scholarly journals Intramedullary fixation of distal fibular fractures: a systematic review of clinical and functional outcomes

2014 ◽  
Vol 15 (4) ◽  
pp. 245-254 ◽  
Author(s):  
Sameer Jain ◽  
Benjamin A. Haughton ◽  
Christopher Brew
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Intramedullary Fixation

scholarly journals Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Paul Hoogervorst ◽  
Tess van Dam ◽  
Nico Verdonschot ◽  
Gerjon Hannink
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Intramedullary Fixation ◽  
Common Complication ◽  
Fixation Device ◽  
Operative Strategy ◽  
Fixation Devices ◽  
Clavicle Fractures

Abstract Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures (DMCF) using plate osteosynthesis, is internal fixation by means of intramedullary fixation devices. These devices differ considerably in their specifications and characteristics. The aim of this systematic review is to generate an overview of functional outcomes and complications in the management of DMCF per available intramedullary device.Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group.Results Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively (GRADE High). The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are most common (GRADE Moderate). For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35) (GRADE Low). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases (GRADE Very low). Conclusion Although most studies were of low quality, good functional results and union rates irrespective of the type of device are found. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

scholarly journals Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

2019 ◽  
Author(s):  
Paul Hoogervorst ◽  
Tess van Dam ◽  
Nico Verdonschot ◽  
Gerjon Hannink
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Functional Results ◽  
Intramedullary Fixation ◽  
Common Complication ◽  
Fixation Device ◽  
Operative Strategy ◽  
Clavicle Fractures

Abstract Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures using plate osteosynthesis, is internal fixation by means of an intramedullary fixation device. These devices differ considerably in their specifications and characteristics and an adequate evaluation of their clinical results is warranted. Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases were searched from inception until January 2018. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Results Fifty-eight studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the titanium elastic nail and Sonoma CRx report an average Constant-Murley score of 94.2 (96%CI 93.2-95.3) and 93.4 (95%CI 92.1-94.7) respectively. The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence of 20% (95%CI 14-27) and 13% (95%CI 9-20), are major contributors to the total complication rate. For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 21% (95%CI 11-35). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 7% (95%CI 2-22) of cases. Conclusion Although most studies were of low quality, in general, good functional results and union rates irrespective of the type of device are found in the reviewed literature. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

scholarly journals Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Paul Hoogervorst ◽  
Tess van Dam ◽  
Nico Verdonschot ◽  
Gerjon Hannink
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Intramedullary Fixation ◽  
Common Complication ◽  
Fixation Device ◽  
Operative Strategy ◽  
Clavicle Fractures

Abstract Background: An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures using plate osteosynthesis, is internal fixation by means of an intramedullary fixation device. These devices differ considerably in their specifications and characteristics and an adequate evaluation of their clinical results is warranted.Methods: A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group.Results: Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively. The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are major contributors to the total complication rate. For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases. Conclusion: Although most studies were of low quality, in general, good functional results and union rates irrespective of the type of device are found in the reviewed literature. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.Level of Evidence IV

scholarly journals Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review

Oral Oncology ◽  
2020 ◽  
Vol 109 ◽  
pp. 104848 ◽  
Author(s):  
Jerome R. Lechien ◽  
Nicolas Fakhry ◽  
Sven Saussez ◽  
Carlos-Miguel Chiesa-Estomba ◽  
Younes Chekkoury-Idrissi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Robotic Surgery ◽  
Functional Outcomes ◽  
Transoral Robotic Surgery

scholarly journals Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

2021 ◽  
Author(s):  
Gabriele Anania ◽  
Richard Justin Davies ◽  
Alberto Arezzo ◽  
Francesco Bagolini ◽  
Vito D’Andrea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Neoadjuvant Therapy ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Mesorectal Excision ◽  
Timeline Analysis

Abstract The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer. Methods A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer. Results Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND. Conclusion Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND.

scholarly journals Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review

2016 ◽  
Vol 25 (4) ◽  
pp. 509-516 ◽  
Author(s):  
Zorica Buser ◽  
Darrel S. Brodke ◽  
Jim A. Youssef ◽  
Hans-Joerg Meisel ◽  
Sue Lynn Myhre ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Comparative Studies ◽  
Functional Outcomes ◽  
Retrospective Studies ◽  
Synthetic Bone ◽  
Synthetic Bone Graft ◽  
Bone Graft Substitutes

The purpose of this review was to compare the efficacy and safety of synthetic bone graft substitutes versus autograft or allograft for the treatment of lumbar and cervical spinal degenerative diseases. Multiple major medical reference databases were searched for studies that evaluated spinal fusion using synthetic bone graft substitutes (either alone or with an autograft or allograft) compared with autograft and allograft. Randomized controlled trials (RCT) and cohort studies with more than 10 patients were included. Radiographic fusion, patient-reported outcomes, and functional outcomes were the primary outcomes of interest. The search yielded 214 citations with 27 studies that met the inclusion criteria. For the patients with lumbar spinal degenerative disease, data from 19 comparative studies were included: 3 RCTs, 12 prospective, and 4 retrospective studies. Hydroxyapatite (HA), HA+collagen, β-tricalcium phosphate (β-TCP), calcium sulfate, or polymethylmethacrylate (PMMA) were used. Overall, there were no differences between the treatment groups in terms of fusion, functional outcomes, or complications, except in 1 study that found higher rates of HA graft absorption. For the patients with cervical degenerative conditions, data from 8 comparative studies were included: 4 RCTs and 4 cohort studies (1 prospective and 3 retrospective studies). Synthetic grafts included HA, β-TCP/HA, PMMA, and biocompatible osteoconductive polymer (BOP). The PMMA and BOP grafts led to lower fusion rates, and PMMA, HA, and BOP had greater risks of graft fragmentation, settling, and instrumentation problems compared with iliac crest bone graft. The overall quality of evidence evaluating the potential use and superiority of the synthetic biological materials for lumbar and cervical fusion in this systematic review was low or insufficient, largely due to the high potential for bias and small sample sizes. Thus, definitive conclusions or recommendations regarding the use of these synthetic materials should be made cautiously and within the context of the limitations of the evidence.

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