scholarly journals A systematic review on conservative treatment options for OSGOOD-Schlatter disease

2021 ◽  
Vol 49 ◽  
pp. 178-187
Author(s):  
Cornelia Neuhaus ◽  
Christian Appenzeller-Herzog ◽  
Oliver Faude
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Treatment Options

Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

2020 ◽  
Vol 46 (1) ◽  
pp. 30-36
Author(s):  
Michel E. H. Boeckstyns
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Internal Fixation ◽  
Comparative Studies ◽  
Closed Reduction ◽  
Treatment Options ◽  
Clinical Results ◽  
Threshold Values ◽  
Angulated Neck ◽  
Angular Deformities

Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.

Good results for treatment of flexor hallucis longus (stenosing) tenosynovitis: a systematic review

2017 ◽  
Vol 2 (6) ◽  
pp. 325-331 ◽  
Author(s):  
Kim T M Opdam ◽  
Johannes I Wiegerinck ◽  
C Niek van Dijk
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Operative Treatment ◽  
Treatment Options ◽  
Return To Sport ◽  
Population Characteristics ◽  
Successful Outcome ◽  
Flexor Hallucis Longus ◽  
Number Of Patients ◽  
Stenosing Tenosynovitis

ImportanceNowadays, it is unclear what kind of non-operative and operative treatment protocols exist for flexor hallucis longus (FHL) (stenosing) tenosynovitis and to what extent conservative treatment is effective.ObjectiveThe purpose of this study was to evaluate the literature on treatment of FHL (stenosing) tenosynovitis and to provide an overview of the different treatment options as well as an analysis, evaluation and comparison of their outcomes.Evidence reviewA structured systematic review of literature was performed to identify non-operative and operative therapeutic studies reporting on five or more patients with FHL (stenosing) tenosynovitis. Medline, Embase (Classic), Cumulative Index to Nursing and Allied Health Literature, Sportdiscus and Pedro databases were searched. Two reviewers independently performed data extraction. Extracted data consisted of population characteristics, treatment, outcome of treatment. The primary outcome was success rate. The secondary outcomes were patient satisfaction, complication rate, return to sport and the time to achieve return to sport or full activity after treatment. The Coleman score was used to assess the methodological quality of the studies.FindingsSix articles were included. The number of patients in these studies totalled 138 with 151 affected ankles. Overall good results were found for treatment of FHL (stenosing) tenosynovitis. Specific exercises to stretch the FHL are successful in 64%. An injection with 1% lidocaine to inflate the FHL tendon sheath is successful in 33%. If conservative treatment fails, operative treatment can offer a solution. There are open and endoscopic techniques for release of the FHL tendon and all the techniques have a successful outcome. All athletes return to sport after an average of 5 weeks and 90% of the athletes have a full return to sport after a mean time of 4 months.ConclusionThere are many conservative treatment options mentioned for FHL tenosynovitis; nevertheless only outcomes of stretching and lidocaine injections are reported. If conservative treatment does not give sufficient relief of symptoms, operative treatment, by releasing the FHL by an arthroscopic or open technique, offers a safe and effective solution. Thereby, arthroscopic techniques are promising; however, there is a paucity of literature on this issue.RelevanceIt is important to know what kind of conservative and operative treatments are effective for FHL (stenosing) tenosynovitis.Level of evidenceLevel IV.

scholarly journals Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials

2002 ◽  
Vol 249 (3) ◽  
pp. 272-280 ◽  
Author(s):  
Annette A. M. Gerritsen ◽  
Marc C. T. F. M. de Krom ◽  
Margaretha A. Struijs ◽  
Rob J. P. M. Scholten ◽  
Henrica C. W. de Vet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Randomised Controlled Trials ◽  
Treatment Options ◽  
Controlled Trials ◽  
Tunnel Syndrome ◽  
Randomised Controlled

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

BMC Surgery ◽  
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).

scholarly journals The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

2020 ◽  
Author(s):  
Jason Derry Onggo ◽  
James Randolph Onggo ◽  
Mithun Nambiar ◽  
Andrew Duong ◽  
Olufemi R Ayeni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Protective Factor ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Suture Repair ◽  
Significant Heterogeneity ◽  
Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle &gt;65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P&lt;0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P&lt;0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P&lt;0.05), 12-months (MD=22.0, P&lt;0.05) and 28-months (MD=17.5, P&lt;0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

A systematic review and meta-analysis on endovascular treatment as an attractive alternative for acute superior mesenteric venous thrombosis

Vascular ◽  
2021 ◽  
pp. 170853812199127
Author(s):  
Lixin Wang ◽  
Enci Wang ◽  
Fei Liu ◽  
Wei Zhang ◽  
Xiaolong Shu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Published Data ◽  
Mesenteric Venous Thrombosis ◽  
Surgery Group

Objective This systematic review and meta-analysis evaluated the published data on the efficacy and safety of therapies for superior mesenteric venous thrombosis (SMVT), aiming to provide a reference and set of recommendations for clinical treatment. Methods Relevant databases were searched for studies published from 2000 to June 2020 on SMVT treated with conservative treatment, surgical treatment, or endovascular approach. Different treatment types were grouped for analysis and comparison, and odds ratios with corresponding 95% confidence intervals were calculated. The outcomes were pooled using meta-analytic methods and presented by forest plots. Results Eighteen articles, including eight on SMVT patients treated with endovascular therapies, were enrolled. The treatment effectiveness was compared between different groups according to the change of symptoms, the occurrence of complications, and mortality as well. The conservative treatment group had better efficacy compared to the surgery group (89.0% vs. 78.6%, P <0.05), and the one-year survival rate was also higher (94.4% vs. 80.0%, P >0.05), but without statistical significance. As for endovascular treatment, the effectiveness was significantly higher than the surgery group (94.8% vs. 75.2%, P <0.05), and the conservative treatment group as well (93.3% vs. 86.3%, P >0.05), which still requires further research for the lack of statistical significance. Conclusions Present findings indicate that anticoagulation, as conservative treatment should be the preferred clinical option in the clinic for SMVT, due to its better curative effect compared to other treatment options, including lower mortality, fewer complications, and better prognosis. Moreover, endovascular treatment is a feasible and promising approach that is worth in-depth research, for it is less invasive than surgery and has relatively better effectiveness, thus can provide an alternative option for SMVT treatment and may be considered as a reliable method in clinical.

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