scholarly journals Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Hui Yao ◽  
Tangzhao Liang ◽  
Yichun Xu ◽  
Gang Hou ◽  
Lulu Lv ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Calcaneal Fracture ◽  
Evidence Base ◽  
Lateral Approach ◽  
Current Evidence ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Current Evidence Base ◽  
Extensile Lateral Approach

scholarly journals Sinus tarsi approach vs. extensile lateral approach for intra-articular calcaneal fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Methee Khongphaophong
Keyword(s):  
Hospital Stay ◽  
Open Reduction ◽  
Operative Time ◽  
Locking Plate ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Wound Complications ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Trauma Introduction/Purpose: The options of operative treatment for intra-articular calcaneal fracture still remains controversial. Extensile lateral approach allow excellent exposure to fracture, but bring high rate of wound complications. The aim of this study was to compare the outcome of intra-articular calcaneal fracture treated with open reduction and internal fixation via an extensile lateral versus. Sinus tarsi approach Methods: Prospective study of 62 intra-articular calcaneal fractures treated by open reduction and internal fixation between 2014, October to 2017, June. 29 were treated with extensile lateral approach with calcaneal locking plate(Wright medical, Tennessee), 33 sinus tarsi approach(4 cases need additional mini medial incision approaches for SanderIII AC, BC) with mini-calcaneal locking plate(Normed, Florida). Durations until operation, operative time, foot functional index(total score), visual analog scale, SF-36, Bohler’s angle, angle of Gissane, wound complications and duration of hospital stay were recorded post-operatively and minimal 6 months follow up. Results: Compared 2 groups with demographic datas.Average duration until operation; extensile group was 13.32 days, sinus tarsi group was 6.08 days, p <0.001. Operative time; extensile group was 123.41minutes vs. sinus tarsi group was 91.20 minutes, p <0.001. Wound complications was 24.13% in extensile group vs. 6.06% in sinus tarsi group, p =0.045, Duration of post-operative admission was 6.68 days in extensile group vs. 3.10 days in sinus tarsi group p <0.001 FFI last visits was 25.36 in extensile group vs. 25.65 in sinus tarsi group, p =0.969, VAS activity was 29.68 in extensile group vs. 28.54 in sinus tarsi group, p=0.271. Conclusion: Sinus tarsi approach with mini-calcaneal locking plate was a great option for treatment of intra-articular calcaneal fracture. This approach brought lower rate of wound complications, earlier operations, shorter operation times and shorter hospital stay compared to extensile lateral approach.

scholarly journals Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
James P. Davies ◽  
W. Bret Smith ◽  
Steven Steinlauf ◽  
Mary Millikin
Keyword(s):  
High Risk ◽  
Gold Standard ◽  
Wound Complication ◽  
Lateral Approach ◽  
Wound Complications ◽  
Complication Rates ◽  
Calcaneal Fractures ◽  
Sinus Tarsi ◽  
Sinus Tarsi Approach ◽  
Extensile Lateral Approach

Category: Ankle, Diabetes, Hindfoot, Trauma Introduction/Purpose: Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach. Methods: A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes. Results: In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level. Conclusion: In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.

scholarly journals Investigation of antihypertensive class, dementia, and cognitive decline

Neurology ◽  
2019 ◽  
Vol 94 (3) ◽  
pp. e267-e281 ◽  
Author(s):  
Ruth Peters ◽  
Sevil Yasar ◽  
Craig S. Anderson ◽  
Shea Andrews ◽  
Riitta Antikainen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Meta Analysis ◽  
Evidence Base ◽  
Reliable Change Index ◽  
Current Evidence ◽  
Index Method ◽  
Current Evidence Base ◽  
Registration Number ◽  
Prospective Longitudinal

ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.ResultsOver 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.ConclusionOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.Clinical trials registrationThe review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

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