Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Background
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There are several studies on nonunion, but there are no systematic overviews of the current evidence of risk factors for nonunion. The aim of this study was to systematically review risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures.
Methods
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Medline, Embase, Scopus, and Cochrane were searched using a search string developed with aid from a scientific librarian. The studies were screened independently by two authors using Covidence. We solely included studies with at least ten nonunions. Eligible study data were extracted, and the studies were critically appraised. We performed random-effects meta-analyses for those risk factors included in five or more studies. PROSPERO registration number: CRD42021235213.
Results
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Of 11,738 records screened, 30 were eligible, and these included 38,465 patients. Twenty-five studies were eligible for meta-analyses. Nonunion was associated with smoking (odds ratio (OR): 1.7, 95% CI: 1.2–2.4), open fractures (OR: 2.6, 95% CI: 1.8–3.9), diabetes (OR: 1.6, 95% CI: 1.3–2.0), infection (OR: 7.0, 95% CI: 3.2–15.0), obesity (OR: 1.5, 95% CI: 1.1–1.9), increasing Gustilo classification (OR: 2.2, 95% CI: 1.4–3.7), and AO classification (OR: 2.4, 95% CI: 1.5–3.7). The studies were generally assessed to be of poor quality, mainly because of the possible risk of bias due to confounding, unclear outcome measurements, and missing data.
Conclusion
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Establishing compelling evidence is challenging because the current studies are observational and at risk of bias. We conclude that several risk factors are associated with nonunion following surgically managed, traumatic, diaphyseal fractures and should be included as confounders in future studies.
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University Hospital for Orthopaedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
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Purpose
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A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.
Material and methods
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A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.
Results
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Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.
Conclusion
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Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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The Swedish National Patient Insurance Company, Stockholm, Sweden
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Department of Orthopedics, Hässleholm-Kristianstad Hospitals, Hässleholm, Sweden
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developed treatment protocols can most probably prevent misdiagnosis and maltreatment of scaphoid fractures, leading to pseudoarthrosis and degenerative arthritis. The reasons for misdiagnosis and maltreatment may vary, but considering the potentially
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Computed Tomography Research Group, University of Applied Sciences Upper Austria, Wels, Austria
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Extracorporeal shock wave therapy (ESWT) is a safe therapy and there are only a few side effects known (such as pain during ESWT and minor haematomata), but no severe complications are to be expected if it is performed as recommended.
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Contraindications are severe coagulopathy for high-energy ESWT, and ESWT with focus on the foetus or embryo and focus on severe infection.
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The effect mechanism of ESWT is still a component of diverse studies, but as far as we can summarize today, it is a similar process to a cascade triggered by mechano-transduction: mechanical energy causes changes in the cellular skeleton, which provokes a reaction of the cell core (for example release of mRNA) to influence diverse cell structures such as mitochondria, endoplasmic reticulum, intracellular vesicles, etc., so the enzymatic response leads to the improvement of the healing process.
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The usage of ESWT should be taught, to improve the outcome. Courses should be organized by national societies, since the legal framework conditions are different from one country to another.
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In this update the musculoskeletal indications are addressed (mainly bone and tendons): pseudoarthrosis, delayed fracture healing, bone marrow oedema and osteonecrosis in its early stages, insertional tendinopathies such as plantar fasciitis and Achilles tendon fasciitis, calcifying tendonitis of the rotator cuff, tennis elbow, and wound healing problems.
Cite this article: EFORT Open Rev 2020;5:584-592. DOI: 10.1302/2058-5241.5.190067
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not correspond to the level of osteotomy and were not detected by neuro-monitoring. The incidence of neurological injury in the series of Yang et al 17 and Ahn et al 18 was 3.6% and 12%, respectively. Pseudoarthrosis: this is a late
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arthrodesis. Theriot et al. closed the fascia around the patella and fixed the patellar tendon on the posterior tendons. The authors reported rewarding results compared with AKA but did not mention their pseudoarthrosis rate ( 17 ). Lim et al. fixed the
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% of cases. Delayed bone union or pseudoarthrosis, fracture of the humerus, and infection were observed most often and were at the level of 10%, 6%, and 5% of cases, respectively. The remaining complications were less common, and their frequency was
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in Table 5 . As can be seen, there is a very wide variance in the incidences reported, especially with regard to pseudoarthrosis and implant failures (ranging between 0.5% and 54.0%). Table 5. The probability table for life-threatening (LT) and
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% 18 M OS DF (19 cm) Arthrodesis (screws) CT 49 Pseudoarthrosis, deep infection # NED, na 15 F OS DF (13 cm) Arthrodesis (nail) CT 14 Implant removal NED, MSTS 90% 16 M ES DF (19 cm
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operation, there are also health aspects, such as the avoidance of foreign body reactions, a feeling of alienation and the avoidance of pseudoarthrosis and adverse reactions to metal and metal debris. However, despite all of the advantages mentioned, the
