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

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.

scholarly journals Saccharin test: Methodological validation and systematic review of the literature

2021 ◽  
pp. 014556132110640
Author(s):  
Pasquale Caponnetto ◽  
Rosalia Emma ◽  
Francesca Benfatto ◽  
Salvatore Ferlito ◽  
Alessandro Gulino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Defense Mechanism ◽  
Respiratory Health ◽  
Linear Regression Analysis ◽  
Study Data ◽  
Review Of The Literature ◽  
Upper Airways ◽  
Mean Values ◽  
High Level

Objectives Saccharin test (ST) is a convenient method to assess the efficiency of mucociliary clearance, the primary defense mechanism of the upper airways’ tract. The study objectives are to: (1) substantiate its short- (3 days) and long-term (30 days) repeatability; (2) assess its tolerability; (3) conduct a systematic literature review and to compare our results with the existing evidence. Methods Twenty-nine healthy subjects were enrolled in an observational prospective study to perform an ST on three separate visits (at baseline; at follow-up visits at day 3 and at day 30). Transit times were recorded and self-reported nasal and general symptoms noted. A systematic review of the literature was conducted to compare our results with the existing literature. Results The mean values (±SD) of ST transit time (STTT) were 7.085 (±2.19), 7.788 (±2.11), and 7.790 (±2.06) minutes at baseline, day 3, and day 30, respectively. Significant linear regression analysis was observed between day 3 and baseline ( r = .193; P = .019) and day 30 and baseline ( r = .182 P = .024). Significant agreement for the intrasession repeatability was observed with an ICC = .354 ( P = .001). Outcomes’ comparisons between baseline vs day 3 ( P = .197) and baseline vs day 30 ( P = .173) were not statistically significant. ST was well tolerated. Concordance with existing literature’s data and high level of STTT repeatability were confirmed by the qualitative analysis. Conclusion STTT reproducibility was good both in the short- and long-term. ST tolerability was very good. Our study data are consistent with the existing literature, indicating ST as a sound methodology for detection of early respiratory health changes and for specific regulatory application in respiratory research.

scholarly journals The Effect of Delayed Surgical Debridement in the Management of Open Tibial Fractures: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1017
Author(s):  
Marios Nicolaides ◽  
Alexandros Vris ◽  
Nima Heidari ◽  
Peter Bates ◽  
Georgios Pafitanis
Keyword(s):  
Systematic Review ◽  
Infection Rate ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Tibial Fractures ◽  
Surgical Debridement ◽  
Union Rate ◽  
Non Union ◽  
Open Tibial Fractures ◽  
Study Characteristics

Introduction: Open tibial fractures are complex injuries with variable outcomes that significantly impact patients’ lives. Surgical debridement is paramount in preventing detrimental complications such as infection and non-union; however, the exact timing of debridement remains a topic of great controversy. The aim of this study is to evaluate the association between timing of surgical debridement and outcomes such as infection and non-union in open tibial fractures. Materials and Methods: We performed a systematic review and meta-analysis of the literature to capture studies evaluating the association between timing of initial surgical debridement and infection or non-union, or other reported outcomes. We searched the MEDLINE, PubMed Central, EMBASE, SCOPUS, Cochrane Central and Web of Science electronic databases. Our methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane handbook for systematic reviews of interventions. Results: The systematic review included 20 studies with 10,032 open tibial fractures. The overall infection rate was 14.3% (314 out of 2193) and the overall non-union rate 14.2% (116 out of 817). We did not find any statistically significant association between delayed debridement and infection rate (OR = 0.87; 95% CI, 0.68 to 1.11; p = 0.23) or non-union rate (OR = 0.70; 95% CI, 0.42 to 1.15; p = 0.13). These findings did not change when we accounted for the effect of different time thresholds used for defining early and late debridement, nor with the Gustilo–Anderson classification or varying study characteristics. Conclusion: The findings of this meta-analysis support that delayed surgical debridement does not increase the infection or non-union rates in open tibial fracture injuries. Consequently, we propose that a reasonable delay in the initial debridement is acceptable to ensure that optimal management conditions are in place, such that the availability of surgical expertise, skilled staff and equipment are prioritised over getting to surgery rapidly. We recommend changing the standard guidance around timing for performing surgical debridement to ‘as soon as reasonably possible, once appropriate personnel and equipment are available; ideally within 24-h’.

Olecranon Fracture through Persistent Olecranon Apophysis in a 21-Year-Old Male: A Case Report and Systematic Review of the Literature

2020 ◽  
Vol 25 (01) ◽  
pp. 110-113
Author(s):  
Jonathan Twu ◽  
David C. Landy ◽  
Jennifer Moriatis Wolf
Keyword(s):  
Systematic Review ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Case Reports ◽  
Plate Fixation ◽  
Review Of The Literature ◽  
Non Union ◽  
Elbow Injury ◽  
Acute Fracture ◽  
Clinical Healing

Traumatic fractures involving an ununited olecranon apophysis in adults have been rarely documented in the literature. We present the case of a 21-year-old male wrestler with an elbow injury after a fall. Imaging revealed an acute fracture of the olecranon with sclerotic rounded edges indicating an injury through a persistent olecranon apophysis. Open reduction and internal fixation was performed with plate fixation and bone grafting with radiographic and clinical healing at 6 weeks. Review of the literature revealed 5 case reports showing high rates of non-union with tension band constructs while plate and screw fixation had no incidence of nonunion. Fractures through an ununited olecranon apophysis are successfully treated with plate and screw fixation with bone grafting.

A systematic review of the treatment of acute fractures of the scaphoid

2011 ◽  
Vol 36 (9) ◽  
pp. 802-810 ◽  
Author(s):  
T. H. Symes ◽  
J. Stothard
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Functional Outcome ◽  
Grip Strength ◽  
Review Of The Literature ◽  
Range Of Movement ◽  
Cost Functional ◽  
Non Union ◽  
Significant Difference

A systematic review of the literature identified eight trials comparing surgery with cast treatment and found no significant difference in pain, tenderness, cost, functional outcome or patient satisfaction. In the group treated surgically, the rate of non-union was three times less, there was a quicker return to function and grip strength and range of movement was also transiently better. There were, however, more complications among those treated surgically. No significant differences were reported in the two trials that compared above and below elbow casts or the trial that compared scaphoid and Colles’ casts.

Telepractice for Adult Speech-Language Pathology Services: A Systematic Review

2020 ◽  
Vol 5 (1) ◽  
pp. 326-338 ◽  
Author(s):  
Kristen Weidner ◽  
Joneen Lowman
Keyword(s):  
Systematic Review ◽  
Primary Progressive Aphasia ◽  
Future Research ◽  
Service Delivery Model ◽  
Speech Language Pathology ◽  
Review Of The Literature ◽  
Research Designs ◽  
Assessment And Treatment ◽  
Language Pathology ◽  
Screening Assessment

Purpose We conducted a systematic review of the literature regarding adult telepractice services (screening, assessment, and treatment) from approximately 2014 to 2019. Method Thirty-one relevant studies were identified from a literature search, assessed for quality, and reported. Results Included studies illustrated feasibility, efficacy, diagnostic accuracy, and noninferiority of various speech-language pathology services across adult populations, including chronic aphasia, Parkinson's disease, dysphagia, and primary progressive aphasia. Technical aspects of the equipment and software used to deliver services were discussed. Some general themes were noted as areas for future research. Conclusion Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults. Strong research designs, including experimental control, across multiple well-described settings are still needed to definitively determine effectiveness of telepractice services.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

Psychological and Cognitive Aspects of Borderline Intellectual Functioning

2017 ◽  
Vol 22 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Bastianina Contena ◽  
Stefano Taddei
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Intellectual Functioning ◽  
Clinical Impact ◽  
Review Of The Literature ◽  
Borderline Intellectual Functioning ◽  
General Quality ◽  
Meta Analyses ◽  
Over Time

Abstract. Borderline Intellectual Functioning (BIF) refers to a global IQ ranging from 71 to 84, and it represents a condition of clinical attention for its association with other disorders and its influence on the outcomes of treatments and, in general, quality of life and adaptation. Furthermore, its definition has changed over time causing a relevant clinical impact. For this reason, a systematic review of the literature on this topic can promote an understanding of what has been studied, and can differentiate what is currently attributable to BIF from that which cannot be associated with this kind of intellectual functioning. Using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, we have conducted a review of the literature about BIF. The results suggest that this condition is still associated with mental retardation, and only a few studies have focused specifically on this condition.

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