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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Purpose
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This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities.
Methods
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Following PRISMA guidelines, we conducted a comprehensive search of databases from 2000 to 2023. This search identified 15 relevant studies involving a total of 33 patients. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria.
Results
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Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization.
Conclusion
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Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.
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Purpose
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To compile all the scientific evidence available to date to evaluate the effect of virtual reality based therapy (VRBT) on reducing pain intensity, kinesiophobia, and associated disability, and on increasing the hr-QoL in patients with chronic neck pain (CNP) or chronic low back pain (CLBP).
Methods
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Studies published in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete, and Physiotherapy Evidence Database (PEDro) up to June 2023 were searched. All searches followed the PICOS Framework. Two authors independently screened the studies found in the searches. Any differences of opinion regarding the selection of studies were settled by a third author.
Results
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Twenty-five RCTs, published between 2013 and 2022, providing data from 1261 patients (20 RCTs) with CLBP and 261 patients (five RCTs) with CNP, were included. In reducing pain intensity for patients with CLBP, meta-analyses showed that VRBT is effective in reducing pain just to the end of the intervention, and this effect could be maintained 1 and 6 months after the therapy.
Conclusion
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VRBT was found to be better than therapeutic exercise (TE), sham, and no intervention (NI), showing a major effect when VRBT was used as a complementary therapy to conventional physiotherapy (CPT). Further, VRBT showed an immediate effect and immersive VRBT was the most adequate VRBT modality in reducing pain in CNP patients. No differences were found between non-immersive VRBT and immersive VRBT in reducing pain, kinesiophobia, disability, and hr-QoL in patients with CLBP.
Dworska Hospital, Kraków, Poland
Hospital in Proszowice, Poland
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Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies.
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The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries.
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The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs.
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Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed.
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There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears.
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In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results.
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The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.
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Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch behind the posterior surface of the distal tibia.
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BF is a complex injury affecting multiple structures of the ankle joint, which is still frequently misjudged even today, potentially leading to severe complications.
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CT examination, including 3D reconstructions, should be the diagnostic standard in BF, as it provides a complete picture of the fracture pathoanatomy, most prominently the morphology of the frequently associated posterior malleolar fracture.
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BF requires early reduction of the displaced fibular fragment without repeated attempts on closed reduction. Non-operative treatment of BF almost always fails. The standard treatment procedure is early open reduction internal fixation.
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Due to the relative severity and paucity of the injury, BF seems to be particularly prone to soft tissue complications, including compartment syndrome.
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The results of operative treatment are mixed. Many studies report persistent pain even after a short time interval, with limitations of the range of motion or even stiffness of the ankle joint, and development of degenerative changes. Larger studies with long-term results are still missing.
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Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Purpose
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Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor.
Methods
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A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the ‘Down and Black’s Checklist for measuring quality’.
Results
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About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient’s will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%).
Conclusion
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The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient’s willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.
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Department of Hematology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China
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Purpose
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For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not increase the risk of wound infection, it remains rare in practice for patients to be allowed earlier postoperative bathing. We performed this meta-analysis to determine how earlier bathing affected rates of wound infection, other complications, and patient satisfaction.
Methods
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This systematic review conforms to PRISMA guidelines. The PubMed, EMBASE, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception dates to December 31, 2022. We estimated pooled values for the efficacy of trial of earlier bathing versus delayed bathing using the odds ratio and their associated 95% CI, and we used the I 2 statistic to assess heterogeneity between studies contributing to these estimates.
Results
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Of the 1813 articles identified by our search, 11 randomized controlled trials including 2964 patients were eligible for inclusion. The incidence of wound infection did not differ significantly between the earlier bathing and delayed bathing groups, nor did rates of other wound complications such as redness and swelling, or wound dehiscence. However, the incidence of hematoma in the delayed bathing group was higher than in the earlier bathing group. Reported patient satisfaction was significantly higher in the earlier bathing group.
Conclusion
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The medical community, health authorities, and government should create and disseminate clinical practice guidelines to guide patients to evidence-based beneficial treatment.
NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, Porto, Portugal
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CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Hospital das Forças Armadas, Porto, Portugal
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Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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CINTESIS@RISE - Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
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Study design
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Systematic review; meta-analysis.
Purpose
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Lumbar degenerative disease is frequent and has a tremendous impact on patients’ disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures.
Methods
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Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: ‘(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion’. PRISMA guidelines were followed.
Results
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Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition.
Conclusion
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Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.
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Objective
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Through meta-analysis, this study aims to comprehensively evaluate the efficacy of single-plating and double-plating in the treatment of comminuted fractures of the distal femur.
Methods
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Computer searches of PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang digital journals were performed, and the timeframe for the searches was from the establishment of each database to July 2023 for each of the databases. Meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Library, and the review process was registered in the PROSPERO database.
Results
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A total of ten studies were included for statistical analysis. One randomised controlled study and nine retrospective cohort studies with a total of 563 patients were included. The double-plate group was superior to the single-plate group in terms of knee mobility at 6 months postoperatively, overall postoperative complications, and the rate of healing of knee deformity. However, it increased the operation time and intraoperative bleeding, and the difference between the two groups was statistically significant (P < 0.05). There was no significant difference between the two groups in terms of excellent knee function rate, fracture healing time, plate fracture, postoperative infection, delayed fracture healing, and non-union (P ≥ 0.05).
Conclusion
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Double plate fixation for comminuted fractures of the distal femur can improve knee mobility at 6 months postoperatively, reduce overall postoperative complications, and decrease the incidence of malunion healing. However, it increases operative time and bleeding. Randomised studies are needed to provide strong evidence in the future.
Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Department of Emergency Medicine, Emergency University Hospital, Bucharest, Romania
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Department of Orthopaedics and Traumatology, Emergency University Hospital Bucharest, Romania
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Renal cell carcinoma (RCC) is a common type of tumor that can develop in the kidney. It is responsible for around one-third of all cases of neoplasms. RCC manifests itself in a variety of distinct subtypes. The most frequent of which is clear cell RCC, followed by papillary and chromophobe RCC.
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RCC has the potential for metastasis to a variety of organs; nevertheless, bone metastases are one of the most common and potentially fatal complications. These bone metastases are characterized by osteolytic lesions that can result in pathological fractures, hypercalcemia, and other complications, which can ultimately lead to a deterioration in quality of life and an increase morbidity.
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While nephrectomy remains a foundational treatment for RCC, emerging evidence suggests that targeted therapies, including tyrosine kinase inhibitors and T cell checkpoint inhibitors, may offer effective alternatives, potentially obviating the need for adjuvant nephrectomy in certain cases of metastatic RCC
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Bone metastases continue to be a difficult complication of RCC, which is why more research is required to enhance patient outcome.
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Purpose
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Primary bone tumors of the fibula are rare. Distal fibular resection has a significant impact on ankle biomechanics and gait, possibly leading to complications such as ankle instability, valgus deformity, and degenerative changes. Question: Is there a need for reconstructive surgery after distal fibular resection, and what reconstructive procedures are available?
Materials and methods
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The review is registered with the PROSPERO International Register of Systematic Reviews. Inclusion criteria consisted of all levels of evidence, human studies, patients of all ages and genders, publication in English, and resection of the distal portion of the fibula due to tumor pathology. The reviewers defined four different categories of interest by method of treatment. Additional articles of interest during full-text review were also added.
Results
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The initial search resulted with a total of 2958 records. After screening, a total of 50 articles were included in the study. Articles were divided into ‘No reconstruction’, ‘Soft tissue reconstruction’, ‘Bone and soft tissue reconstruction’, and ‘Arthrodesis, arthroplasty or other reconstruction options’ groups.
Conclusion
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Limb salvage surgery should be followed by reconstruction in order to avoid complications. Soft tissue reconstructions should always be considered to stabilize the joint after fibular resection. Bone reconstruction with reversed vascularized fibula is the preferred technique in young patients and in cases of bone defects more than 3 cm, while arthrodesis should be considered in adult patients. Whenever possible for oncologic reason, if a residual peroneal malleolus could be preserved, we prefer augmentation with a sliding ipsilateral fibular graft.
