Surgical versus non surgical management of Geriatrics ankle fractures. A Systematic Review and Meta-analysis

Category: Trauma Introduction/Purpose: Ankle fractures are common orthopedics injuries especially in elderly. Bone quality, activity, and other comorbidities play a role in the management of ankle fracture in older age group. Conservative treatment by casting with or without reduction consider valid option whereas the open reduction and internal fixation still the stander of care for all age groups. This review aims to provide evidence-based difference between surgical and non-surgical management of geriatrics ankle fracture in regards to healing, complication and functional outcome. Methods: Relevant comparative studies in English literature were identified up to October 2017 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic-based search on MEDLINE (PubMed), EMBASE, Google Scholar and Cochrane databases, and hand searching of abstracts in orthopedics, trauma and foot and ankle journals. The research team systematically reviewed published studies according to the following criteria:(1) subjects whom sustained ankle fractures with age above 50 years;(2) the intervention was done through surgical management (open reduction and internal fixation) or conservative management (closed reduction and casting or casting alone) (3) the study reported at least one desirable outcome(non-union/mal-union rate, hospital stay, period on cast, mortality, re-admission rate, functional outcome, complication rate)(4) followed up at least one year after surgical /conservative management. The data analysis was done by Comprehensive meta-analysis software using a random-effect model and SPSS 22. Statistical heterogeneity across the studies was tested using I2. Results: The non-union rate in surgical group was significantly less than conservative group, (OR: 0.127, 95% CI: [0.055, 0.292], [P <0.001])and the mal-union was similarly less in surgical group (OR: 0.128, 95% CI: [0.063, 0.262], [P <0.001]). No difference in the hospital stays detected between two groups and similarly in re-admission rate. No difference in the period in cast reported between two groups. The return to pre-injury level was better in surgery group comparing to surgical one, whereas no difference in patient satisfaction was reported between two group. The mortality rate was less in the surgical group. The total number of skin complication was more in the conservative group.No difference in the incidence of DVT between two groups whereas the PE was in the surgical group. Conclusion: Geriatrics ankle fractures are challenging injury. The surgical management of such injuries showed superior results comparing to conservative management in terms of non-union /mal-union rate and return to pre-injury level with less mortality rate, whereas no difference in complications rate, hospital stay and patient satisfaction.

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Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000152 ◽

2017 ◽

Vol 3 (2) ◽

pp. 98-104 ◽

Cited By ~ 3

Author(s):

Amre Hussein ◽

Asser A Sallam ◽

Mohamed A Imam ◽

Martyn Snow

Keyword(s):

Conservative Treatment ◽

Surgical Management ◽

Conservative Management ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Meta Analysis ◽

Treated Group ◽

Current Evidence ◽

Conservative Group ◽

Kujala Score

ImportanceLateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.ObjectiveThe aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.Evidence reviewA systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.FindingsOur analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).Conclusions and relevanceContrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.Level of evidenceMeta-analysis, therapeutic type II.

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Surgical versus conservative management of ankle fractures in adults: A systematic review and meta-analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2019.09.008 ◽

2020 ◽

Vol 26 (7) ◽

pp. 723-735

Author(s):

Omar A. Javed ◽

Qasim A. Javed ◽

Obioha C. Ukoumunne ◽

Livio Di Mascio

Keyword(s):

Systematic Review ◽

Conservative Management ◽

Meta Analysis ◽

Ankle Fractures

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Diabetic Ankle Fracture Complications: A Meta-Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00281 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0028

Author(s):

Laia Lopez-Capdevila ◽

Juan Manuel Rios Ruh ◽

Jorge Fortuño Vidal ◽

Andres Eduardo Costa ◽

Mario Alexandre Sanchez Mata ◽

...

Keyword(s):

Ankle Fracture ◽

Meta Analysis ◽

Patient Characteristics ◽

Postoperative Management ◽

Ankle Fractures ◽

Diabetic Patients ◽

Charcot Neuroarthropathy ◽

Non Union ◽

Major Complications ◽

Increased Risk

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Fractures in diabetic patients have a well-known increased risk of complications and this makes the decision to treat these fractures either surgically or conservatively a difficult choice. However, ankle fractures are mostly treated surgically because of their pattern and the postoperative management does not differ from those ankle fractures in non-diabetic patients. The following study aims to review the evident rate of complications following the treatment of an ankle fracture in diabetic patients and their matched controls. Methods: Searches of PubMed, Scopus, Cochrane and ISI Web of Knowledge were performed for studies published between the date of database inception and March 2018. An initial selection of 202 abstracts was performed by at least 2 different reviewers, of which 77 articles were selected to complete review. After following strict inclusion and exclusion criteria, only 17 papers were admitted to the final meta-analysis. Demographics patient characteristics and incidence of the overall and specific complications were extracted from each study selected and an odds ratio with a 95% confidence interval of each complication was calculated between the diabetic and non- diabetic groups. Major complications (infection, non-union, malunion, Charcot neuroarthropathy, amputation, death) were compared not only between the two main groups but also between subgroups (complicated diabetic and non-complicated diabetic patients, surgical and orthopaedic treatment). The statistics data was analysed by Stata 15. Results: There is a significant increased rate of complications after treating an ankle fracture orthopaedically or surgically in diabetic patients (OR 1.74, IC 95% 1.67 to 1.82). This risk is considerably higher when the ankle fracture is treated surgically (OR 5.14, IC 95% 2.79 -9.58). Among the complications in diabetic patients, the rate is greater in complicated diabetic patients (neuropathy, vasculopathy) compared to the non-complicated diabetic patients (OR 8, IC 95% 2.61 - 26.31). The main complication postoperative in ankle fracture described is infection, which is 7 times higher in diabetic patients in comparison to non-diabetic patients (OR 6.9, IC 95% 3.03 -15.73). The risk of amputation and/or non-union after an ankle fracture in diabetic patients is about 0.2%. Conclusion: This meta-analysis provides evidence that diabetic patients have a significant greater risk of presenting a complication after an ankle fracture. The rate of major complications (infection, malunion, non-union, amputation and death) is by far significantly higher among those diabetic patients treated surgically and even greater among complicated diabetic patients.

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Return to sport following navicular stress fracture: a systematic review and meta-analysis of three hundred and fifteen fractures

International Orthopaedics ◽

10.1007/s00264-021-05147-6 ◽

2021 ◽

Author(s):

Ahmed Khalil Attia ◽

Karim Mahmoud ◽

Jason Bariteau ◽

Sameh A. Labib ◽

Christopher W. DiGiovanni ◽

...

Keyword(s):

Success Rate ◽

Conservative Management ◽

Meta Analysis ◽

Operative Management ◽

Return To Play ◽

Inclusion Criteria ◽

Duration Of Symptoms ◽

Non Union ◽

Statistical Heterogeneity ◽

Significant Difference

Abstract Purpose This meta-analysis aims to provide updated evidence on the success rate, return to play (RTP) rate, time to RTP, and complications of operatively and conservatively managed navicular stress fractures (NSFs) as well as delays in diagnosis while avoiding limitations of previous similar studies. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent team members electronically searched MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases throughout February 2021 using the following keywords with their synonyms: “Navicular stress fracture,” “return to play,” and “athletes.” The primary outcomes were (1) management success rate, (2) RTP rate, and (3) time to RTP. The secondary outcomes were (1) non-union, (2) time to diagnosis, (3) refracture, and (4) other complications. Inclusion criteria were clinical studies on NSFs reporting at least one of the desirable outcomes. Studies not reporting any of the outcomes of interest or the full text was not available in English, German, French, or Arabic were excluded. Case reports, case series with less than ten cases, and studies reporting exclusively on navicular non-union management were also excluded. The Newcastle–Ottawa scale was used for quality assessment while Review Manager (RevMan) Version 5.4 was used for the risk of bias assessment. Data were presented by type of treatment (surgical or conservative). If enough studies were present that were clinically and statistically homogeneous and data on them adequately reported, a meta-analysis was performed using a fixed-effects model. In case of statistical heterogeneity, a random-effects model was used. If meta-analysis was not possible, results were reported in a descriptive fashion. The need to explore for statistical heterogeneity was determined by an I2 greater than 40%. Results Eleven studies met the inclusion criteria with a total of 315 NSF. Out of those, 307 (97.46%) NSFs were in athletes. One hundred eight (34.29%) NSFs were managed operatively, while 207 (65.71%) NSFs were managed conservatively. Successful outcomes were reported in 104/108 (96.30%) NSF treated operatively with a mean success rate of 97.9% (CI: 95.4–100%, I2 = 0%). Successful outcomes were reported in 149/207 (71.98%) NSF treated conservatively, with a mean success rate of 78.1% (CI: 66.6–89.6%, I2 = 84.93%). Successful outcome differences were found to be significant in favor of operative management (OR = 5.52, CI: 1.74–17.48, p = 0.004, I2 = 4.6%). RTP was noted in 97/98 (98.98%) NSF treated operatively and in 152/207 (73.43%) NSF treated conservatively, with no significant difference between operative and conservative management (OR = 2.789, CI: 0.80–9.67, p = 0.142, I2 = 0%). The pooled mean time to RTP in NSF treated operatively was 4.17 months (CI: 3.06–5.28, I2 = 92.88%), while NSF treated conservatively returned to play at 4.67 months (CI: 0.97–8.37, I2 = 99.46%) postoperatively, with no significant difference between operative and conservative management (SMD = − 0.397, CI: − 1.869–1.075, p = 0.60, I2 = 92.24). The pooled mean duration of symptoms before diagnosis was 9.862 (3.3–123.6) months (CI: 6.45–13.28, I2 = 94.92%), reported in ten studies. Twenty (23.53%) refractures were reported after conservative management of 85 NSFs, while one (1.28%) refracture was reported after operative management of 78 NSFs, with a significant difference in favor of operative management (OR = 0.083, CI: 0.007–0.973, p = 0.047, I2 = 38.78%). Conclusion Operative management of NSF provides a higher success rate, a lower refracture rate, and a lower non-union rate as compared to other non-operative management options. While not significant, there is a notable trend towards superior RTP rates and time to RTP following operative management. Therefore, we recommend operative fixation for all NSFs type I through III in athletes. Athletes continue to exhibit an alarmingly long duration of symptoms before diagnosis is made; a high index of suspicion must be maintained, therefore, and adjunct CT imaging is strongly recommended in the case of any work-up. Unfortunately, the published literature on NSFs remains of lower level of evidence and high-quality studies are needed.

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Current Evidence of Interleukin-6 Signaling Inhibitors in Patients With COVID-19: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2020.615972 ◽

2020 ◽

Vol 11 ◽

Author(s):

Qi Han ◽

Mingyue Guo ◽

Yue Zheng ◽

Ying Zhang ◽

Yanshan De ◽

...

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Interleukin 6 ◽

Meta Analysis ◽

Admission Rate ◽

Current Evidence ◽

Cochrane Library ◽

Improvement Rate ◽

Secondary Infections ◽

Signaling Inhibitors

Background: Interleukin-6 (IL-6) is known to be detrimental in coronavirus disease 2019 (COVID-19) because of its involvement in driving cytokine storm. This systematic review and meta-analysis aimed to assess the safety and efficacy of anti-IL-6 signaling (anti-IL6/IL-6R/JAK) agents on COVID-19 based on the current evidence.Methods: Studies were identified through systematic searches of PubMed, EMBASE, ISI Web of Science, Cochrane library, ongoing clinical trial registries (clinicaltrials.gov), and preprint servers (medRxiv, ChinaXiv) on August 10, 2020, as well as eligibility checks according to predefined selection criteria. Statistical analysis was performed using Review Manager (version 5.3) and STATA 12.0.Results: Thirty-one studies were included in the pooled analysis of mortality, and 12 studies were identified for the analysis of risk of secondary infections. For mortality analysis, 5630 COVID-19 cases including 2,132 treated patients and 3,498 controls were analyzed. Anti-IL-6 signaling agents plus standard of care (SOC) significantly decreased the mortality rate compared to SOC alone (pooled OR = 0.61, 95% CI 0.45–0.84, p = 0.002). For the analysis of secondary infection risk, 1,624 patients with COVID-19 including 639 treated patients and 985 controls were included, showing that anti-IL-6 signaling agents did not increase the rate of secondary infections (pooled OR = 1.21, 95% CI 0.70–2.08, p = 0.50). By contrast, for patients with critical COVID-19 disease, anti-IL-6 signaling agents failed to reduce mortality compared to SOC alone (pooled OR = 0.75, 95% CI 0.42–1.33, p = 0.33), but they tended to increase the risk of secondary infections (pooled OR = 1.85, 95% CI 0.95–3.61, p = 0.07). A blockade of IL-6 signaling failed to reduce the mechanical ventilation rate, ICU admission rate, or elevate the clinical improvement rate.Conclusion: IL-6 signaling inhibitors reduced the mortality rate without increasing secondary infections in patients with COVID-19 based on current studies. For patients with critical disease, IL-6 signaling inhibitors did not exhibit any benefit.

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

Diagnostics ◽

10.3390/diagnostics11061017 ◽

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’.

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Management of Spontaneous Pneumothorax in Children: A Systematic Review and Meta-Analysis

European Journal of Pediatric Surgery ◽

10.1055/s-0039-3402522 ◽

2020 ◽

Vol 30 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Maria Enrica Miscia ◽

Giuseppe Lauriti ◽

Gabriele Lisi ◽

Angela Riccio ◽

Pierluigi Lelli Chiesa

Keyword(s):

Surgical Management ◽

Conservative Management ◽

Spontaneous Pneumothorax ◽

Case Reports ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Chest Drain ◽

Level Of Evidence ◽

Risk Of Recurrence ◽

Nonsurgical Management

Abstract Introduction Management of primary spontaneous pneumothorax (PSP) is mainly based on adults. Data are controversial with regards to its management in children. We aimed to assess: (1) the length of hospital stay (LOS) between conservative management (i.e., observation with O2 administration), aspiration/chest drain, and surgical management; (2) the risk of recurrence after nonsurgical treatment versus surgery; (3) the risk of recurrence in the presence of bullae. Materials and Methods Using a defined search strategy, three independent investigators identified all the studies on the management of PSP in children. Case reports, opinion articles, and gray literature publications were excluded. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was performed using RevMan 5.3. Data are expressed as mean ± SD. Results Of 3,089 abstracts screened, 95 full-text were analyzed, 23 were included in the quantitative analysis, and 16 were included in the meta-analysis (1,633 patients). LOS was similar between conservative and surgical management (6.2 ± 0.8 days vs. 5.9 ± 1.4 days; p = ns). Recurrence of PSP was significantly higher among children with a nonsurgical management (32%) versus those surgically treated (18%; p = 0.002). The incidence of recurrence was slightly higher in patients managed by aspiration/chest drain (34%) compared with those with a conservative management (27%; p = 0.05). Risk of recurrence in patients with or without documented bullae was not significantly different (26 vs. 38%, respectively; p = ns). Conclusion Given the lack of a standardized management of pediatric PSP, the present study seems to demonstrate a better outcome in children treated with surgery as first-line of management. Level of Evidence This is a Level III study.

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Does candidate for plate fixation selection improve the functional outcome after midshaft clavicle fracture? A systematic review of 1348 patients

Shoulder & Elbow ◽

10.1177/1758573218777996 ◽

2018 ◽

Vol 11 (1) ◽

pp. 9-16 ◽

Cited By ~ 3

Author(s):

M Vautrin ◽

G Kaminski ◽

B Barimani ◽

J Elmers ◽

V Philippe ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Randomized Controlled Trials ◽

Functional Outcome ◽

Surgical Management ◽

Controlled Trial ◽

Clavicle Fracture ◽

Controlled Trials ◽

Union Rate ◽

Non Union ◽

Randomized Controlled

Introduction The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation. Methods We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included. Results Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial). Discussion This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.

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Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546521990020 ◽

2021 ◽

pp. 036354652199002

Author(s):

Ahmed Khalil Attia ◽

Tarek Taha ◽

Geraldine Kong ◽

Abduljabbar Alhammoud ◽

Karim Mahmoud ◽

...

Keyword(s):

Surgical Management ◽

Nonoperative Management ◽

Screw Fixation ◽

Meta Analysis ◽

Delayed Union ◽

Return To Play ◽

Cochrane Library ◽

Union Rate ◽

Surgical Fixation ◽

Nonoperative Group

Background: Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population. Purpose: To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures. Study Design: Meta-analysis. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures. Results: Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; P < .001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%). Conclusion: The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes.

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Gastroenterological and Hepatic Manifestations of Patients with COVID-19, Prevalence, Mortality by Country, and Intensive Care Admission Rate: Systematic Review and Meta-analysis

10.1101/2020.10.29.20207167 ◽

2020 ◽

Author(s):

Mohammad Shehab ◽

Fatema Alrashed ◽

Sameera Shuaibi ◽

Dhuha Alajmi ◽

Alan Barkun

Keyword(s):

United States ◽

Systematic Review ◽

Mortality Rate ◽

Meta Analysis ◽

Gastrointestinal Symptoms ◽

Geographic Location ◽

Admission Rate ◽

The United States ◽

Icu Admission ◽

Gi Symptoms

AbstractBackground & AimsPatient infected with the SARS-COV2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhea and abdominal pain has been described. The aim of this study was to evaluate the prevalence of GI, liver function test (LFT) abnormalities, and mortality of COVID-19 patients.MethodsWe performed a systematic review and meta-analysis of published studies that included cohort of patients infected with SARS-COV2 from December 1st, 2019 to July 1st, 2020. We collected data from the cohort of patients with COVID-19 by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the preferred reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms, LFTs abnormalities and performed subanalyses to investigate the relationship between gastrointestinal symptoms, geographic location, fatality, and ICU admission.ResultsThe available data of 17,802 positive patients for SARS-COV2 from 120 studies were included in our analysis. The most frequent manifestations were diarrhea (13.3%, 95% CI 12-16), nausea (9.1%, 95% CI 9-13) and elevated LFTs (23.7%, 95% CI 21- 27). The overall and GI fatality were 7.2% (95% CI 6 -10), and 1% (95% CI 1- 4) respectively. Subgroup analysis showed non statistically significant associations between GI symptoms/LFTs abnormalities and ICU admissions (OR=3.41, 95% CI 0.87 – 13.4). The GI mortality rate was 0.58% in China and 3.5% in the United States (95% CI 2 - 5).ConclusionDigestive symptoms and LFTs abnormalities are common in COVID-19 patients. Our subanalysis shows that the presence of gastrointestinal and liver manifestations does not appear to affect mortality, or ICU admission rate. However, the mortality rate was higher in the United States compared to China.

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