TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany
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Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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APC III ( n = 11) and LC ( n = 6) injuries ( 18 ), and van Loon et al. included B1.2 injuries ( n = 9) ( 20 ). One hundred twenty-six patients (45%) were treated using SP fixation, and 116 (55%) were treated using SP+SIS fixation. Aggarwal et al
Walsall Manor Hospital, Moat Road, Walsall, WS2 9PS, UK
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Walsall Manor Hospital, Moat Road, Walsall, WS2 9PS, UK
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Platelet-rich plasma (PRP) is an autologous blood product with platelet concentrations above baseline values. The process involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets by plasmapheresis. It then undergoes a two-stage centrifugation process to separate the solid and liquid components of the anticoagulated blood. PRP owes its therapeutic use to the growth factors released by the platelets which are claimed to possess multiple regenerative properties.
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In the knee, PRP has been used in patients with articular cartilage pathology, ligamentous and meniscal injuries.
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There is a growing body of evidence to support its use in selected indications and this review looks at the most recent evidence. We also look at the current UK National Institute of Health & Clinical Excellence (NICE) guidelines with respect to osteoarthritis and the use of PRP in the knee.
Cite this article: EFORT Open Rev 2017;2:28–34. DOI: 10.1302/2058-5241.2.160004.
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In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days.
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Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid.
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After adequate conservative management, union is achieved at six weeks for approximately 90% of non-displaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures.
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Scaphoid waist fractures with moderate displacement (0.5–1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks.
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Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm.
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Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type.
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In general, proximal scaphoid fractures should be treated with internal fixation.
Cite this article: EFORT Open Rev 2020;5:96-103. DOI: 10.1302/2058-5241.5.190025
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NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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based on the stability of the implant and the quality of the surrounding bone. Fig. 1 The Vancouver classification: AG, greater trochanter fracture; AL, lesser trochanter fracture: B1, fracture around the tip of prosthesis-stable implant; B2
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Purpose
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The aim of this study was to systematically review clinical studies on the employed definitions of longitudinal forearm instabilities referred to as Essex-Lopresti (EL) injuries, interosseous membrane (IOM) injuries or longitudinal radioulnar dissociation.
Methods
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A systematic literature search was performed in MEDLINE, Embase, CINAHL, Web of Science and Cochrane databases, adhering to PRISMA guidelines. All data on diagnosis and treatment were collected.
Results
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In total, 47 clinical studies involving 266 patients were included. Thirty-nine of 47 studies did not mention an IOM lesion as part of the EL injury. The amount of preoperative positive ulnar variance varied from >1 to >12 mm. Nine studies used some form of dynamic pre-operative or intraoperative test of longitudinal radioulnar instability.
Conclusions
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There is no accepted definition of EL injury in the literature. In order to prevent underdetection of acute EL injury, a radial head fracture in a patient with wrist and/or forearm pain should raise awareness of the possibility of an EL injury. In this case, comparative radiographic studies and some form of dynamic assessment of longitudinal radioulnar stability should be performed.
Department of Orthopedic Surgery, Spine Unit, Centre Hospitalier de l’Université de Montréal (CHUM), Canada.
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compared with bony B1 fractures and could lead to long-term instability and neurological compromise. Nonetheless, the conclusions drawn on type A fractures could be extended to neurologically-intact type B fractures. In fact, Grossbach et al compared open
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Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Department of Orthopaedics, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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Prosthetic joint infection (PJI) is one of the most devastating complications for a patient following arthroplasty.
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This scoping review aims to evaluate the burden of PJI on individual patients and the healthcare system regarding the mortality rate, patient-reported quality of life, and healthcare resource utilisation.
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Patients with PJI have up to a five-fold higher mortality rate than those who have undergone an uninfected primary arthroplasty. There is an increased use of ambulatory aids and reduced joint function scores in patients with PJI. Global quality of life is poorer, specifically measured by the EQ-5D. Direct hospitalisation costs are two- to five-fold higher, attributed to surgery and prostheses, antibiotics, and a prolonged inpatient stay.
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There is an immense clinical and health economic burden secondary to PJI worldwide. This is expected to rise exponentially due to the increasing number of primary procedures and an ageing population with comorbidities
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Improving preventative and treatment strategies is imperative for patients and the healthcare system.
Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
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Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands
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Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Purpose: Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called ‘high-volume’ hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA.
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Methods: A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale.
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Results: Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found.
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Conclusions: Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.
School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
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Australian Ballet, Southbank, Victoria, Australia
Victorian Institute of Sport, Albert Park Victoria, Australia
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Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
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La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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Purpose
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The aim of the study was to quantify motor cortex descending drive and voluntary activation (VA) in people with lower-limb OA compared to controls.
Methods
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A systematic review and meta-analysis according to the PRISMA guidelines was carried out. Seven databases were searched until 30 December 2022. Studies assessing VA or responses to transcranial magnetic stimulation (TMS; i.e. motor evoked potential, intracortical facilitation, motor threshold, short-interval intracortical inhibition, and silent period) were included. Study quality was assessed using Joanna Briggs Institute criteria and evidence certainty using GRADE. The meta-analysis was performed using RevMan inverse variance, mixed-effect models.
Results
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Eighteen studies were included, all deemed low-quality. Quadriceps VA was impaired with knee OA compared to healthy controls (standardised mean difference (SMD) = 0.84, 95% CI = −1.12–0.56, low certainty). VA of the more symptomatic limb was impaired (SMD = 0.42, 95% CI = −0.75–0.09, moderate certainty) compared to the other limb in people with hip/knee OA. As only two studies assessed responses to TMS, very low-certainty evidence demonstrated no significant difference between knee OA and healthy controls for motor evoked potential, intracortical facilitation, resting motor threshold or short-interval intracortical inhibition.
Conclusions
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Low-certainty evidence suggests people with knee OA have substantial impairments in VA of their quadriceps muscle when compared to healthy controls. With moderate certainty we conclude that people with hip and knee OA had larger impairments in VA of the quadriceps in their more painful limb compared to their non-affected/other limb.
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treated surgically (with or without open reduction internal fixation, ORIF); although non-operative measures are also used. 16 , 17 In general, it is accepted that Vancouver B1 fractures can be treated with ORIF, and some newer studies on Vancouver B2