concepts and custom-fitted Biomet prostheses. The global revision rate was 1.19 per 100 prosthesis-years. The most common reason for revision was heterotopic bone formation. Stock prostheses appeared to have a lower risk of revision compared to custom prostheses: rate ratio 0.52 (95% confidence interval 0.33-0.81, P-value 0.003). Regarding causes of revision, the only significant difference between the types of devices was a higher rate of heterotopic bone formation for custom-made prostheses (P = 0.001). The results of this study revealed a low revision rate post TMJR revision, with stock devices even less prone to such risk. Nevertheless, these results can be explained by the fact that custom-made prostheses are more likely to be used for cases in which the anatomy is significantly abnormal or there is a history of multiple joint surgeries, which carry a greater risk of complications and heterotopic bone formation.
Topics: Arthroplasty, Replacement; Cimetidine; Humans; Joint Prosthesis; Ossification, Heterotopic; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35012826
DOI: 10.1016/j.ijom.2021.12.012 -
Orthopaedic Journal of Sports Medicine Jan 2022Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported... (Review)
Review
BACKGROUND
Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported adverse outcomes of Grammont-style rTSA.
PURPOSE
To compare the clinical and radiological outcomes of medialized and lateralized center of rotation (COR) in rTSA.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies with a level of evidence ≥3 that compared medialized and lateralized rTSA with a minimum follow-up of 12 months. Functional scores including the American Shoulder and Elbow Surgeons (ASES) score and Constant score (CSS), range of motion at final follow-up, gain of external rotation (ER), visual analog scale (VAS) pain score, scapular notching, and heterotopic ossification (HO) were compared. Data were analyzed using random-effects or fixed-effects models in accordance with heterogeneity.
RESULTS
Five retrospective cohort studies and 1 randomized controlled study (n = 594 patients) were included. Lateralized rTSA resulted in greater improvement in ER degree ( < .001), a lower VAS pain score (standardized mean difference [SMD], -0.39; = .002), and a lower rate of scapular notching (risk ratio [RR], 0.40; < .001) and HO (RR, 0.52; < .001). Final forward flexion (SMD, -0.14; = .629) and ER (SMD, 0.21; = .238) did not differ significantly between the 2 groups. Overall functional scores, including ASES score (SMD, 0.22; = .310) and CSS (SMD, 0.37; = .077), also did not differ significantly (SMD, 0.28; = .062). The overall complication rate did not differ significantly between the 2 groups (RR, 0.71; = .339).
CONCLUSION
Compared with medialized rTSA, lateralized COR rTSA results in greater improvement in ER and the VAS pain score, decreased rates of scapular notching and HO, and no significant changes in functional outcome scores or the complication rate.
PubMed: 35005051
DOI: 10.1177/23259671211063922 -
Acta Ortopedica Brasileira 2021Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures.... (Review)
Review
OBJECTIVE
Heterotopic ossification is defined as the formation of trabecular bone in soft tissues. It is a common complication after surgical treatment of acetabular fractures. However, its prophylaxis and treatment are still controversial. The objective of this research is to evaluate the effectiveness of actions to prevent the development of heterotopic ossification after surgical correction of acetabular fractures.
METHODS
A systematic review was carried out with research in the databases PubMed/MEDLINE, Embase, LILACS and Cochrane until August 4, 2020, without restrictions on language and year of publication. Only randomized clinical studies carried out in humans without restrictions based on the dosage of treatments, use and duration of prophylaxis were included in this review.
RESULTS
Two studies compared the use of radiotherapy and indomethacin and three compared the use of indomethacin with a placebo or non-indomethacin group. The meta-analysis calculations did not indicate statistical differences between radiotherapy versus indomethacin (RR 1.45, IC 95% 0.97 to 2.17, p = 0,55) and indomethacin versus placebo or not indomethacin (RR 0.85, IC 95% 0.68 to 1.06, p = 0,59). There is insufficient evidence to affirm that the use of radiotherapy or indomethacin are effective to prevent the formation of heterotopic ossification after surgery for fractures of the acetabulum. In addition, the number of complications was higher in the indomethacin group when compared to placebo or no intervention.
PubMed: 34849100
DOI: 10.1590/1413-785220212906244689