Biological and molecular profile of fracture non‐union tissue: A systematic review and an update on current insights

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414554359 ◽

2014 ◽

Vol 40 (5) ◽

pp. 450-457 ◽

Cited By ~ 54

Author(s):

B. M. Saltzman ◽

J. M. Frank ◽

W. Slikker ◽

J. J. Fernandez ◽

M. S. Cohen ◽

...

Keyword(s):

Systematic Review ◽

Grip Strength ◽

Complication Rate ◽

Contralateral Side ◽

Wrist Flexion ◽

Proximal Row Carpectomy ◽

Non Union ◽

Radial Deviation ◽

Hand Grip ◽

Flexion Extension

We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I–III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate. Level of evidence: Level III (Level I-III studies), Systematic Review. Therapeutic.

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Genetic determinants of fracture non-union: A systematic review from the literature

Gene ◽

10.1016/j.gene.2020.144766 ◽

2020 ◽

Vol 751 ◽

pp. 144766

Author(s):

Ting Yan ◽

Jin Li ◽

Xindie Zhou ◽

Zhicheng Yang ◽

Yi Zhang ◽

...

Keyword(s):

Systematic Review ◽

Genetic Determinants ◽

Non Union

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Fracture union rates across a century of war: a systematic review of the literature

BMJ Military Health ◽

10.1136/bmjmilitary-2019-001375 ◽

2020 ◽

pp. bmjmilitary-2019-001375

Author(s):

Sarah K Stewart ◽

O Tenenbaum ◽

C Higgins ◽

S Masouros ◽

A Ramasamy

Keyword(s):

Systematic Review ◽

Linear Regression Analysis ◽

Soft Tissue Injury ◽

Past Century ◽

Common Denominator ◽

Review Of The Literature ◽

Union Rate ◽

Fracture Union ◽

Non Union ◽

Combat Environment

IntroductionFractures have been a common denominator of the injury patterns observed over the past century of warfare. The fractures typified by the blast and ballistic injuries of war lead to high rates of bone loss, soft tissue injury and infection, greatly increasing the likelihood of non-union. Despite this, no reliable treatment strategy for non-union exists. This literature review aims to explore the rates of non-union across a century of conflict, in order to determine whether our ability to heal the fractures of war has improved.MethodsA systematic review of the literature was conducted, evaluating the rates of union in fractures sustained in a combat environment over a 100-year period. Only those fractures sustained through a ballistic or blast mechanism were included. The review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Quality and bias assessment was also undertaken.ResultsThirty studies met the inclusion criteria, with a total of 3232 fractures described across 15 different conflicts from the period 1919–2019. Male subjects made up 96% of cases, and tibial fractures predominated (39%). The lowest fracture union rate observed in a series was 50%. Linear regression analysis demonstrated that increasing years had no statistically significant impact on union rate.ConclusionsFailure to improve fracture union rates is likely a result of numerous factors, including greater use of blast weaponry and better survivability of casualties. Finding novel strategies to promote fracture healing is a key defence research priority in order to improve the rates of fractures sustained in a combat environment.

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A Systematic Review and Meta-Analysis of treatment of infected Tibial non union

Benha Medical Journal ◽

10.21608/bmfj.2021.16742.1051 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

peter abadir ◽

gamal hosny ◽

Mohamed Meselhy ◽

adel elhammady

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Non Union

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Bone Graft as an Adjunctive Treatment for Delayed Union and Non-Union of Fractures in Dogs: Systematic Review.

10.46940/gjvcr.02.1004 ◽

2020 ◽

pp. 1-7

Keyword(s):

Systematic Review ◽

Bone Graft ◽

Companion Animals ◽

Delayed Union ◽

Adjunctive Treatment ◽

Financial Investment ◽

Non Union ◽

Scientific Databases ◽

Orthopedic Patient ◽

Substitute Materials

Abstract The cases of non-union or delayed union are the main diagnoses related to complications of orthopedic fractures within the veterinary surgery of companion animals, mainly dogs. Bone graft transplantation is a growing competence as an adjuvant treatment in these cases. The study reveals its use through the evaluation of the data obtained in an advanced research on the topic referring to the main scientific databases, resulting in a systematic review, in addition to proving its means of extraction and conservation. Although there is the possibility of performing autograft and xenograft, among other substitute materials, a choice on the part of the veterinarian must make a tiny assessment of each case. However, this therapeutic approach requires greater professional, structural and, consequently, financial investment by veterinarians and hospital doctors. As well as, the realization of scientific works with the objective of contributing to the evolution of this method of associated treatment and bringing more and more benefits to the orthopedic patient.

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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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Extramedullary versus Intramedullary bone fixation Treatment of peritrochanteric fractures

QJM ◽

10.1093/qjmed/hcaa059.016 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O M E Farag ◽

A M Mohasseb ◽

A M M M Hefny

Keyword(s):

Systematic Review ◽

Gold Standard ◽

Exclusion Criteria ◽

Funnel Plot ◽

Non Union ◽

Search Results ◽

Bone Fixation ◽

Duration Of Surgery ◽

Fixation Treatment ◽

High Velocity Trauma

Abstract Background In the last few decades the rate of peritrochanteric fractures has increased because of increased rate of high velocity trauma accident and bone rarefaction due to osteoporosis in old age. DHS and PFN are the gold standard treatments used in treatment of these fractures. Nineteen studies were identified for analysis from 2007 to 2017 that meet our points of comparison. Aim of the Work Assessing of efficacy and complications of treatmeant of preitrochantric fracture by DHS versus PFN. Materials and Methods Outcomes from included trials will be combined using the systematic review manger software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion /exclusion criteria. After pooling of the collected data from the desired search studies, the relative risk of each of intended outcome measures of interest will be calculated and compared between each of the two main methods of peritrochanteric bone fixation treatment to reach a satisfactory conclusion. Evidence of publication bias will be sought using the funnel plot method. Results PFN is better for treating unstable peritrochanteric fractures as it has less complications and better efficacy than DHS. Conclusion The present study supports the treatment of peritrochanteric fractures with PFN, as it has less failure of fixation, decreased wound infection, less duration of surgery and less non-union complication than DHS.

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Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415604778 ◽

2015 ◽

Vol 41 (5) ◽

pp. 492-500 ◽

Cited By ~ 31

Author(s):

D. O. Ferguson ◽

V. Shanbhag ◽

H. Hedley ◽

I. Reichert ◽

S. Lipscombe ◽

...

Keyword(s):

Systematic Review ◽

Bone Graft ◽

Study Design ◽

Scaphoid Fracture ◽

Vascularized Bone Graft ◽

Level Of Evidence ◽

Data Set ◽

Non Union ◽

Quality And Outcomes ◽

Vascularized Bone

This systematic review assesses the quality and outcomes of published articles concerning bone graft surgery for scaphoid fracture non-union. Searches of the CENTRAL, MEDLINE, EMBASE, CINAHL and AMED databases captured 2710 articles. Each article was screened and 144 met our inclusion criteria. Data regarding source, study design, population, intervention, comparator and outcomes were extracted. There were 5464 scaphoid non-union outcomes within the 144 studies. Mean reported union rates for vascularized and non-vascularized bone graft were 84% and 80%, respectively. Avascular necrosis was diagnosed in several ways and, when present, the vascularized bone graft union rate was 74% compared with 62% with non-vascularized bone graft. Reported union rates vary considerably. These differences may be due to patient factors, fracture factors, treatment factors or study design failures or bias. We recommend that future researchers take into account the deficiencies of previous studies and use the suggested minimum data set in future studies. Level of evidence: II

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