scholarly journals Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

2019 ◽  
Vol 08 (05) ◽  
pp. 430-438 ◽  
Author(s):  
Eva A.K. van Delft ◽  
Tamara G. van Gelder ◽  
Ralph de Vries ◽  
Jefrey Vermeulen ◽  
Frank W. Bloemers
Keyword(s):  
Systematic Review ◽  
Nonoperative Treatment ◽  
Outcome Data ◽  
Cochrane Library ◽  
Future Research ◽  
Cast Immobilization ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Homogeneous Groups ◽  
Patient Reported

Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.

scholarly journals Cochlear Implantation and Single-sided Deafness: A Systematic Review of the Literature

2015 ◽  
Vol 20 (01) ◽  
pp. 069-075 ◽  
Author(s):  
Francisco Cabral Junior ◽  
Mariana Pinna ◽  
Ricardo Alves ◽  
Andrea Malerbi ◽  
Ricardo Bento
Keyword(s):  
Systematic Review ◽  
Cochlear Implantation ◽  
Binaural Hearing ◽  
Outcome Data ◽  
Current Data ◽  
Cochrane Library ◽  
Speech Discrimination ◽  
Level Of Evidence ◽  
Unilateral Deafness ◽  
Single Sided Deafness

Introduction Current data show that binaural hearing is superior to unilateral hearing, specifically in the understanding of speech in noisy environments. Furthermore, unilateral hearing reduce onés ability to localize sound. Objectives This study provides a systematic review of recent studies to evaluate the outcomes of cochlear implantation in patients with single-sided deafness (SSD) with regards to speech discrimination, sound localization and tinnitus suppression. Data Synthesis We performed a search in the PubMed, Cochrane Library and Lilacs databases to assess studies related to cochlear implantation in patients with unilateral deafness. After critical appraisal, eleven studies were selected for data extraction and analysis of demographic, study design and outcome data. Conclusion Although some studies have shown encouraging results on cochlear implantation and SSD, all fail to provide a high level of evidence. Larger studies are necessary to define the tangible benefits of cochlear implantation in patients with SSD.

scholarly journals Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096491
Author(s):  
Matthew W. DeFazio ◽  
Emily J. Curry ◽  
Michael J. Gustin ◽  
David C. Sing ◽  
Hussein Abdul-Rassoul ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
Hamstring Tendon ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Primary Acl Reconstruction

Background: Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose: To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design: Systematic review; Level of evidence, 4. Methods: The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results: Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion: ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.

scholarly journals Clinical Outcomes After the Nonoperative Management of Lateral Patellar Dislocations: A Systematic Review

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711876627 ◽  
Author(s):  
Munim Moiz ◽  
Nick Smith ◽  
Toby O. Smith ◽  
Amit Chawla ◽  
Peter Thompson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Randomized Controlled Trials ◽  
Case Series ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Quality Evidence

Background: The first-line treatment for patellar dislocations is often nonoperative and consists of physical therapy and immobilization techniques, with various adjuncts employed. However, the outcomes of nonoperative therapy are poorly described, and there is a lack of quality evidence to define the optimal intervention. Purpose: To perform a comprehensive review of the literature and assess the quality of studies presenting patient outcomes from nonoperative interventions for patellar dislocations. Study Design: Systematic review; Level of evidence, 4. Methods: The MEDLINE, AMED, Embase, CINAHL, Cochrane Library, PEDro, and SPORTDiscus electronic databases were searched through July 2017 by 3 independent reviewers. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Study quality was assessed using the CONSORT (Consolidated Standards for Reporting Trials) criteria for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies and case series. Results: A total of 25 studies met our inclusion criteria, including 12 randomized controlled trials, 7 cohort studies, and 6 case series, consisting of 1066 patients. Studies were grouped according to 4 broad categories of nonoperative interventions based on immobilization, weightbearing status, quadriceps exercise type, and alternative therapies. The most commonly used outcome measure was the Kujala score, and the pooled redislocation rate was 31%. Conclusion: This systematic review found that patient-reported outcomes consistently improved after all methods of treatment but did not return to normal. Redislocation rates were high and close to the redislocation rates reported in natural history studies. There is a lack of quality evidence to advocate the use of any particular nonoperative technique for the treatment of patellar dislocations.

scholarly journals Correction of Thumb Duplication: A Systematic Review of Surgical Techniques

2019 ◽  
Vol 12 (02) ◽  
pp. 074-084
Author(s):  
Robert Miller ◽  
Alexandre Kaempfen ◽  
Jamil Moledina ◽  
Bran Sivakumar ◽  
Gill Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Spare Parts ◽  
Risk Of Bias ◽  
Future Research ◽  
Level Of Evidence ◽  
Thumb Duplication ◽  
Patient Reported

AbstractSurgical intervention for thumb duplication can be divided into three categories: simple excision of the accessory thumb, excision of the accessory thumb with reconstruction from available “spare parts,” and combining the two thumbs into one, as described by Bilhaut. This prospectively PROSPERO registered systematic review evaluates the overall, aesthetic and functional outcomes for the latter two options (reconstruction from spare parts vs. combining two thumbs into one), aiming to facilitate evidence-based decision making when addressing thumb duplication and direct future research. The review was performed in accordance with the Cochrane Handbook of Systematic Reviews and PRISMA statement. Embase, PubMed, Medline, and Cochrane databases were systematically searched. Studies offering comparisons of techniques were included. Risk of bias was assessed using the Risk of Bias In Non-randomized Studies—of Intervention tool. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Ten retrospective observational studies were included. Data did not consistently allow analysis by procedure type. Four studies reported similar overall outcomes between techniques, while two specifically reported poor overall outcomes for the Bilhaut procedure. Two studies reported comparatively worse aesthetic outcomes for the Bilhaut procedure with four studies reporting comparatively improved functional outcomes for this procedure. Overall, interpretation of outcomes was challenging with no patient-reported outcome measures used. The quality of the evidence was universally “very low” due to all studies being at risk of methodological bias. Based on the available evidence, surgical techniques for thumb duplication correction appear comparable regarding overall outcome. There is limited evidence suggesting reconstruction with spare parts offers superior aesthetic outcomes at the expense of stability. The level of evidence is III.

Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan

2021 ◽  
pp. 175319342097778
Author(s):  
Muhammad Tahir ◽  
Faridullah Khan Zimri ◽  
Nadeem Ahmed ◽  
Allah Rakhio Jamali ◽  
Ghulam Mehboob ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Randomized Trial ◽  
Closed Reduction ◽  
Primary Outcome ◽  
Locking Plate ◽  
Cast Immobilization ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Anterior Plating ◽  
Plaster Immobilization

This prospective, multi-centred, randomized trial examined outcomes of 3- and 12-month follow-ups of 159 elderly participants aged more than 75 years with isolated distal radial fractures, treated by anterior locking plate or closed reduction and cast immobilization. The primary outcome was the patient-rated wrist evaluation (PRWE) score. The PRWE score at 12 months was not significantly different between the two groups; however, the radiological outcomes and complications rates were worse in the casting group. Level of evidence: III

scholarly journals Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988817 ◽  
Author(s):  
Darby A. Houck ◽  
John W. Belk ◽  
Armando F. Vidal ◽  
Eric C. McCarty ◽  
Jonathan T. Bravman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Patient Reported ◽  
Lateral Decubitus ◽  
Beach Chair

Background: Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD) position. Purpose: To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library databases for studies reporting clinical outcomes of patients undergoing ACR in either the BC or LD position. All English-language literature from 1990 through 2017 reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and patient-reported outcome (PRO) scores were collected. Study methodological quality was evaluated using the modified Coleman Methodology Score (MCMS). Results: A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21 level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male; mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months) were included. There were no significant differences in overall mean recurrence rates between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores between groups ( P > .05). There were no significant differences in improvement in ROM between groups, including external rotation at the side (BC, 36.4°; LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°; P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82), or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P = .70). Significantly more patients in the BC group (91.6%) underwent concomitant manipulation than in the LD group (63%) ( P < .0001). There were significantly more patients with diabetes in the LD group (22.4%) versus the BC group (9.6%) ( P < .0001). Conclusion: Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be achieved after ACR in either the LD or BC position. Concomitant manipulation under anesthesia is performed more frequently in the BC position compared with the LD position.

Complications following volar locking plate fixation for distal radial fractures: a systematic review

2013 ◽  
Vol 39 (7) ◽  
pp. 745-754 ◽  
Author(s):  
A. Bentohami ◽  
K. de Burlet ◽  
N. de Korte ◽  
M. P. J. van den Bekerom ◽  
J. C. Goslings ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Locking Plate ◽  
Assessment Tool ◽  
Plate Fixation ◽  
Assessment Tools ◽  
Volar Locking Plate ◽  
Locking Plate Fixation ◽  
Distal Radial Fractures ◽  
Level Of Evidence

The purpose of this systematic review is to assess the prevalence of complications following volar locking plate fixation of distal radial fractures. A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Only prospective comparative and prospective cohort studies that presented data concerning complications after treatment of distal radial fractures with a volar locking plate in human adults with a minimal follow-up of 6 months were included. Two quality assessment tools were used to assess the methodological quality of the studies (level of evidence rating according to the Oxford Centre of Evidence Based Medicine and the modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool). Thirty three studies were eligible for final assessment. Most complications were problems with nerve and tendon function as well as complex regional pain syndrome. With an overall complication rate of 16.5%, most of which were ‘minor’ complications and low rates of nonunion and malunion, volar locking plate fixation can be considered a reasonably safe treatment option for patients with distal radial fractures.

scholarly journals Applications of Medical Tattooing: A Systematic Review of Patient Satisfaction Outcomes and Emerging Trends

2021 ◽  
Author(s):  
Stacie J Becker ◽  
Jeffrey E Cassisi
Keyword(s):  
Patient Satisfaction ◽  
Medical Condition ◽  
Case Series ◽  
Outcome Data ◽  
Future Research ◽  
Health Service Provider ◽  
Level Of Evidence ◽  
Case Examples ◽  
Areola Complex ◽  
Clinical Series

Abstract Background Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome. Objectives This article reviews various conditions that medical tattooing have been empirically studied in terms of patient satisfaction outcomes; makes practice recommendations; and suggests future directions for research. Methods This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data was provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author’s practice to illustrate emerging medical tattooing applications that need further evaluation. Results Eighteen studies met the inclusion criteria and were applied to the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple areola complex reconstruction following breast surgery. Conclusions The application of medical tattooing has shown high levels of patient satisfaction across various conditions. The practice recommendation grade is “B” or recommend since the level of evidence for these interventions ranged from III to IV according to the ASPS guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using RCT methodology with waitlist controls is needed.

scholarly journals Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098753
Author(s):  
Cammille C. Go ◽  
Cynthia Kyin ◽  
Jeffrey W. Chen ◽  
Benjamin G. Domb ◽  
David R. Maldonado
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
System Perspective ◽  
Labral Tears ◽  
The Cost

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

Infrared Thermography for the Evaluation of Inflammatory and Degenerative Joint Diseases: A Systematic Review

Cartilage ◽  
2021 ◽  
Vol 13 (2_suppl) ◽  
pp. 1790S-1801S
Author(s):  
Guglielmo Schiavon ◽  
Gianluigi Capone ◽  
Monique Frize ◽  
Stefano Zaffagnini ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Progression ◽  
Infrared Thermography ◽  
Rheumatic Diseases ◽  
English Language ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Joint Diseases ◽  
Level Of Evidence ◽  
Post Evaluation

Objective Inflammation plays a central role in the pathophysiology of rheumatic diseases as well as in osteoarthritis. Temperature, which can be quantified using infrared thermography, provides information about the inflammatory component of joint diseases. This systematic review aims at assessing infrared thermography potential and limitations in these pathologies. Design A systematic review was performed on 3 major databases: PubMed, Cochrane library, and Web of Science, on clinical reports of any level of evidence in English language, published from 1990 to May 2021, with infrared thermography used for diagnosis of osteoarthritis and rheumatic diseases, monitoring disease progression, or response to treatment. Relevant data were extracted, collected in a database, and analyzed for the purpose of this systematic review. Results Of 718 screened articles 32 were found to be eligible for inclusion, for a total of 2094 patients. Nine studies reported the application to osteoarthritis, 21 to rheumatic diseases, 2 on both. The publication trend showed an increasing interest in the last decade. Seven studies investigated the correlation of temperature changes with osteoarthritis, 16 with rheumatic diseases, and 2 with both, whereas 2 focused on the pre-post evaluation to investigate treatment results in patients with osteoarthritis and 5 in patients with rheumatic diseases. A correlation was shown between thermal findings and disease presence and stage, as well as the clinical assessment of disease activity and response to treatment, supporting infrared thermography role in the study and management of rheumatic diseases and osteoarthritis. Conclusions The systematic literature review showed an increasing interest in this technology, with several applications in different joints affected by inflammatory and degenerative pathologies. Infrared thermography proved to be a simple, accurate, noninvasive, and radiation-free method, which could be used in addition to the currently available tools for screening, diagnosis, monitoring of disease progression, and response to medical treatment.

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