Complete proximal hamstring avulsions: is there a role for conservative management? A systematic review of acute repairs and non-operative management

Author(s):  
Joseph Buckwalter ◽  
Robert Westermann ◽  
Annunziato Amendola
BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028172
Author(s):  
Masahiro Kashiura ◽  
Noritaka Yada ◽  
Kazuma Yamakawa

IntroductionOver the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.Methods and analysisWe will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.Ethics and disseminationOur study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.PROSPERO registration numberCRD42018108304.


2014 ◽  
Vol 27 (4) ◽  
pp. 433 ◽  
Author(s):  
José Estevão-Costa ◽  
Ana Sofia Alvarenga ◽  
Ana Catarina Fragoso ◽  
Maria Garcia ◽  
Miguel Campos

<p><strong>Introduction</strong>: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution.<br /><strong>Material and Methods:</strong> Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed.<br /><strong>Results:</strong> There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy.<br /><strong>Discussion:</strong> Imaging techniques were diagnostic of omental infarction in the majority of cases, enabling a conservative approach to be adopted. Non-operative management was successful with no complications in all patients presenting at the initial course of disease. One patient presented with a harmful complication that required operative treatment.<br /><strong>Conclusion:</strong> In the absence of a standard approach for omental infarction, conservative management is an effective noninvasive alternative but it claims for active surveillance.<br /><strong>Keywords:</strong> Infarction; Omentum.</p>


The Surgeon ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 113-121 ◽  
Author(s):  
James M. Halle-Smith ◽  
James Hodson ◽  
Lewis Stevens ◽  
Darius F. Mirza ◽  
Keith J. Roberts

2017 ◽  
Vol 45 ◽  
pp. 58-66 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Nilanjan Panda ◽  
Rao Muhammad Asaf Khan ◽  
Samik Kumar Bandyopadhyay ◽  
...  

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