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Clinical Rheumatology Feb 2023Osteoarticular manifestations such as arthritis and bone pain are scarce among adults with acute lymphoblastic leukemia (ALL). We present a systematic review of... (Review)
Review
Osteoarticular manifestations such as arthritis and bone pain are scarce among adults with acute lymphoblastic leukemia (ALL). We present a systematic review of osteoarticular first clinical manifestation related to ALL in adults, and we report a case of an adult patient with a B-cell ALL revealed by refractory pygalgia and arthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including case reports and case series describing osteoarticular manifestations revealing ALL in adults. There were 29 patients with osteoarticular manifestations, revealing ALL (including our case). The mean age was 34.00 ± 13.29 years. Osteoarticular manifestations were peripheral articular signs (7 cases), axial manifestations (17 cases), and osteolytic lesions (21 cases). Vertebral fractures were reported in 4 cases. MRI was performed in 15 cases, showing heterogeneous signal changes in the vertebra, skull, and sacroiliac bones. It showed avascular necrosis of the femoral head in one case. PET scan, performed in 7 cases, showed diffuse or localized FDG uptakes in the bone marrow. Hypercalcemia was noted in 9 cases. The treatment was based on chemotherapy (23 patients) and radiotherapy (4 cases). During the follow-up, remission was noted in 14 cases, death in 9 cases, and was not available in 6 patients. Our review showed that axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of ALL in adults, making the diagnosis of ALL difficult to recognize, leading to a diagnosis delay. Key Points • Acute lymphoblastic leukemia in adults revealed by osteoarticular manifestations can be misdiagnosed as rheumatic diseases. • Axial manifestations, joint swelling, bone pain, and hypercalcemia could be the first and only symptoms of acute lymphoblastic leukemia in adults. • Complete blood count and calcium blood test should be performed as first-line investigations in adults with axial or peripheral articular symptoms. • Physicians should be aware of this clinical presentation to avoid diagnosis delay and improve prognosis.
Topics: Humans; Adult; Young Adult; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Arthritis; Joint Diseases; Bone Diseases; Acute Disease; Pain
PubMed: 36454343
DOI: 10.1007/s10067-022-06459-7 -
Oral Surgery, Oral Medicine, Oral... May 2023The recent trend favors the open reduction and internal fixation of condylar fractures to prevent long-term consequences. Nonendoscopic intraoral approach is an option... (Review)
Review
OBJECTIVE
The recent trend favors the open reduction and internal fixation of condylar fractures to prevent long-term consequences. Nonendoscopic intraoral approach is an option for management without a visible scar. The purpose of this systematic review was to explore the evidence, armamentarium, methods of reduction and fixation, challenges, and complications.
STUDY DESIGN
We have systematically reviewed published articles on the intraoral approach for condylar fracture management following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane library database, to find relevant articles from January 1980 to March 2022. Descriptive statistics were applied to obtain the results.
RESULTS
Finally, 23 studies were included. The incision described for the intraoral approach was similar to sagittal split osteotomy in all studies. A wide array of specialized instruments, methods, and challenges has been outlined for visualization, reduction, and fixation. The incidence of complications in the entire review was 23% (72/306).
CONCLUSION
The challenges encountered in the nonendoscopic intraoral approach for condylar fracture management can be negated with the use of specialized instruments and with experience. However, further research is warranted for a specialized set of miniature instruments to ease the procedure, make it time-efficient and optimize hardware selection.
Topics: Humans; Mandibular Condyle; Mandibular Fractures; Fracture Fixation, Internal; Osteotomy
PubMed: 36257907
DOI: 10.1016/j.oooo.2022.09.003 -
Ophthalmic Plastic and Reconstructive...The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital blow-in fractures involving compression of the globe by bone...
PURPOSE
The purpose of this study was to describe the clinical characteristics, management, and outcomes of orbital blow-in fractures involving compression of the globe by bone fragments.
METHODS
A retrospective case series and systematic literature review were performed.
RESULTS
Three male patients (mean age 29 years) with orbital blow-in fractures causing globe indentation presented with extraocular movement restriction, choroidal folds, and B-scan ultrasonography demonstrating deformation of the globe contour by a hyperechoic bone fragment. All underwent surgical repair within 1 day of presentation resulting in improved visual outcomes. An additional 10 cases were identified in the literature review. The majority of patients were male (80%) with a mean age of 29 years. Fractures originated primarily from the lateral orbital wall (50%) or the orbital roof (40%). Globe compression was evident on CT of the orbit (100%) and ultrasonography (30%). Common presenting signs included decreased visual acuity (70%), restriction of supraduction (40%) or abduction (40%), choroidal folds (30%), brow laceration (40%), periorbital edema (40%), and hypoglobus (40%). Most patients underwent surgical intervention (80%) involving fracture reduction (50%) or fragment removal (38%). Reported postsurgical outcomes were excellent with resolution of diplopia, motility, and visual acuity.
CONCLUSION
Globe indentation from blow-in fractures are rare. Clinicians should be suspicious in cases of high-velocity trauma to the superolateral orbit with hypoglobus, motility limitation, and indentation of the globe upon dilated exam. Prompt diagnosis and early surgical removal of the compressive orbital bone fragments in a multidisciplinary fashion can lead to good visual, functional, and cosmetic outcomes.
Topics: Humans; Male; Female; Adult; Retrospective Studies; Orbital Fractures; Cellulitis; Diplopia
PubMed: 36190787
DOI: 10.1097/IOP.0000000000002272 -
The British Journal of Oral &... Nov 2022Oral and maxillofacial (OMFS) facial fractures account for approximately 5%-10% of presentations to emergency departments in the UK. Although most trauma is treated... (Review)
Review
Oral and maxillofacial (OMFS) facial fractures account for approximately 5%-10% of presentations to emergency departments in the UK. Although most trauma is treated operatively, different methods of surgery exist for the same clinical presentation and non- surgical management is in some cases appropriate. Analysis of patient morbidity is an essential component of clinical governance in surgery. OMFS units in the UK should hold regular morbidity and mortality (M&M) meetings, but no consensus exists for which cases should be discussed. For example, most units focus only on cases treated surgically, primarily unexpected returns to theatre. Finally, there is no agreed structure for describing how complications occur and a focus on terms such as error. The aim of this review is to help inform which patients should be discussed in M&M meetings based on existing scoring systems. A systematic review of the literature has been undertaken using the Preferred Reporting in Systematic Reviews and Meta-Analysis methodology. Databases searched were PubMed and Science Direct. Eleven unique papers and a companion article met the criteria and were analysed. Many M&M classification systems exist, but these systems are unsuited for maxillofacial purposes. There is a need for a novel system which is tailored to the specialty.
Topics: Humans; Emergency Service, Hospital; Skull Fractures
PubMed: 36115744
DOI: 10.1016/j.bjoms.2022.08.006 -
International Journal of Pediatric... Nov 2022Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for...
OBJECTIVE
Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for work-up, diagnosis, treatment, and otolaryngological follow-up of pediatric basilar skull fractures secondary to MLFs. Through a systematic literature review and retrospective review of an institution's trauma experience, we sought to identify clinical findings among pediatric MLF patients that indicate the need for otolaryngological follow-up.
METHODS
A two-researcher team following the PRISMA guidelines performed a systematic literature review. PubMed, Web of Science, and EBSCO databases were searched August 16th 2020 and again on November 20th 2021 for English language articles published after 1980 using search terms Pediatric AND (fall OR "multi level fall" OR "fall from height") AND ("basilar fracture" OR "basilar skull fracture" OR "skull base fracture" OR "skull fracture"). Simultaneously, an institutional trauma database and retrospective chart review was performed for all patients under age 18 who presented with a MLF to a pediatric tertiary care center between 2007 and 2018.
RESULTS
168 publications were identified and 13 articles reporting pediatric basilar skull fracture data and MLF as a mechanism of injury were selected for review. MLF is the most common etiology of BSF, accounting for 26.5-37.7% of pediatric BSFs. In the retrospective review, there were 180 cases of BSF from MLF in the study period (4.2%). BSF and fall height were significantly associated (p < 0.001), as well as presence of a CSF leak and fall height (p = 0.02), intracranial hemorrhage (ICH) (p = 0.047), and BSF fracture type (p < 0.001). However, when stratified by age, these associations were only present in the younger group. Of those with non-temporal bone BSFs (n = 71), children with hemotympanum (n = 7) were approximately 18 times more likely (RR 18.3, 95% CI 1.89 to 177.02) than children without hemotympanum (n = 64) to have hearing loss at presentation (28.6% vs. 1.6% of patients).
CONCLUSIONS
MLF is the most common cause of pediatric basilar skull fractures. However, there is limited information on the appropriate work-up or otolaryngologic follow-up for this mechanism of injury. Our retrospective review suggests fall height is predictive for BSF, ICH, and CSF leak in younger children. Also, children with non-temporal bone BSFs and hemotympanum may represent a significant population requiring otolaryngology follow-up.
Topics: Adolescent; Child; Humans; Retrospective Studies; Skull; Skull Fractures
PubMed: 36030630
DOI: 10.1016/j.ijporl.2022.111291 -
The Journal of Craniofacial SurgeryEncephaloceles rarely develop following traumatic skull fractures. Given their low incidence, the clinical presentations and management strategies of these lesions are...
Encephaloceles rarely develop following traumatic skull fractures. Given their low incidence, the clinical presentations and management strategies of these lesions are confined to case reports and limited case series. A systematic literature review was performed using PubMed, Ovid, and Web of Science databases to identify relevant articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 37 articles met inclusion criteria, including the case presented herein. These articles reported 52 traumatic encephaloceles. Mean patient age was 25.3 years (range 6 mo-66 y) with a male predominance (63%, 33/52). The most common bony defects resulting in encephalocele formation were the orbital roof (52%, 27/52), ethmoid (35%, 18/52), and sphenoid (10%, 5/52). Mean time from traumatic injury to initial presentation was 21.3 months (range 0 d-36 y) with a bimodal distribution split between immediately following the traumatic injury (57%, 26/46) or in a delayed manner (43%, 20/46). Common presentations of orbital roof, frontonasal, and temporal bone encephaloceles were exophthalmos (85%, 23/27), cerebrospinal fluid rhinorrhea (71%, 17/24), and hearing loss (100%, 4/4), respectively. Operative approach, repair technique, and materials used for encephalocele reduction were highly variable. Surgical intervention afforded definitive symptomatic improvement or resolution in the majority of cases (89%, 42/47). Clinical outcomes did not differ between orbital, frontonasal, or temporal bone encephaloceles ( P =0.438). Traumatic encephaloceles are a rare entity with diverse presenting symptomatology dependent upon the location of fracture dehiscence. Surgical intervention affords symptomatic improvement in the majority of cases irrespective of encephalocele location, time to presentation, or operative approach.
Topics: Humans; Male; Child; Female; Encephalocele; Cerebrospinal Fluid Rhinorrhea; Temporal Bone; Orbit; Hearing Loss
PubMed: 36000749
DOI: 10.1097/SCS.0000000000008955 -
The British Journal of Oral &... Nov 2022The purpose of this study was to determine if three-dimensional (3D) printed orbit models and preoperative plate contouring provides benefit over traditional surgical... (Meta-Analysis)
Meta-Analysis Review
The purpose of this study was to determine if three-dimensional (3D) printed orbit models and preoperative plate contouring provides benefit over traditional surgical reconstruction of orbit fractures. This systematic review and meta-analysis searched five databases to identify cases of 3D printing for orbital fracture reconstruction. Primary outcomes were resolution of diplopia and enophthalmos, orbital volume symmetry and operation duration. Meta-analyses were used to calculate log odds ratios (OR) for diplopia and enophthalmos and absolute mean difference for orbital volume. A total of 58 articles describing 906 patient cases were included. A single article for each of diplopia and enophthalmos compared 3D printing with traditional management, which prevented answering the primary research question. However, pre-post meta-analysis showed that postoperative groups were less likely to have diplopia (n = 747, log OR = -2.35, 95%CI -1.72 to -2.98, p < 0.001, I = 10.91%) and enophthalmos (n = 486, log OR = -2.47, 95%CI -1.95 to -2.99, p < 0.001, I = 11.33%) than preoperatively. Mean orbital volume did not differ between the repaired and uninjured orbits (n = 290, mean difference = -0.13 cm, 95%CI -0.48 to 0.22, p = 0.472, I = 9.48%). Pooled mean operation duration for orbital reconstruction with 3D printing was 67.70 minutes (standard error [SE] = 4.24 minutes). Orbital reconstruction combined with 3D printing adequately restores orbital volume symmetry and improves diplopia and enophthalmos. Due to a lack of controlled studies, it remains unclear what contribution 3D printing alone makes to these results. Three-dimensional printing is likely a safe, accurate and effective adjunct; however, further controlled studies are required.
Topics: Humans; Enophthalmos; Diplopia; Plastic Surgery Procedures; Tomography, X-Ray Computed; Orbital Fractures; Printing, Three-Dimensional; Orbit; Retrospective Studies
PubMed: 35931592
DOI: 10.1016/j.bjoms.2022.07.001 -
Journal of Stomatology, Oral and... Nov 2022The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures.
METHODS
A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.
RESULTS
Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I=29.33%) were statistically significantly higher in the two miniplates arm.
CONCLUSION
One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.
Topics: Humans; Bone Plates; Fracture Fixation, Internal; Pseudarthrosis; Cicatrix; Mandibular Fractures; Malocclusion
PubMed: 35872351
DOI: 10.1016/j.jormas.2022.07.008 -
American Journal of Surgery Nov 2022While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death. (Meta-Analysis)
Meta-Analysis Review
Full-face motorcycle helmets to reduce injury and death: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.
BACKGROUND
While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death.
METHODS
We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929).
RESULTS
Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]).
CONCLUSION
Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.
Topics: Humans; Accidents, Traffic; Brain Injuries, Traumatic; Craniocerebral Trauma; Head Protective Devices; Motorcycles; Practice Management; Skull Fractures; Practice Guidelines as Topic
PubMed: 35821175
DOI: 10.1016/j.amjsurg.2022.06.018 -
Journal of Stomatology, Oral and... Nov 2022This systematic review aims to investigate the effect of virtual planning on the treatment of zygomaticomaxillary complex (ZMC) traumatology followed by intraoperative...
OBJECTIVE
This systematic review aims to investigate the effect of virtual planning on the treatment of zygomaticomaxillary complex (ZMC) traumatology followed by intraoperative navigation. Furthermore, clinical outcomes following intraoperative navigation surgery or conventional surgery will be compared.
MATERIALS AND METHODS
A systematic literature search was conducted in PubMed, Embase, Web-of-Science, and Cochrane on January 1st, 2022. Inclusion criteria were articles using preoperative three-dimensional (3D) virtual planning combined with intraoperative navigation or comparing these 3D methods with conventional methods. Furthermore, at least one of the following outcomes needed to be included in the article: technical accuracy of the procedure, preoperative planning time, operative time, number of fixation points, patient satisfaction, complications, or total costs of the intervention.
RESULTS
Following the screening of 4478 articles, 17 were included. Five articles appeared to indicate a significantly better technical linear accuracy, one article reported better accuracy for rotation and two articles showed better accuracy in restoring orbital volume when using navigation. Nine articles investigated operative time with varying results. Seven articles calculated the additional costs, of which three concluded no extra cost while the others indicated high additional costs or questionable cost-effectiveness.
CONCLUSION
Virtual planning and intraoperative navigation technologies have the potential to assist maxillofacial trauma surgeons in reducing ZMC fractures significantly more accurately and restoring the facial contour in a less invasive manner at an acceptable cost.
REGISTRATION
The protocol for this systematic review (CRD42020216717) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).
Topics: Humans; Zygomatic Fractures
PubMed: 35809796
DOI: 10.1016/j.jormas.2022.07.003