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European Journal of Trauma and... Jun 2022The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess... (Review)
Review
PURPOSE
The aim of this systematic review was to provide an overview of current applications of 3D technologies in surgical management of tibial plateau fractures and to assess whether 3D-assisted surgery results in improved clinical outcome as compared to surgery based on conventional imaging modalities.
METHODS
A literature search was performed in Pubmed and Embase for articles reporting on the use of 3D techniques in operative management of tibial plateau fractures. This systematic review was performed in concordance with the PRISMA-guidelines. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Differences in terms of operation time, blood loss, fluoroscopy frequency, intra-operative revision rates and patient-reported outcomes between 3D-assisted and conventional surgery were assessed. Data were pooled using the inverse variance weighting method in RevMan.
RESULTS
Twenty articles evaluating 948 patients treated with 3D-assisted surgery and 126 patients with conventional surgery were included. Five different concepts of 3D-assisted surgery were identified: '3D virtual visualization', '3D printed hand-held fracture models', 'Pre-contouring of osteosynthesis plates', '3D printed surgical guides', and 'Intra-operative 3D imaging'. 3D-assisted surgery resulted in reduced operation time (104.7 vs. 126.4 min; P < 0.01), less blood loss (241 ml vs. 306 ml; P < 0.01), decreased frequency of fluoroscopy (5.8 vs. 9.1 times; P < 0.01). No differences in functional outcome was found (Hospital for Special Surgery Knee-Rating Scale: 88.6 vs. 82.8; P = 0.23).
CONCLUSIONS
Five concepts of 3D-assisted surgical management of tibial plateau fractures emerged over the last decade. These include 3D virtual fracture visualization, 3D-printed hand-held fracture models for surgical planning, 3D-printed models for pre-contouring of osteosynthesis plates, 3D-printed surgical guides, and intra-operative 3D imaging. 3D-assisted surgery may have a positive effect on operation time, blood loss, and fluoroscopy frequency.
Topics: Bone Plates; Fracture Fixation, Internal; Humans; Operative Time; Printing, Three-Dimensional; Tibial Fractures; Treatment Outcome
PubMed: 34463771
DOI: 10.1007/s00068-021-01773-2 -
Annals of Translational Medicine Apr 2022The aim of the present study was to systematically evaluate the application value and complications of 3D printing technology on Schatzker tibial platform fracture...
BACKGROUND
The aim of the present study was to systematically evaluate the application value and complications of 3D printing technology on Schatzker tibial platform fracture surgery.
METHODS
By searching the Cochrane Library, PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM), screening randomized controlled trials (RCTs), and two researchers included the study according to PICOS criteria and performed bias risk assessments. Quality evaluation and data extraction were performed for the included literatures, and meta-analysis was performed for RCTs included at using Review Manager 5.2 software.
RESULTS
A total of 15 articles were included in the present study, which included a total of 758 patients, 342 3D printing techniques, 416 conventional surgical procedures. Meta-analysis showed 3D printing operation time [risk difference (RD) =-0.12, 95% CI: -0.16, -0.08, I=46%, P<0.00001], surgical bleeding [odds ratio (OR) =0.59, 95% CI: 0.45-0.77, I=0%, P<0.001), intraoperative fluoroscopy (OR =0.59, 95% CI: 0.41-0.85, I=0%, P=0.004), fracture healing time (OR =0.46, 95% CI: 0.33-0.63, I=0%, P<0.00001), and complication morbidity (OR =0.60, 95% CI: 0.45-0.81, I=0%, P=0.001) were significantly lower than in the traditional group.
DISCUSSION
3D printing technology for tibia platform fracture surgery has advantages of reduced operation time, less surgical bleeding, less complications, less intraoperative perspective, fast fracture healing, and can improve the accuracy of tibial platform fracture reduction and postoperative knee function recovery.
PubMed: 35530967
DOI: 10.21037/atm-21-7008 -
Sports Health Jul 2016Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly... (Review)
Review
CONTEXT
Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods.
OBJECTIVE
To determine the current evidence for the treatment of and return to sport after tibial shaft fractures.
DATA SOURCES
OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014.
STUDY SELECTION
Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non-English language were excluded.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis.
RESULTS
A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, -83.36 to -55.64; P < 0.01). Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P < 0.01).
CONCLUSION
The general principles are to undertake surgical management for displaced fractures and to attempt nonsurgical management for undisplaced fractures. Primary surgical intervention of undisplaced fractures, however, may result in higher return rates and shorter return times, though this exposes the patient to the risk of surgical complications, which include surgical site infection and compartment syndrome.
Topics: Casts, Surgical; Fracture Fixation, Internal; Humans; Postoperative Complications; Return to Sport; Tibial Fractures; Time Factors
PubMed: 27340245
DOI: 10.1177/1941738115601425 -
Journal of Orthopaedic Surgery and... May 2022To review the current clinical evidence on advantages and risks of early weight bearing (EWB) after internal fixation for tibial plateau fracture. (Review)
Review
BACKGROUND
To review the current clinical evidence on advantages and risks of early weight bearing (EWB) after internal fixation for tibial plateau fracture.
METHODS
Data source: PubMed and Google Scholar from inception of database to 20 August 2021, using PRISMA guidelines. The included studies were randomized controlled trials, prospective and retrospective observational studies, case reports. Data extraction was performed independently by 2 reviewers. Collected data were compared to verify agreement. Statistical analysis was not performed in this study.
RESULTS
The literature search produced 174 papers from PubMed and 186 from Google Scholar, with a total amount of 360 papers. The two reviewers excluded 301 papers by title or duplicates. Of the 59 remaining, 33 were excluded after reading the abstract, and 17 by reading the full text. Thus, 9 papers were finally included in the review.
CONCLUSIONS
EWB can be considered safe and effective in selected cases after internal fixation for tibial plateau fractures. Level of evidence Therapeutic Level III.
Topics: Fracture Fixation, Internal; Humans; Prospective Studies; Retrospective Studies; Tibial Fractures; Treatment Outcome; Weight-Bearing
PubMed: 35549974
DOI: 10.1186/s13018-022-03156-8 -
Knee Surgery, Sports Traumatology,... Nov 2023Tibial plateau fractures (TPFs) may lead to posttraumatic osteoarthritis and increase the risk for total knee arthroplasty (TKA). The aim of this systematic review was... (Review)
Review
PURPOSE
Tibial plateau fractures (TPFs) may lead to posttraumatic osteoarthritis and increase the risk for total knee arthroplasty (TKA). The aim of this systematic review was to analyse the conversion rate to TKA after TPF treatment.
METHODS
A systematic search for studies reviewing the conversion rate to TKA after TPF treatment was conducted. The studies were screened and assessed by two independent observers. The conversion rate was analysed overall and for selected subgroups, including different follow-up times, treatment methods, and study sizes.
RESULTS
A total of forty-two eligible studies including 52,577 patients were included in this systematic review. The overall conversion rate of treated TPF to TKA in all studies was 5.1%. Thirty-eight of the forty-two included studies indicated a conversion rate under 10%. Four studies reported a higher percentage, namely, 10.8%, 10.9%, 15.5%, and 21.9%. Risk factors for TKA following TPF treatment were female sex, age, and low surgeon and hospital volume. The conversion rate to TKA is particularly high in the first 5 years after fracture.
CONCLUSION
Based on the studies, it can be assumed that the conversion rate to TKA is approximately 5%. The risk for TKA is manageable in clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42023385311.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Female; Male; Arthroplasty, Replacement, Knee; Osteoarthritis, Knee; Tibial Plateau Fractures; Tibial Fractures; Risk Factors; Retrospective Studies; Treatment Outcome; Tibia
PubMed: 37792085
DOI: 10.1007/s00167-023-07585-8 -
Knee Surgery & Related Research Aug 2020One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intra-operative fracture during revision knee arthroplasty has been... (Review)
Review
BACKGROUND
One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intra-operative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty.
METHODS
The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords "intra-operative fracture", "distal femoral fracture", "tibial fracture", "patella fracture" and "primary total knee arthroplasty". A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review.
RESULTS
The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component.
CONCLUSIONS
Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.
PubMed: 32778166
DOI: 10.1186/s43019-020-00054-3 -
Annals of Medicine Dec 2022A meta-analysis of eligible studies was performed to evaluate the effectiveness of bone substitute materials (BSMs) in opening wedge high tibial osteotomy (OWHTO) for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A meta-analysis of eligible studies was performed to evaluate the effectiveness of bone substitute materials (BSMs) in opening wedge high tibial osteotomy (OWHTO) for knee osteoarthritis.
METHODS
A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive literature search was performed, and studies comparing BSM with bone graft (BG) and without bone graft (WG) were included. The Cochrane risk of bias tool (version 1.0) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool were used to assess the risk of bias for randomized controlled trials (RCTs) and non-randomized studies (NRSs), respectively. The outcomes measured were the osteotomy gap size, the occurrence rates of non-union and lateral hinge fractures, knee functional score, infection and the Visual Analogue Scale (VAS). The quality of evidences was evaluated by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system.
RESULTS
Five RCTs and eight NRS including 769 participants were included in our meta-analysis. The BSM group had a larger osteotomy gap size than the control group (MD: 0.41 mm, 95% confidence interval (CI): [0.06, 0.76], =.02, =0%), with a significant difference. No significant difference was found between BSM and control group in main analysis in terms of bone non-union, but with a higher non-union rate when BSM combined with long locking plate was used. No significant differences were found in other outcome measures except for VAS from NRS subgroup. The quality of evidence for outcomes was low.
CONCLUSIONS
BSM combined with locking plate techniques offers a safe and efficient alternative option in OWHTO for osteotomy gap larger than 10 mm, but be aware of the possibility of bone non-union. Given the inherent heterogeneity and low quality of the included studies, future well-designed RCTs are essential to verify the findings.KEY MESSAGEThe treatment of the osteotomy gap is still controversial.BSM combined with a locking plate offers a safe and efficient alternative option for OWHTO with an over 10 mm of osteotomy gap over 10 mm.Due to the inherent heterogeneity and low quality of the included studies, the results should be cautiously interpreted in clinical practice.
Topics: Bone Plates; Bone Substitutes; Humans; Osteoarthritis, Knee; Osteotomy; Tibia
PubMed: 35166617
DOI: 10.1080/07853890.2022.2036805 -
Plastic and Reconstructive Surgery Dec 2008The question of whether to recommend amputation or salvage after type IIIB and IIIC tibial fractures remains unanswered. The purpose of this study was to conduct a... (Review)
Review
BACKGROUND
The question of whether to recommend amputation or salvage after type IIIB and IIIC tibial fractures remains unanswered. The purpose of this study was to conduct a systematic review to derive evidence-based recommendations concerning primary amputation versus limb salvage for type IIIB and IIIC open tibial fractures.
METHODS
Articles from Medline, Cinahl, and Embase that met predetermined criteria were included. Outcomes of interest included length of hospital stay, complications, rehabilitation time, quality of life, limb function, pain, and return to work data. Pooling of statistical data was performed when possible.
RESULTS
The authors reviewed 1947 articles, and 28 observational studies were included. Length of hospital stay was 56.9 days for salvage patients and 63.7 days for amputees. The most common complications after salvage attempt were osteomyelitis (17.9 percent), nonunion (15.5 percent), secondary amputation (7.3 percent), and flap failure (5.8 percent). Rehabilitation time for salvaged patients was reported as time to union (10.2 months) and time to full weight-bearing (8.1 months). Pain, quality of life, and limb function outcomes were assessed differently among studies and could not be combined. The proportion of patients who returned to work was 63.5 percent for salvage patients and 73 percent for amputees.
CONCLUSIONS
The current literature offers no evidence to support superior outcomes of either limb salvage or primary amputation for type IIIB and IIIC tibial fractures. When outcomes are similar between two treatment strategies, economic analysis that incorporates cost and preference (utility) may define an optimal treatment strategy to guide physicians and patients.
Topics: Amputation, Surgical; Humans; Limb Salvage; Postoperative Complications; Plastic Surgery Procedures; Tibial Fractures
PubMed: 19050533
DOI: 10.1097/PRS.0b013e31818d69c3 -
Chinese Journal of Traumatology =... Apr 2017To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF)... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture.
METHODS
We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated.
RESULTS
Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group.
CONCLUSION
LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.
Topics: Combined Modality Therapy; External Fixators; Fracture Fixation, Internal; Humans; Tibial Fractures
PubMed: 28359592
DOI: 10.1016/j.cjtee.2016.06.012 -
International Journal of Surgery... Sep 2018The objective of this meta-analysis was to assess the influence of three dimensional printing technology on the open reduction and internal fixation (ORIF) of tibial... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
The objective of this meta-analysis was to assess the influence of three dimensional printing technology on the open reduction and internal fixation (ORIF) of tibial plateau fractures from current randomized controlled trials and prospective comparative studies.
METHODS
The electronic literature database of Pubmed, Embase, and Cochrane library were searched in January 2018. The data operation time, intraoperative blood loss, follow-up knee function (Rasmussen score, HSS) and complications (including infection, screw loosening, knee stiffness, knee instability, posttraumatic osteoarthritis, VTE) were extracted. Stata 12.0 software was used for our meta-analysis.
RESULTS
11 RCTs and 6 prospective comparative studies met our inclusion criteria with 358 tibial plateau fractures patients in the 3D group and 378 patients in the routine ORIF group. The meta-analysis showed that there were significant differences in operation time, intraoperative blood loss and bony union time between the 3D group and conventional group. As for the complications and follow-up function recovery evaluated by the excellent and good rate based on HSS and Rasmussen score, no significant differences were found.
CONCLUSION
The 3D group showed shorter operation time, less intraoperative blood loss and faster union time for patients with tibial plateau fractures. Therefore, compared with conventional ORIF, ORIF assisted by three-dimensional printing technology should be a more appropriate treatment of tibial plateau fractures. Further large-sample randomized controlled trials are needed in the future to confirm the superiority of three-dimensional printing assisted ORIF.
Topics: Adult; Aged; Blood Loss, Surgical; Bone Screws; Female; Fracture Fixation, Internal; Humans; Knee Joint; Male; Middle Aged; Open Fracture Reduction; Operative Time; Printing, Three-Dimensional; Prospective Studies; Randomized Controlled Trials as Topic; Tibia; Tibial Fractures; Treatment Outcome; Young Adult
PubMed: 30081183
DOI: 10.1016/j.ijsu.2018.07.012