Thromboembolic complications after surgical fixation of bone metastases: A systematic review

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

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Comparison of Time to Healing and Major Complications after Surgical Fixation of Nondisplaced Femoral Neck Stress Fractures: A Systematic Review

Injury ◽

10.1016/j.injury.2021.02.046 ◽

2021 ◽

Author(s):

Jensen G. Kolaczko ◽

Christopher J. McMellen ◽

Steven J. Magister ◽

Robert J. Wetzel

Keyword(s):

Systematic Review ◽

Femoral Neck ◽

Stress Fractures ◽

Major Complications ◽

Surgical Fixation

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Systematic Review of the Role of Stereotactic Radiotherapy for Bone Metastases

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz101 ◽

2019 ◽

Vol 111 (10) ◽

pp. 1023-1032 ◽

Cited By ~ 8

Author(s):

Katie L Spencer ◽

Joanne M van der Velden ◽

Erin Wong ◽

Enrica Seravalli ◽

Arjun Sahgal ◽

...

Keyword(s):

Systematic Review ◽

Bone Metastases ◽

Local Control ◽

Stereotactic Radiotherapy ◽

Palliative Radiotherapy ◽

Included Study ◽

Pain Response ◽

Solid Organ ◽

International Consensus ◽

Conventional Radiotherapy

Abstract Background Stereotactic radiotherapy (SBRT) might improve pain and local control in patients with bone metastases compared to conventional radiotherapy, although an overall estimate of these outcomes is currently unknown. Methods A systematic review was carried out following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Embase, and Cochrane databases were systematically searched to identify studies reporting pain response and local control among patients with bone metastases from solid-organ tumors who underwent SBRT in 1–6 fractions. All studies prior to April 15, 2017, were included. Study quality was assessed by predefined criteria, and pain response and local control rates were extracted. Results A total of 2619 studies were screened; 57 were included (reporting outcomes for 3995 patients) of which 38 reported pain response and 45 local control rates. Local control rates were high with pain response rates above those previously reported for conventional radiotherapy. Marked heterogeneity in study populations and delivered treatments were identified such that quantitative synthesis was not appropriate. Reported toxicity was limited. Of the pain response studies, 73.7% used a retrospective cohort design and only 10.5% used the international consensus endpoint definitions of pain response. The median survival within the included studies ranged from 8 to 30.4 months, suggesting a high risk of selection bias in the included observational studies. Conclusions This review demonstrates the potential benefit of SBRT over conventional palliative radiotherapy in improving pain due to bone metastases. Given the methodological limitations of the published literature, however, large randomized trials are now urgently required to better quantify this benefit.

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Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review

BMJ Open ◽

10.1136/bmjopen-2018-024737 ◽

2019 ◽

Vol 9 (5) ◽

pp. e024737

Author(s):

Alison Booth ◽

Helen Margaret Ann Ingoe ◽

Matthew Northgraves ◽

Elizabeth Coleman ◽

Melissa Harden ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Case Series ◽

Fragility Fractures ◽

Hospital Length Of Stay ◽

Cochrane Central Register ◽

Lateral Compression ◽

Post Surgery ◽

Surgical Fixation ◽

And Function

ObjectivesTo undertake a systematic review of the evidence base for the effectiveness of surgical fixation of lateral compression (LC-1) fragility fractures of the pelvis compared with non-surgical approaches.SearchesMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and two international trials registers were searched up to January 2017 (MEDLINE to February 2019) for studies of internal or external fixation of fragility fractures of the pelvis.ParticipantsPatients with lateral compression pelvic fractures, sustained as the result of a low-energy mechanism, defined as a fall from standing height or less.InterventionsSurgery using either external or internal fixation devices. Conservative non-surgical treatment was the defined comparator.Outcome measuresOutcomes of interest were patient mobility and function, pain, quality of life, fracture union, mortality, hospital length of stay and complications (additional operative procedures, number and type of adverse events and serious adverse events).Quality assessment and synthesisThe Joanna Briggs Institute Checklist for Case Series was used to assess the included studies. Results were presented in a narrative synthesis.ResultsOf 3421 records identified, four retrospective case series met the inclusion criteria. Fixation types were not consistent between studies or within studies and most patients had more than one type of pelvic fixation. Where reported, mobility and function improved post-surgery, and a reduction in pain was recorded. Length of hospital stay ranged from 4 days to 54 days for surgical fixation of any type. Reported complications and adverse outcomes included: infections, implant loosening, pneumonia and thrombosis. Use of analgesia was not reported.ConclusionsThere is insufficient evidence to support guidance on the most effective treatment for patients who fail to mobilise after sustaining an LC-1 fragility fracture.Trial registration numberCRD42017055872.

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