scholarly journals Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

2020 ◽  
pp. 145749692095783
Author(s):  
E. Ekman ◽  
K. Lehtimäki ◽  
J. Syvänen ◽  
M. Saltychev
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Intramedullary Nail ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Controlled Trials ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background and Aims: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. Material and Methods: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. Conclusion: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

scholarly journals Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

2015 ◽  
Vol 9 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Izzet Bingol ◽  
Nadir Yalcin ◽  
Vedat Bicici ◽  
Tolga Tulunay ◽  
Kaan Yuksel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Soft Tissues ◽  
Callus Formation ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Cohort Analysis ◽  
Tibial Fractures ◽  
Full Weight Bearing ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

scholarly journals Intramedullary nail versus plate treatments for distal tibial fractures: A meta-analysis

2015 ◽  
Vol 16 ◽  
pp. 60-68 ◽  
Author(s):  
Jiwen Yu ◽  
Leiming Li ◽  
Tong Wang ◽  
Luxin Sheng ◽  
Yongfeng Huo ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Meta Analysis ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

Infectious complications in lupus nephritis treatment: a systematic review and meta-analysis

Lupus ◽  
2019 ◽  
Vol 28 (3) ◽  
pp. 334-346 ◽  
Author(s):  
K M Thong ◽  
T M Chan
Keyword(s):  
Lupus Nephritis ◽  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Induction Treatment ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Serious Infections ◽  
Related Mortality

Objectives Infection is an important concern in lupus nephritis treatment, but few studies have focused on this complication. Available data suggest marked variation in occurrence and outcome. This meta-analysis and review aims to provide an overview of infective complications, focusing on the risk factors and outcomes. Methods Original articles on lupus nephritis Class III/IV/V published in the period January 1980 to December 2016 were identified from the Pubmed/Medline electronic database. Meta-analysis of randomized controlled trials was performed to investigate total and serious infections at different phases of treatment and their associated factors. A descriptive review that included all studies was also performed, providing details on the types of infection, infection-related mortality, and potential impact of different eras on infection rates. Results A total of 56 studies (32 randomized controlled trials) were included. The incidence rates of overall and serious infections were higher during the induction than maintenance phase of therapy, with serious infections occurring at 8.2–50 and 3.5 per 100 patient-years, respectively. Recent data, predominantly from Asia, suggested lower rates of overall infections with induction regimens that included tacrolimus compared with mycophenolate (risk ratio 0.50, 95% confidence interval 0.33–0.76, p = 0.001). Mycophenolate as induction treatment was associated with lower overall infection risks than cyclophosphamide in non-Asians (risk ratio 0.60, 95% confidence interval 0.48–0.75, p < 0.001). The rates of serious infections were 4.1–25% in Asian and 4.4–8.5% in non-Asian countries; with infection-related mortality rates of 0–6.7% in Asian, compared to 0–2.1% in non-Asian locations. Conclusions Infection remains a serious complication during treatment of lupus nephritis, but the reported rates and outcomes varied markedly. Mycophenolate was associated with lower infection risk than cyclophosphamide in non-Asians. Infection-related deaths appeared more common in Asian patients.

scholarly journals Influency of pentoxifylline treatment for neonatal sepsis: A meta-analysis of randomized controlled studies

2019 ◽  
pp. 102490791986424
Author(s):  
Peiyun Peng ◽  
Yunfeng Xia
Keyword(s):  
Confidence Interval ◽  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Risk Ratio ◽  
Neonatal Sepsis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled ◽  
Mean Differences

Introduction: Pentoxifylline may be an important approach to treat neonatal sepsis. However, its use has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of pentoxifylline treatment for neonatal sepsis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials assessing the influence of pentoxifylline treatment on neonatal sepsis are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis is performed using the random-effect model. Results: Seven randomized controlled trials involving 439 patients are included in the meta-analysis. Compared with control intervention for neonatal sepsis, pentoxifylline treatment is associated with reduced hospital stay (standard mean differences = −0.61; 95% confidence interval = −0.93 to −0.29; p = 0.0002) and metabolic acidosis (risk ratio = 0.38; 95% confidence interval = 0.22 to 0.66; p = 0.0006), but has no remarkable impact on mortality (risk ratio = 0.59; 95% confidence interval = 0.30 to 1.16; p = 0.13), serum tumor necrosis factor-α (standard mean differences = −0.38; 95% confidence interval = −1.29 to 0.52; p = 0.41), serum C-reactive protein (standard mean differences = −0.25; 95% confidence interval = −0.92 to 0.42; p = 0.47), plasma interleukin-6 (standard mean differences = −0.13; 95% confidence interval = −0.41 to 0.15; p = 0.37), disseminated intravascular coagulopathy (risk ratio = 0.55; 95% confidence interval = 0.25 to 1.21; p = 0.14), and oliguria/anuria (risk ratio = 0.77; 95% confidence interval = 0.28 to 2.16; p = 0.62). Conclusion: Pentoxifylline treatment may be associated with reduced mortality and hospital stay in neonatal sepsis with caution.

Robotic Versus Laparoscopic Rectal Surgery for Rectal Cancer: A Meta-Analysis of 7 Randomized Controlled Trials

2019 ◽  
Vol 26 (4) ◽  
pp. 497-504 ◽  
Author(s):  
Laiyuan Li ◽  
Weisheng Zhang ◽  
Yinyin Guo ◽  
Xiaolin Wang ◽  
Huichuan Yu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Rectal Surgery ◽  
Current Evidence ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Complication Rates ◽  
Randomized Controlled ◽  
Laparoscopic Rectal Surgery

Background. Robotic surgery has been recently used as a novel tool for rectal surgery. This study assessed the current evidence regarding the efficiency, safety, and potential advantages of robotic rectal surgery (RRS) compared with laparoscopic rectal surgery (LRS). Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library databases and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) assessing the 2 approaches. Results. Seven RCTs including a total of 1022 cases were identified. The conversion rate is significantly lower for RRS (odds ratio: 0.29; 95% confidence interval: 0.09 to 0.96; P = .04). The length of the distal margin was significantly shorter in the LRS group than in the RRS group (weighted mean difference: 0.60; 95% confidence interval: 0.09 to 1.10; P = .02). Perioperative complication rates, harvested lymph nodes, positive circumferential resection margins, complete total mesorectal excision, first flatus, and length of stay did not differ significantly between approaches ( P > .05). Conclusions. This meta-analysis indicates that RRS is a safe and effective approach. It is not inferior to LRS in terms of oncologic outcomes and postoperative complications. Future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.

scholarly journals Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials

2021 ◽  
Vol 0 ◽  
pp. 1-10
Author(s):  
Chawan Kritsanaviparkporn ◽  
Phoomphut Sangaphunchai ◽  
Arucha Treesirichod
Keyword(s):  
Systematic Review ◽  
Atopic Dermatitis ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Young Patients ◽  
Controlled Trials ◽  
Assessment Development ◽  
Randomised Controlled

Background: Topical moisturizer is recommended for atopic dermatitis. Aims: The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. Methods: A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant’s ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Results: Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05–26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31–0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47–0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47–0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three–six months remission (95% confidence interval1.18–6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. Limitations: There is a dire need to conduct randomised controlled trialswith more robust and standardised designs. Conclusion: Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.

scholarly journals Convalescent plasma therapy for COVID-19 patients: a protocol of a prospective meta-analysis of randomized controlled trials

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lajos Szakó ◽  
Nelli Farkas ◽  
Szabolcs Kiss ◽  
Szilárd Váncsa ◽  
Noémi Zádori ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Organ Failure ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Plasma Therapy ◽  
Monthly Basis ◽  
Randomized Controlled

Abstract Background Coronavirus disease 2019 (COVID-19) is an infection with possible serious consequences. The plasma of recovered patients might serve as treatment, which we aim to assess in the form of a prospective meta-analysis focusing on mortality, multi-organ failure, duration of intensive care unit stay, and adverse events. Methods A systematic search was conducted to find relevant registered randomized controlled trials in five trial registries. A comprehensive search will be done continuously on a monthly basis in MEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science to find the results of previously registered randomized controlled trials. The selection will be done by two independent authors. Data extraction will be carried out by two other independent reviewers. Disagreements will be resolved by a third investigator. An update of the search of the registries and the first search of the databases will be done on the 21st of July. Data synthesis will be performed following the recommendations of the Cochrane Collaboration. In the case of dichotomous outcomes (mortality and organ failure), we will calculate pooled risk ratios with a 95% confidence interval (CI) from two-by-two tables (treatment Y/N, outcome Y/N). Data from models with multivariate adjustment (hazard ratios, odds ratio, risk ratio) will be preferred for the analysis. P less than 0.05 will be considered statistically significant. In the case of ICU stay, weighted mean difference with a 95% confidence interval will be calculated. Heterogeneity will be tested with I2, and χ2 tests. Meta-analysis will be performed if at least 3 studies report on the same outcome and population. Discussion Convalescent plasma therapy is a considerable alternative in COVID-19, which we aim to investigate in a prospective meta-analysis.

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