Epidemiology of scaphoid fractures and non-unions: A systematic review

Abstract Background The scaphoid is the most commonly fractured carpal bone in adults as well as in children. Previous studies have reported a wide range of fracture incidences. Scaphoid fractures and non-unions in children have been sparsely investigated. Aim To perform a systematic review of the current literature on epidemiology of scaphoid fractures and non-unions in adults and children. Methods An electronic literature search was conducted investigating all studies in the literature published between January 1989 and June 23 2020. The systematic review following the PRISMA guidelines and searching in PubMed, Embase, Web of Science and Cochrane library databases was done in June 2020. Results 42 studies met our inclusion criteria, 6 studies were prospective, 32 were retrospective and 4 were register studies. The majority of studies relied on conventional radiographs for diagnosis. Scaphoid fractures in adults are predominately found in males with a peak incidence in the age group from 20 to 29 years. Incidence rates in males are reported from 107 to 151/100 000. Females have an earlier peak, in the age group 10 to 19 years, with an incidence from 14 to 46/100 000. Most fractures occur in the middle third of the scaphoid representing 60–69 % of cases. Scaphoid fractures in children are predominately found in boys age 12 and above, while it seldomly occur for children younger than 9 years. In adults the risk for developing a scaphoid non-union is between 2 % and 5 %, the majority affecting males and predominately located at the middle third of the scaphoid. Non-unions among children are rare and mainly due to missed or delayed diagnosis of a fracture in the middle third of the scaphoid. Conclusion This review revealed a substantial heterogeneity among studies concerning study population, diagnosis criterial and outcome measures. Currently, evidence on epidemiology for scaphoid fractures and non-unions are low.

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Protocol for a systematic review of the incidence of infection in operative vs non-operative management of Seymour fractures in children and adolescents

10.21203/rs.3.rs-21070/v1 ◽

2020 ◽

Author(s):

Ailbhe Lynda Kiely ◽

Grant Switzer Nolan ◽

Lilli Cooper

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Children And Adolescents ◽

Grey Literature ◽

Operative Management ◽

Fracture Pattern ◽

Cochrane Library ◽

Non Union ◽

Fractures In Children ◽

Non Operative Management

Abstract Background Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence to establish whether operative or non-operative management of Seymore fractures is associated with a lower incidence of infection. Methods We designed and registered a study protocol for a systematic review of comparative and observational studies. A comprehensive literature search will be conducted (from 1966 to present) in MEDLINE, EMBASE, CINAHL, Cochrane Library and Google Scholar databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures in children & adolescents will be included, comparing operative and non-operative groups. Operative management will be defined as formal washout and soft tissue debridement prior to reduction, whether in the emergency department or operating theatre. Non-operative management refers to washout without surgical debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include adverse events such mal-union, non-union, need for re-operation, physeal disturbance, nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed and if two or more studies with comparable design and reporting the same outcome are identified, data will be pooled for comparative analysis. Discussion This review will provide robust evidence for the management of Seymour fractures, based on a cumulation of existing studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence, assessing its risk of bias and performing meta-analysis where possible to guide clinicians. Registration PROSPERO CRD42020153726

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The optimal management of Seymour fractures in children: a systematic review protocol

10.21203/rs.3.rs-21070/v2 ◽

2020 ◽

Author(s):

Ailbhe Lynda Kiely ◽

Grant Switzer Nolan ◽

Lilli Cooper

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Deep Infection ◽

Fracture Pattern ◽

Cochrane Library ◽

Optimal Management ◽

Non Union ◽

Fractures In Children ◽

Epiphyseal Fractures

Abstract Background: Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity. At present, there is no consensus as to the optimal management of Seymour fractures. The objective of this study will be to systematically evaluate the existing evidence to establish what are the most important factors pertaining to an uncomplicated recovery.Methods: We designed and registered a study protocol for a systematic review of comparative and observational studies. A comprehensive literature search will be conducted (from inception to present) in MEDLINE, EMBASE, CINAHL and Cochrane Library databases. Grey literature will be identified through searching Open Grey and dissertation databases using an exhaustive search strategy. All clinical studies examining the management of Seymour fractures will be included. The interventions (irrigation and debridement; prophylactic antibiotics) and their timings (early vs late) will be compared to no antibiotics and no debridement. Primary outcome measures will be the incidence of superficial and deep infection. Secondary outcomes will include other adverse events such mal-union, non-union, need for re-operation, physeal disturbance, nail dystrophy/atrophy. Two independent reviewers will screen all citations, full-text articles, and abstract data. Conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. A narrative synthesis will be performed. If data permits, we will conduct random-effects meta-analysis where appropriate. The review will be PRISMA-P compliant at each stage.Discussion: This review will provide robust evidence for the management of Seymour fractures, based on a cumulation of existing smaller studies. Due to the rarity of this fracture pattern, included studies are expected to be mainly observational and prone to bias; however, there is value in summarising the evidence to guide clinicians. Registration: registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42020153726).

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Prevention, Diagnosis, and Treatment of COVID-19 in Infants and Children: A Systematic Review Study of Performed Protocols

Archives of Clinical Infectious Diseases ◽

10.5812/archcid.103180 ◽

2021 ◽

Vol 15 (6) ◽

Author(s):

Mohammad Karimian ◽

Feizollah Mansouri ◽

Milad Borji ◽

Asma Tarjoman ◽

Somayeh Mahdikhani ◽

...

Keyword(s):

Systematic Review ◽

Web Of Science ◽

Library Science ◽

Infants And Children ◽

Diagnosis And Treatment ◽

Cochrane Library ◽

Viral Diseases ◽

Age Group ◽

Review Study ◽

In Infants And Children

Context: Coronavirus disease 2019 (COVID-19) is one of the most dangerous viral diseases that started spreading in China in 2019 and has caused many deaths so far. Therefore, this study aimed to systematically review studies on the prevention, diagnosis, and treatment of coronavirus in infants and children. Evidence Acquisition: This is a systematic review study conducted in PubMed/Medline, Scopus, Embase, Cochrane Library, Science Direct, and Web of Science (ISI) databases on October 8 2020. Also, we searched Google Scholar to find all in-press articles. To extract data, a checklist was used, which included the author’s name, year of publication, purpose, age group of patients under study, and the protocol applied for coronavirus prevention, diagnosis, and treatment. The search was done with AND, OR, NOT strategies. The results of the study were reported in a descriptive manner using Endnote version 8 software. Results: According to the results of the basic search, 120 articles were extracted on the management of coronavirus. Of the articles extracted, 30 were articles related to children, of which only eight developed protocols for prevention, diagnosis, and treatment in infants and children. Of the studies extracted, six were from China, one from Iran, and one from Australia. It should be noted that the protocols for infants were extracted from two studies on infants and four studies on the pediatric group. Conclusions: It is proposed to consider and study this systematic review of coronavirus management in infants and children.

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Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

Journal of Wrist Surgery ◽

10.1055/s-0040-1713800 ◽

2020 ◽

Vol 9 (06) ◽

pp. 458-464

Author(s):

Rachana Tataria ◽

Jeannette Ting ◽

Andrea Jester ◽

Tommy R. Lindau ◽

Kerstin Oestreich

Keyword(s):

Pediatric Population ◽

Age Groups ◽

Case Series ◽

Final Diagnosis ◽

Scaphoid Bone ◽

Age Group ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Fractures In Children ◽

Common Location

Abstract Background Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. Methods The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. Results A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4–10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Conclusion Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. Level of Evidence This is a Level IV study.

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Patient and primary care delays in the diagnostic pathway of gynaecological cancers: a systematic review of influencing factors

British Journal of General Practice ◽

10.3399/bjgp19x700781 ◽

2019 ◽

Vol 69 (679) ◽

pp. e106-e111 ◽

Cited By ~ 4

Author(s):

Pauline Williams ◽

Peter Murchie ◽

Christine Bond

Keyword(s):

Systematic Review ◽

Primary Care ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

Gynaecological Cancer ◽

Current Evidence ◽

Cochrane Library ◽

Cancer Type ◽

Patient Demographics ◽

Diagnostic Pathway

BackgroundGynaecological cancers are the second most common female cancer type, with survival rates in the UK lower than in many comparable countries. A potentially important factor in the UK’s poorer cancer outcomes is diagnostic delay; gynaecological cancers are the cancer type most likely to be affected by less timely diagnosis.AimTo examine current evidence for factors that contribute to patient and primary care delays in the diagnostic pathway of gynaecological cancer.Design and settingA systematic review of the available literature.MethodPRISMA guidelines were followed. MEDLINE and Embase databases and the Cochrane Library were searched using three terms: primary care; gynaecological cancer; and delay. Citation lists of all identified articles were searched. Two authors independently screened the titles, abstracts, and full texts of publications. Data extraction was performed by one author and quality assured by a second reviewer in a 20% sample of selected articles. Synthesis was narrative.ResultsA total of 1253 references was identified, of which 37 met the inclusion criteria. Factors associated with delayed diagnosis were categorised as either patient factors (patient demographics, symptoms or knowledge, and presentation to the GP) or primary care factors (doctor factors: patient demographics, symptoms or knowledge, and referral process); and system factors (such as limited access to investigations).ConclusionDelayed diagnosis in the patient and primary care intervals of the diagnostic journey of gynaecological cancer is complex and multifactorial. This review identifies areas of future research that could lead to interventions to enable prompter diagnosis of gynaecological cancers.

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Two cases of non-union of carpal scaphoid fractures in children

Injury ◽

10.1016/0020-1383(82)90103-6 ◽

1982 ◽

Vol 13 (5) ◽

pp. 441-443 ◽

Cited By ~ 32

Author(s):

M.J. Maxted ◽

R. Owen

Keyword(s):

Non Union ◽

Scaphoid Fractures ◽

Fractures In Children

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Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care

10.21203/rs.3.rs-266226/v1 ◽

2021 ◽

Author(s):

Pallavi Prathivadi ◽

Natalie Connell ◽

Louisa Picco ◽

Karleen F Giannitrapani ◽

Hong-nei Wong ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Primary Care Providers ◽

Cochrane Library ◽

Narrative Synthesis ◽

Care Providers ◽

Strict Adherence ◽

Targeted Interventions ◽

Opioid Prescribing ◽

Wide Range

Abstract Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration

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Hospital Preparedness Plans for Chemical Incidents and Threats: A Systematic Review

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2019.91 ◽

2019 ◽

Vol 14 (4) ◽

pp. 477-485

Author(s):

Parisa Moradi Majd ◽

Hesam Seyedin ◽

Hasan Bagheri ◽

Nader Tavakoli

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Final Analysis ◽

Cochrane Library ◽

Job Descriptions ◽

Preparedness Plan ◽

Preparedness Planning ◽

Wide Range ◽

Hospital Preparedness ◽

Chemical Incidents

ABSTRACTIn a wide range of events, people may be acutely exposured to chemical substances. Particular hospital preparedness plans and vital resources are essential for appropriate health-care measures. The present study aimed to conduct a systematic review to summarize and evaluate the existing evidence on hospital preparedness plans or protocols against chemical incidents and threats. In this aim, through May 15, 2018, 5 electronic databases were searched in MEDLINE (PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) for the following key words: hospital preparedness, plan, protocol, chemical incident, and chemical threat. The final review included 11 peer-reviewed papers that met inclusion criteria. The systematic review was performed using the Preferred Reporting Items for the Systematic reviews and Meta-Analysis protocol (PRISMA) (www.prisma-statement.org). Finally, of 16,540 selected papers, 11 papers were included in the final analysis. The thematic analyses revealed 11 major categories of chemical incidents and threats planning, such as planning requirements, planning prerequisites, preparation team member (multidisciplinary team), decontamination, personal protective equipment, education and training, job descriptions and roles, communication, database, staff /volunteer organization, as well as planning barriers and challenges for chemical incidents. Most countries have launched hospital preparedness planning against chemical incidents and threat activities, but the preparedness of hospitals is often less than desirable. Many items, such as databases, hospital preparation team members, communications, etc., are still challenging.

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Efficacy of Terpenoid in Attenuating Aortic Atherosclerosis in Apolipoprotein-E Deficient Mice: A Meta-Analysis of Animal Studies

BioMed Research International ◽

10.1155/2019/2931831 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12

Author(s):

Han Liu ◽

Yang Zhang ◽

Siqiao Sun ◽

Shuai Wang

Keyword(s):

Systematic Review ◽

Apolipoprotein E ◽

Animal Studies ◽

Meta Analysis ◽

Atherosclerotic Lesion ◽

Vehicle Control ◽

Cochrane Library ◽

High Dose ◽

Lesion Area ◽

Wide Range

Background. The apolipoprotein E knockout (ApoE -/-) mouse model is well established for the study of terpenoids in the prevention of atherosclerosis. Studies investigating the clinical benefit of terpenoids in humans are scarce. This systematic review and meta-analysis evaluated the effects of terpenoid administration on atherosclerotic lesion area in ApoE -/- mice. Methods. A comprehensive literature search using PubMed, Embase, and the Cochrane Library databases was performed to identify studies that assessed the effects of terpenoids on atherosclerosis in ApoE -/- mice. The primary outcome was atherosclerotic lesion area, and study quality was estimated using SYRCLE’s risk of bias tool. Results. The meta-analysis included 25 studies. Overall, terpenoids significantly reduced atherosclerotic lesion area when compared to vehicle control (P<0.00001; SMD: -0.55; 95% CI: -0.72, -0.39). In terpenoid type and dose subgroup analyses, sesquiterpenoid (P=0.002; SMD -0.93; 95% CI: -1.52, -0.34), diterpenoid (P=0.01; SMD: -0.30; 95% CI: -0.54, -0.06), triterpenoid (P<0.00001; SMD: -0.66; 95% CI: -0.94, -0.39), tetraterpenoid (P<0.0001; SMD: -1.81; 95% CI: -2.70, -0.91), low dose (P=0.0001; SMD: -0.51; 95% CI: -0.76, -0.25), medium dose (P<0.0001; SMD: -0.48; 95% CI: -0.72, -0.24), and high dose (P=0.002; SMD: -1.07; 95% CI: -1.74, -0.40) significantly decreased atherosclerotic lesion area when compared to vehicle control. PROSPERO register number is CRD42019121176. Conclusion. Sesquiterpenoid, diterpenoid, triterpenoid, and tetraterpenoid have potential as antiatherosclerotic agents with a wide range of doses. This systematic review provides a reference for research programs aimed at the development of terpenoid-based clinical drugs.

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A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

10.25259/jassm_28_2020 ◽

2020 ◽

Vol 0 ◽

pp. 1-4

Author(s):

Syed Shumon ◽

Moin Durrani ◽

Karthikeyan P. Iyengar ◽

William Y. C. Loh

Keyword(s):

Conservative Treatment ◽

Internal Fixation ◽

Bone Grafting ◽

Scaphoid Fracture ◽

Carpal Bone ◽

Non Union ◽

Scaphoid Fractures ◽

First Case ◽

Vascularized Bone ◽

Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

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