Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.

Download Full-text

Perilunate Injury Timing and Treatment Options: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0041-1735841 ◽

2021 ◽

Author(s):

Mark J.W. van der Oest ◽

Liron S. Duraku ◽

Madina Artan ◽

Caroline A. Hundepool ◽

Dominic M. Power ◽

...

Keyword(s):

Systematic Review ◽

Internal Fixation ◽

Closed Reduction ◽

Assessment Tool ◽

Meta Analysis ◽

Hand Function ◽

Treatment Options ◽

Case Series ◽

Health Study ◽

Control Series

Abstract Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7–45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.

Download Full-text

A systematic review on conservative treatment options for OSGOOD-Schlatter disease

Physical Therapy in Sport ◽

10.1016/j.ptsp.2021.03.002 ◽

2021 ◽

Vol 49 ◽

pp. 178-187

Author(s):

Cornelia Neuhaus ◽

Christian Appenzeller-Herzog ◽

Oliver Faude

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Treatment Options

Download Full-text

Peer review report 2 on “Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies”

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2017.02.017 ◽

2017 ◽

Vol 13 ◽

pp. 78

Keyword(s):

Systematic Review ◽

Peer Review ◽

Comparative Studies ◽

Meta Analysis ◽

Clinical Results

Download Full-text

A comparative study of management of Colles fracture by closed reduction with cast versus closed reduction with internal fixation (K-wires/4 mm CC screws)

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175655 ◽

2017 ◽

Vol 4 (1) ◽

pp. 86

Author(s):

Vamshi Varenya Nimmagadda ◽

Bhanu Prabha T. ◽

Johorul Islam Tapadar

Keyword(s):

Comparative Study ◽

Internal Fixation ◽

Distal Radius Fracture ◽

Distal Radius ◽

Closed Reduction ◽

Simple Procedure ◽

Treatment Options ◽

Radius Fracture ◽

Neutral Position ◽

Percutaneous Pinning

Background: Distal radius fracture is extremely common and represents 16% of fractures treated by orthopaedic surgeons. Near anatomical reduction with restoration of radial length, radial tilt and ulnar variances are important for good functional results. A variety of treatment options have been proposed for distal radius fracture closed reduction and immbolization in cast has been the main stay of treatment, but because it invariably results in malunion, poor functional outcome and cosmetic outcome, other modality of treatment were brought into practice like percutaneous intrafocal pinning, transulnar percutaneous pinning, external fixation, plating etc. This comparative study was to compare the clinical outcomes of closed reduction with cast and closed reduction with Percutaneous Kirschner wiring (PKW)/canullated cancellous screws (CC screws 4 mm)for the management of Colles fractures in patients between 20 and 70 years old. In this study we did an prospective study in 40 patients with extra articular distal radius fracture treated by both closed reduction with cast and closed reduction internal fixation (PKW/CC screws).Methods: There were 20 patients with Colles fractures treated by closed reduction with cast and 20 patients treated with closed reduction internal fixation (PKW/CC screws). We compared both the managements together. All patients were followed up in the orthopaedic department prospectively for at least 12 months between June 2015-June 2016 The functional outcomes and radiological results were compared between the two groups.Results: The study included 40 patients, aged between 20 to 69 yrs. Average follow up was 12 months. Using the demerit scoring system of Gartland and Werley we had excellent to good results of 60% in closed reduction internal fixation compared to closed reduction with casting excellent to good was 10%.Conclusions: The percutaneous pinning/cc screws and immobilization in neutral position for 3 weeks followed by physiotherapy proved to be better and simple procedure for extra articular non comminuted distal radius fractures.

Download Full-text

Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review

Journal of Functional Morphology and Kinesiology ◽

10.3390/jfmk4030046 ◽

2019 ◽

Vol 4 (3) ◽

pp. 46 ◽

Cited By ~ 2

Author(s):

Vito Pavone ◽

Andrea Vescio ◽

Giuseppe Mobilia ◽

Sara Dimartino ◽

Giovanni Di Stefano ◽

...

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Full Text ◽

Musculoskeletal Disorder ◽

Clinical Results ◽

Achilles Tendinopathy ◽

Reference List ◽

Level Of Evidence ◽

Medical Electronic ◽

Text Reading

Achilles tendinopathy is a common musculoskeletal disorder. Athletes, runners and jumpers, and the sedentary are frequently affected. Numerous are the therapeutic choices to manage these kinds of disorders. The aim of this review is to analyze the available literature to document the up-to-date evidence on conservative management of Achilles tendinopathy. A systematic review of two medical electronic databases was performed by three independent authors, using the following inclusion criteria: conservative treatment consisted of pharmacologic, physical therapy without operative treatment, with more of 6 months symptoms and a minimum average of 6-months follow-up. Studies of any level of evidence, reporting clinical results, and dealing with Achilles tendinopathy and conservative treatment were searched for. A total of n = 1228 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 94 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 29 articles. Achilles tendinopathy is a frequent musculoskeletal disorder and several conservative treatments have been proposed, but no therapy is universally accepted, except for eccentric exercise training, which is the gold standard and a commonly used protocol.

Download Full-text

Treatment options for unstable ankle fractures in older adults: A systematic review and meta-analysis

Trauma ◽

10.1177/1460408620937975 ◽

2020 ◽

pp. 146040862093797

Author(s):

Andrew Grazette ◽

Catrin Wigley ◽

Andrew Metcalfe

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Internal Fixation ◽

Open Reduction ◽

Meta Analysis ◽

Treatment Options ◽

Ankle Fractures ◽

Treatment Modalities ◽

Current Evidence ◽

Treatment Groups

Background Ankle fractures are the third most common fracture in the elderly. Patients over 60 years are more severely affected by these injuries than their younger counterparts and have a higher rate of complications regardless of the management strategy. Traditional management strategies for unstable ankle fractures include plaster immobilisation and open reduction and internal fixation, with newer modalities such as intramedullary fixation becoming increasingly popular. The aim of this review is to establish the best current evidence for or against different treatment strategies. Methods A systematic review and meta-analysis of randomised controlled trials comparing treatment options for unstable ankle fractures in adults over 55 was conducted, with the primary outcome being functional assessment score at 6–12 months (Olerud and Molander Ankle Score). Secondary outcomes were adverse events including infection and re-operation. Results The search strategies identified 426 articles. After screening and full text review, four papers met the inclusion and exclusion criteria, providing data on 754 ankle fractures. Alternative treatment groups were tibio-talo-calcaneal nail, fibular nail and casting and were compared to open reduction and internal fixation. Meta-analysis of the data showed no difference in Olerud and Molander Ankle Score between treatment modalities at 6–12 months. There was, however, a significant reduction in the incidence of adverse events (OR 0.59 (0.44, 0.81)) and wound infection (0.13 (0.05, 0.31)) in the alternative treatment groups compared to open reduction and internal fixation. Conclusion The current evidence shows no significant difference between treatment modalities for ankle fractures in older adults in terms of functional outcome. Open reduction and internal fixation has a higher rate of adverse events and wound infection when compared to alternative treatments. Therefore, surgery should be carefully considered and if undertaken, in a select patient cohort other treatment modalities, such as intramedullary fixation should be considered.

Download Full-text

Peer review report 1 on “Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies”

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2017.02.016 ◽

2017 ◽

Vol 13 ◽

pp. 74

Author(s):

Gabriele Piffaretti

Keyword(s):

Systematic Review ◽

Peer Review ◽

Comparative Studies ◽

Meta Analysis ◽

Clinical Results

Download Full-text

Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417752317 ◽

2018 ◽

Vol 43 (5) ◽

pp. 530-538 ◽

Cited By ~ 5

Author(s):

Will A. Cobb ◽

Lewis Dingle ◽

Raina Zarb Adami ◽

Jeremy Rodrigues

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Search Strategy ◽

Treatment Options ◽

Early Mobilization ◽

Inclusion Criteria ◽

Carpometacarpal Joint ◽

Search Results ◽

Fracture Dislocations ◽

K Wires

Fracture-dislocations of the carpometacarpal joint (CMCJ) of the little ray involve dorsal subluxation of the metacarpal base and they may be associated with injury of neighbouring CMCJs. Different treatment options are described, with no clear consensus on their management. This study presents a systematic review of comparative studies describing the management of these injuries. A bespoke search strategy was applied across multiple databases. Results were screened against specified stepwise inclusion criteria and data were extracted independently by two authors with discrepancy resolution by a third. Of 437 search results, six comparative studies were identified. Comparisons included non-operative or early mobilization versus fixation K-wires or open reduction and internal fixation. Conclusions were mixed; all studies had critical or significant risks of bias (using the ROBINS-I tool) and there was heterogeneity between studies.

Download Full-text

Good results for treatment of flexor hallucis longus (stenosing) tenosynovitis: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000151 ◽

2017 ◽

Vol 2 (6) ◽

pp. 325-331 ◽

Cited By ~ 1

Author(s):

Kim T M Opdam ◽

Johannes I Wiegerinck ◽

C Niek van Dijk

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Operative Treatment ◽

Treatment Options ◽

Return To Sport ◽

Population Characteristics ◽

Successful Outcome ◽

Flexor Hallucis Longus ◽

Number Of Patients ◽

Stenosing Tenosynovitis

ImportanceNowadays, it is unclear what kind of non-operative and operative treatment protocols exist for flexor hallucis longus (FHL) (stenosing) tenosynovitis and to what extent conservative treatment is effective.ObjectiveThe purpose of this study was to evaluate the literature on treatment of FHL (stenosing) tenosynovitis and to provide an overview of the different treatment options as well as an analysis, evaluation and comparison of their outcomes.Evidence reviewA structured systematic review of literature was performed to identify non-operative and operative therapeutic studies reporting on five or more patients with FHL (stenosing) tenosynovitis. Medline, Embase (Classic), Cumulative Index to Nursing and Allied Health Literature, Sportdiscus and Pedro databases were searched. Two reviewers independently performed data extraction. Extracted data consisted of population characteristics, treatment, outcome of treatment. The primary outcome was success rate. The secondary outcomes were patient satisfaction, complication rate, return to sport and the time to achieve return to sport or full activity after treatment. The Coleman score was used to assess the methodological quality of the studies.FindingsSix articles were included. The number of patients in these studies totalled 138 with 151 affected ankles. Overall good results were found for treatment of FHL (stenosing) tenosynovitis. Specific exercises to stretch the FHL are successful in 64%. An injection with 1% lidocaine to inflate the FHL tendon sheath is successful in 33%. If conservative treatment fails, operative treatment can offer a solution. There are open and endoscopic techniques for release of the FHL tendon and all the techniques have a successful outcome. All athletes return to sport after an average of 5 weeks and 90% of the athletes have a full return to sport after a mean time of 4 months.ConclusionThere are many conservative treatment options mentioned for FHL tenosynovitis; nevertheless only outcomes of stretching and lidocaine injections are reported. If conservative treatment does not give sufficient relief of symptoms, operative treatment, by releasing the FHL by an arthroscopic or open technique, offers a safe and effective solution. Thereby, arthroscopic techniques are promising; however, there is a paucity of literature on this issue.RelevanceIt is important to know what kind of conservative and operative treatments are effective for FHL (stenosing) tenosynovitis.Level of evidenceLevel IV.

Download Full-text