Risk of Complications Following Surgical Fixation of Femoral Diaphyseal Fractures in Children Aged 4 to 12 years: a Systematic Review and Meta-Analysis.

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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Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.04.071 ◽

2020 ◽

Cited By ~ 1

Author(s):

Po-Yang Tsou ◽

Yu-Kun Ma ◽

Yu-Hsun Wang ◽

Jason T. Gillon ◽

John Rafael ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Upper Extremity ◽

Meta Analysis ◽

Fractures In Children

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Lateral versus posterior surgical approach for the treatment of supracondylar humeral fractures in children: a systematic review and meta-analysis

F1000Research ◽

10.12688/f1000research.53599.2 ◽

2021 ◽

Vol 10 ◽

pp. 573

Author(s):

Komang Agung Irianto ◽

I Putu Gede Pradnyadewa Pradana ◽

Brigita De Vega

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Meta Analysis ◽

Humeral Fracture ◽

Lateral Approach ◽

Surgical Approaches ◽

Eligibility Criteria ◽

Supracondylar Humeral Fracture ◽

Fractures In Children ◽

Cosmetic Outcomes

Background: Supracondylar humeral fracture (SHF) is the most common type of fracture in children. Moreover, lateral and posterior surgical approaches are the most frequently chosen approaches for open reduction surgery in displaced SHF when C-arm is unavailable. However, previous literature showed mixed findings regarding functional and cosmetic outcomes. Currently, no systematic review and meta-analysis has compared these two procedures. Methods: Our protocol was registered at PROSPERO (registration number CRD42021213763). We conducted a comprehensive electronic database search in MEDLINE, EMBASE, and CENTRAL. Two independent reviewers screened the title and abstract, followed by full-text reading and study selection based on eligibility criteria. The quality of the selected studies was analyzed with the ROBINS-I tool. Meta-analysis was carried out to compare the range of motion (functional outcome) and cosmetic outcome according to Flynn’s criteria. This systematic review was conducted based on PRISMA and Cochrane handbook guidelines. Results: Our initial search yielded 163 studies, from which we included five comparative studies comprising 231 children in the qualitative and quantitative analysis. The lateral approach was more likely to result in excellent (OR 1.69, 95% CI [0.97-2.93]) and good (OR 1.12, 95% CI [0.61-2.04]) functional outcomes and less likely to result in fair (OR 0.84, 95% CI [0.34-2.13]) and poor (OR 0.42, 95% CI [0.1-1.73]) functional outcomes compared to the posterior approach. In terms of cosmetic results, both approaches showed mixed findings. The lateral approach was more likely to result in excellent (OR 1.11, 95% CI [0.61-2.02]) and fair (OR 1.18, 95% CI [0.49-2.80]) but less likely to result in good (OR 0.79, 95% CI [0.40-1.55]) cosmetic outcomes. However, none of these analyses were statistically significant (p> 0.05). Conclusion: Lateral and posterior surgical approaches resulted in satisfactory functional and cosmetic outcomes. The two approaches are comparable for treating SHF in children when evaluated with Flynn’s criteria.

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A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0806-1 ◽

2018 ◽

Vol 13 (1) ◽

Author(s):

Lin-Guo ◽

Xue-Ning Zhang ◽

Jian-Ping Yang ◽

Zhi Wang ◽

Yang Qi ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Humeral Fractures ◽

Fractures In Children ◽

Supracondylar Humeral Fractures

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Management of ‘low-risk’ ankle fractures in children: a systematic review

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0027 ◽

2019 ◽

Vol 101 (8) ◽

pp. 539-545

Author(s):

BA Marson ◽

J Ng ◽

Y Myint ◽

DJC Grindlay ◽

BJ Ollivere

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Core Outcome Set ◽

Normal Function ◽

Low Risk ◽

Ankle Fractures ◽

Ankle Motion ◽

Fractures In Children ◽

Outcome Set ◽

Meta Analyses

Introduction This study aimed to review the literature to establish whether there is a best treatment for low-risk ankle fractures in children. Materials and methods A systematic review and meta-analysis of trials was undertaken, which compared interventions for ‘low-risk’ ankle fractures in children. A meta-analysis was performed using a random effects model. Results Four trials were identified reporting outcomes from 256 patients. All trials reported results using a device that permitted ankle motion compared with more rigid immobilisation. Overall risk of bias was low for three trials and high for one trial. Two trials assessed time to return to normal function. Patients treated in a splint or with a bandage recovering 6–7.5 days sooner than those treated with rigid immobilisation. One trial demonstrated that children returned to school sooner if treated in a bandage rather than in a cast. Two trials found a higher Activity Scale for Kids performance score at four weeks for children treated with splint compared with rigid immobilisation. There was no clear advantage to any device in patient satisfaction, quality of life or total costs. Discussion There is no clear best treatment for these injuries. Studies had significant limitations and outcomes were heterogeneous, limiting meta-analysis. Conclusion There is a need for a definitive trial to establish the best treatment for ankle fractures and a core outcome set to ensure study findings are consistent and can be analysed in future meta-analyses.

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