An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis

Abstract Background The purpose of this meta-analysis was to compare clavicle hook plates versus distal clavicle locking plates for the treatment of Neer type II distal clavicle fractures. Methods PubMed (1996 to January 2019), Embase (1980 to January 2019), Web of Science (1990 to January 2019), the Cochrane Library (January 2019), and the China National Knowledge Infrastructure (January 2019) were systematically searched without language restrictions for literature retrieval. The Constant-Murley shoulder joint function score at 3 and 6 months after the operation and the postoperative complications after the operation (shoulder joint pain, abduction restriction, fracture delay healing, subacromial impingement) were the outcomes. Stata 12.0 was used for the meta-analysis. Results A total of 9 clinical trials involving 446 patients were finally included in this meta-analysis. The results showed that the improvement in the Constant-Murley shoulder joint function score in the distal locking plate group was better than that in the clavicle hook plate group at 3 and 6 months after the operation (P < 0.05). There were fewer cases of shoulder joint pain and restricted shoulder abduction range of motion in the distal locking plate group, and the difference was statistically significant (P < 0.05). There were no statistically significant differences in fracture delay healing and subacromial impingement between the two groups (P > 0.05). Conclusion Compared with the clavicular hook plate, the distal clavicle locking plate for the treatment of Neer type II distal clavicle fractures is associated with better shoulder function recovery and fewer complications related to pain and abduction restriction.

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Arthroscopically assisted coraco-clavicular ligament reconstruction in treatment of acute displaced distal clavicle fractures provides good to excellent shoulder function despite low union rates and high complication rates. A systematic review.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.06.034 ◽

2021 ◽

Author(s):

Shahbaz S. Malik ◽

Muaaz Tahir ◽

Sheraz Malik ◽

Adam Kwapisz ◽

Robert W. Jordan

Keyword(s):

Systematic Review ◽

Ligament Reconstruction ◽

Shoulder Function ◽

Complication Rates ◽

Distal Clavicle ◽

Arthroscopically Assisted ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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Concomitant glenohumeral injuries in patients with distal clavicle fractures undergoing arthroscopic-assisted surgery: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-022-02919-7 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Theodorakys Marín Fermín ◽

Filippo Migliorini ◽

Emmanuel Papakostas ◽

Khalid Al-Khelaifi ◽

David Ricardo Maldonado ◽

...

Keyword(s):

Systematic Review ◽

Surgical Management ◽

Assessment Tool ◽

Shoulder Arthroscopy ◽

Distal Clavicle ◽

Injury Type ◽

Rotator Cuff Injuries ◽

Diagnostic Arthroscopy ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

Abstract Background To determine the incidence of concomitant intra-articular glenohumeral injuries in patients undergoing surgical management from distal clavicle fractures (DCF) with shoulder arthroscopy and their impact on outcome. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, EMBASE, and Virtual Health Library databases were accessed in October 2021. All the clinical studies evaluating the surgical management of DCF and using concomitant intra-operatory shoulder arthroscopy were included. Studies that did not specify the concomitant injury type were not eligible. Data from the incidence of intra-articular glenohumeral injuries, injury type, length of the follow-up, and clinical outcomes were retrieved. The quantitative content assessment was performed using the STROBE statement checklist. Evaluation of the publication bias of the included studies was performed using the risk of bias assessment tool for systematic reviews. Results Data from five retrospective and five prospective cohort studies were analyzed. Eight of the included studies were conducted on patient cohorts with Neer type II injuries. Data pooling revealed a mean of 17.70% of concomitant glenohumeral injuries, whereas 84.21% of them required additional surgical management (Table 1). Rotator cuff injuries, labral tears, and biceps pulley lesions were the most common concomitant injuries. Conclusion Preoperative MRI or diagnostic arthroscopy to evaluate glenohumeral associated injuries to DCF should be recommended.

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Outcomes of Arthroscopic Fixation of Unstable Distal Clavicle Fractures: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211001773 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110017

Author(s):

Gautam P. Yagnik ◽

Jacob R. Seiler ◽

Luis A. Vargas ◽

Anshul Saxena ◽

Raed I. Narvel ◽

...

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Complication Rate ◽

Functional Outcomes ◽

Bony Union ◽

Distal Clavicle ◽

Major Complications ◽

Arthroscopic Fixation ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

Background: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. Purpose: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. Results: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. Conclusion: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.

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Outcomes, Union Rate, and Complications After Operative and Nonoperative Treatments of Neer Type II Distal Clavicle Fractures: A Systematic Review and Meta-analysis of 2284 Patients

The American Journal of Sports Medicine ◽

10.1177/03635465211053336 ◽

2021 ◽

pp. 036354652110533

Author(s):

Sophie J. Uittenbogaard ◽

Laurian J.M. van Es ◽

Chantal den Haan ◽

Derek F.P. van Deurzen ◽

Michel P.J. van den Bekerom

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Operative Treatment ◽

Type Ii ◽

Distal Clavicle ◽

Union Rate ◽

Significant Difference ◽

Clavicle Fractures ◽

Coracoclavicular Fixation ◽

Distal Clavicle Fractures

Background: As nonoperative treatment of Neer type II distal clavicle fractures is associated with nonunion rates up to 33%, operative treatment is frequently advocated. However, evidence is lacking regarding which operative treatment to perform and whether this is superior to nonoperative treatment in terms of functional outcome and complication rate. Purpose: (1) To evaluate which surgical technique in the treatment of Neer type II distal clavicle fractures is optimal with regard to patient-reported outcomes and union and complication rates. (2) To review nonoperatively treated patients. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature and meta-analysis were performed on January 27, 2021, in PubMed, Embase, CENTRAL, CINAHL/EBSCO, Web of Science/Clarivate Analytics, and SPORTDiscus/EBSCO. The search included all studies regarding nonoperative and operative treatment of Neer type II distal clavicle fractures with a minimum of 20 patients and follow-up of 12 months. The primary and secondary outcomes were patient-reported outcome measures at 12 months and union, complication, and revision rates. Results: A total of 59 articles were included involving 2284 patients. Coracoclavicular fixation, hook plate, transacromial pins, alternative plate, tension band wire/K-wire, a combination of surgical techniques, and a nonoperative group were described. Hook plates showed lower Constant-Murley scores as compared with coracoclavicular fixation (standard mean difference, –0.77; 95% CI, –1.26 to –0.28; P = .002). However, no significant difference was seen when the hook plate was compared with the locking plate and tension band wire/K-wire groups, and no significant difference in union rate was seen among all operative treatment groups. Operatively treated patients had significantly higher union rates than patients treated nonoperatively (standard mean difference: 0.05; 95% CI, 0.01 to 0.37; P = .004). Conclusion: Patients treated with hook plates showed significantly lower Constant-Murley scores and higher complication and revision rates as compared with those treated with coracoclavicular fixation, without differences in union rate. Higher Constant-Murley scores were seen in those patients with supplemental coracoclavicular fixation when using locking. Nonoperatively treated patients showed good functional outcome despite the 31% nonunion rate, although future studies are necessary to substantiate this conclusion. When using a locking plate, additional craniocaudal fixation showed significant better functional outcome.

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Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽

10.1186/s12893-021-01272-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefano Granieri ◽

Francesco Sessa ◽

Alessandro Bonomi ◽

Sissi Paleino ◽

Federica Bruno ◽

...

Keyword(s):

Systematic Review ◽

Clinical Symptoms ◽

Rare Complication ◽

Meta Analysis ◽

Treatment Options ◽

Palliative Surgery ◽

Review Of The Literature ◽

Colovesical Fistula ◽

Level Of Evidence ◽

Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

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Residual coracoclavicular separation after plate fixation for distal clavicle fractures: comparison between fracture patterns

JSES International ◽

10.1016/j.jseint.2021.04.017 ◽

2021 ◽

Author(s):

Ryogo Furuhata ◽

Noboru Matsumura ◽

Kazuhiko Udagawa ◽

Satoshi Oki ◽

Hideo Morioka

Keyword(s):

Plate Fixation ◽

Distal Clavicle ◽

Fracture Patterns ◽

Clavicle Fractures ◽

Distal Clavicle Fractures

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1578. Treatments for complicated urinary tract infections (cUTI) caused by multidrug resistant (MDR) Gram-negative (GN) pathogens- a systematic review and network meta-analysis (NMA)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1758 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S787-S787

Author(s):

Tim Reason ◽

Karan Gill ◽

Christopher Longshaw ◽

Rachael McCool ◽

Katy Wilson ◽

...

Keyword(s):

Systematic Review ◽

Health Economics ◽

Meta Analysis ◽

Treatment Options ◽

Final Analysis ◽

Similar Efficacy ◽

Global Public Health ◽

Efficacy And Safety ◽

Support Unit ◽

Tract Infections

Abstract Background Antimicrobial resistance is a major and growing threat to global public health. Cefiderocol (CFDC) is a new siderophore-cephalosporin with a wide activity spectrum covering all aerobic GN pathogens including all WHO critical priority pathogens, that was recently approved by FDA for the treatment of GN cUTI in susceptible organisms. We aim to understand the relative efficacy and safety of current treatment options for cUTI caused by MDR GN pathogens. Methods We conducted a systematic review to identify all relevant trials that investigated the efficacy and safety of antimicrobial regimens, for the treatment of GN pathogens in cUTI. Outcomes of interest included clinical cure and microbiological eradication (ME) at time of cure (TOC) and sustained follow up (SFU), and safety. Evidence networks were constructed using data for outcomes of interest and analyses were conducted in a frequentist framework using NMA methods outlined by the NICE decision support unit using the netmeta package in R. Results A total of 5 studies, 6 interventions and 2,349 randomised patients were included in the final analysis. Interventions included CFDC, imipenem-cilastatin (IPM-CIL), ceftazidime-avibactam (CAZ/AVI), doripenem (DOR), levofloxacin and ceftolozane-tazobactam (CEF/TAZ). Trials included predominantly Enterobacterales, and Pseudomonas aeruginosa and very few Acinetobacter baumannii. The patient population presented some clinical differences across trials, which were not adjusted for the NMA. Overall, there were numerical differences (especially in endpoints at SFU favouring CFDC), but all treatments showed similar efficacy and safety, with exception of higher ME rate at TOC for CFDC vs IPM, Table 1, also observed at SFU, consistent with the data from the individual clinical trial. Table 1- Results for microbiological eradication Table 1- Results for microbiological eradication Conclusion This NMA, showed superiority of CFDC vs IPM-CIL in ME at TOC and SFU and similar efficacy and safety vs all other comparators, with numeric differences favouring CFDC for outcomes at SFU. These traditional methodologies for NMA, are only valid within a similar pathogens pool and population across the trials, and may not reflect the full value of breadth of coverage that new therapeutic options bring for the treatment of MDR GN pathogens. Disclosures Tim Reason, PhD, Shionogi (Consultant) Karan Gill, MSc, Shionogi BV (Employee) Christopher Longshaw, PhD, Shionogi B.V. (Employee) Rachael McCool, PhD, York Health Economics Consortium (Employee, YHEC was commissioned by Shionogi to conduct the systematic review) Katy Wilson, PhD, York Health Economics Consortium (Employee, Shionogi commissioned YHEC to conduct the systematic review) Sara Lopes, PharmD, Shionogi BV (Employee)

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