Arthrodesis of the proximal interphalangeal joint of the finger – a systematic review

Arthrodesis of the proximal interphalangeal (PIP) joint of the finger is an established procedure for advanced osteoarthritis. As there are different techniques of fusion, it seems necessary to evaluate the results. Primary outcome of this review was to evaluate different arthrodesis methods of the PIP joint and describe different numbers of non-unions. Secondary outcome was to evaluate time to consolidation. Respective complications, if mentioned, were listed additionally. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The selected databases were PubMed, Medline, Embase, Google Scholar and Cochrane Library. Studies reporting outcomes of the arthrodesis with a defined technique and radiological consolidation were included. Complication rates and types were recorded. In total, 6162 articles could be identified, 159 full-texts were assessed and 64 studies were included. Methodological quality was assessed using Methodological Index for Non-Randomized Studies. A total of 1923 arthrodeses of the PIP joint could be identified. Twelve different surgical techniques were described, four of these techniques with compression at the arthrodesis site. The most frequently used techniques were K-wires (n = 743, 14 studies), tension-band (n = 313, 15 studies) and compression screws (n = 233, 12 studies). The lowest rate of described non-unions in compression techniques was 3.9% with the compression screw. The highest non-union rate of 8.6% was achieved by interosseous wiring. All the described techniques can achieve the goal of fusing an osteoarthritic joint. There is a tendency in the more recent literature for the use of compression techniques.

Download Full-text

Effect of Using a Safety Checklist on Patient Complications after Surgery

Anesthesiology ◽

10.1097/aln.0000000000000232 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1380-1389 ◽

Cited By ~ 63

Author(s):

Brigid M. Gillespie ◽

Wendy Chaboyer ◽

Lukman Thalib ◽

Melinda John ◽

Nicole Fairweather ◽

...

Keyword(s):

Absolute Risk ◽

Absolute Risk Reduction ◽

Cochrane Library ◽

Number Needed To Treat ◽

Complication Rates ◽

Random Effects Models ◽

Fixed And Random Effects ◽

Before And After ◽

Meta Analyses ◽

The Cochrane Library

Abstract Background: Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods: A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results: Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P < 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion: Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

Download Full-text

A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa050 ◽

2020 ◽

Vol 58 (1) ◽

pp. 40-50 ◽

Cited By ~ 1

Author(s):

Masahiro Yanagiya ◽

Takuya Kawahara ◽

Keiko Ueda ◽

Daisuke Yoshida ◽

Hirokazu Yamaguchi ◽

...

Keyword(s):

Meta Analysis ◽

Pulmonary Nodules ◽

Pulmonary Haemorrhage ◽

Cochrane Library ◽

Complication Rates ◽

Resection Rate ◽

Electromagnetic Navigation ◽

Meta Analyses ◽

Dye Marking ◽

Pleural Injury

Abstract OBJECTIVES Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking. METHODS The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking. RESULTS Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively. CONCLUSIONS This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.

Download Full-text

Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

Journal of Orthopaedic Surgery ◽

10.1177/2309499020911168 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902091116

Author(s):

Rachel XY Wei ◽

Samuel KK Ling ◽

TH Lui ◽

Patrick SH Yung

Keyword(s):

Systematic Review ◽

Surgical Complication ◽

Deformity Correction ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Complication Rates ◽

The Novel ◽

Claw Toe ◽

Hammer Toe ◽

K Wires

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.

Download Full-text

A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine

Global Spine Journal ◽

10.1177/21925682211063855 ◽

2022 ◽

pp. 219256822110638

Author(s):

Colby Oitment ◽

Patrick Thornley ◽

Frank Koziarz ◽

Thorsten Jentzsch ◽

Kunal Bhanot

Keyword(s):

Systematic Review ◽

Cervical Spine ◽

Surgical Techniques ◽

Cochrane Library ◽

Rigid Fixation ◽

Poor Bone Quality ◽

Bone Implant ◽

Meta Analyses ◽

Key Techniques ◽

Biomechanical Strength

Study Design Systematic review. Objectives Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. Results An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. Conclusion The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.

Download Full-text

Functional and Aesthetic Outcomes of Extracorporeal Septoplasty: A Systematic Review and Meta-Analyses

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419891450 ◽

2019 ◽

Vol 129 (4) ◽

pp. 401-410

Author(s):

Amishav Bresler ◽

Roman Povolotskiy ◽

Brandon Nguyen ◽

Giancarlo F. Zuliani ◽

Jean Anderson Eloy ◽

...

Keyword(s):

Systematic Review ◽

Functional Outcomes ◽

Web Of Science ◽

Cochrane Library ◽

Complication Rates ◽

Extracorporeal Septoplasty ◽

Symptom Evaluation ◽

Meta Analyses ◽

Nasal Function ◽

Nasal Flow

Objective: The safety and efficacy of extracorporeal septoplasty (ECS) has long been debated. Our objective was to determine this technique’s functional and aesthetic outcomes and complications through a systematic review of the literature. Data Sources: PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science databases were evaluated for studies detailing functional or aesthetic outcomes of ECS. Review Methods: Bias was evaluated using the Cochrane Risk of Bias Tool and the Methodological Index for Non-randomized Studies (MINORS) score. Aesthetic and functional outcomes in addition to complications were evaluated using subjective and objective measures. Meta-analyses were performed when appropriate. Results: Seventeen studies encompassing 1418 patients were included. The average MINORS score for observational studies was 9.2. Overall there was a significant improvement in subjective nasal function with a preoperative average Nasal Obstruction Symptom Evaluation (NOSE) score of 75 (±16) decreasing to 19.5 (±16.5) postoperatively for a mean difference (MD) of −55 (95% confidence interval (CI): –60 to −49.5). In terms of objective nasal function, at 6 months postoperatively, there was an improvement of nasal flow measured by rhinometry ranging from 70 to 71% across studies. Anthropometric measurements were utilized for objective aesthetic outcomes. There was a significant improvement in I-shaped deviations (MD: –2.7°, 95% CI: –5.6 to −0.16) and C-shaped deviations improved by 11.9° (95% CI +2.8-+21.2). Complication rates ranged from 0 to 18%. Conclusion: ECS can achieve significant improvements in the subjective and objective function of the nose. The associated complication rate is low but variable between surgeons.

Download Full-text

Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses

Journal of Orthopaedic Surgery ◽

10.1177/2309499020915282 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902091528 ◽

Cited By ~ 1

Author(s):

Tao Yu ◽

Yuan Xiong ◽

Alex Kang ◽

Haichao Zhou ◽

Wenbao He ◽

...

Keyword(s):

Systematic Review ◽

Lateral Approach ◽

Cochrane Library ◽

Wound Complications ◽

Complication Rates ◽

Calcaneal Fractures ◽

Sinus Tarsi ◽

Sinus Tarsi Approach ◽

Extensile Lateral Approach ◽

Meta Analyses

Purpose: Accumulated literature has reported the comparative efficacy of the sinus tarsi approach (STA) and the extensile lateral approach (ELA) for the treatment of calcaneal fractures (CFs). However, the best alternative treatment for CF is still inconsistent. Herein, the present systematic review of overlapping meta-analyses aims to achieve an evident conclusion by performing a comprehensive reanalysis of previous meta-analyses regarding the comparison of the STA and the ELA. Methods: We searched several databases, including Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov , OVID, and CNKI for the meta-analyses comparing the STA and the ELA for the treatment of CF. All related meta-analyses of randomized controlled trials and cohort studies were included. Two researchers independently assessed the quality of the articles and extracted the data. The Jadad decision algorithm was used to evaluate the evidence of the articles. Results: Ultimately, five meta-analyses were included in the present study. The Assessment of Multiple Systematic Reviews scores of these articles ranged from 5 to 9 with a median of 7. The analysis of best quality, Bai 2018, was selected based on the Jadad algorithm. In this article, the significant differences were found in wound complications and operating time, recovery of Böhler’s angle, the American Orthopaedic Foot and Ankle Society scores, and the visual analog scale. Conclusion: The clinical relevance of the present study is that both the STA and the ELA are effective in alleviating pain and improving functionality in the treatment of CF. However, due to a shorter operation duration and lower complication rates, the STA was indicated to be a superior alternative for CF treatment.

Download Full-text

A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211024049 ◽

2021 ◽

pp. 000348942110240

Author(s):

Sebastiaan Meijers ◽

Rutger Meijers ◽

Erwin van der Veen ◽

Maaike van den Aardweg ◽

Hanneke Bruijnzeel

Keyword(s):

Surgical Techniques ◽

Postoperative Recurrence ◽

Branchial Arch ◽

Conventional Technique ◽

Surgical Removal ◽

Complication Rates ◽

Recurrence Rates ◽

New Treatment ◽

Meta Analyses

Objective: During the last 2 decades, new treatment methods have been developed for the surgical removal of second branchial cysts which result in less visible scars. The aim of this systematic review is to assess which surgical technique for second branchial arch cyst removal results in the lowest complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed, and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify studies comparing surgical outcomes of second branchial arch cyst removal. Authors appraised selected studies on directness of evidence and risk of bias. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current review including a total of 140 operated cysts. Only 2 studies included pre-operatively infected cysts. Follow up ranged from 3 to 24 months. Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%]; endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with postoperative recurrence. Significantly higher scar satisfaction was found in adult patients who underwent endoscopic or retro-auricular hairline incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up using either conventional surgery or endoscopic/retro-auricular techniques. Although more (temporary) complications occur using endoscopic and retro-auricular techniques, patients report a significantly higher scar satisfaction 3 to 6 months after surgery in comparison to the conventional technique. Future studies are needed to support these findings.

Download Full-text

A systematic review of the keystone design perforator island flap in the reconstruction of trunk defects

Archives of Plastic Surgery ◽

10.5999/aps.2020.00094 ◽

2020 ◽

Vol 47 (6) ◽

pp. 535-541

Author(s):

Irena Sakura Rini ◽

Alberta Jesslyn Gunardi ◽

Renate Parlene Marsaulina ◽

Teguh Aryandono ◽

Ishandono Dachlan ◽

...

Keyword(s):

Systematic Review ◽

Wound Dehiscence ◽

Island Flap ◽

Cochrane Library ◽

Complication Rates ◽

Inclusion Criteria ◽

Pubmed Central ◽

Study Selection ◽

Delayed Healing ◽

Meta Analyses

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

Download Full-text

Comparative efficacy of different flapless ridge preservation techniques: A systematic review and meta-analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-21-00108 ◽

2021 ◽

Author(s):

Ethan Ng ◽

John Tay ◽

Clement Lai ◽

Alvin Yeo ◽

Lum Peng Lim ◽

...

Keyword(s):

Soft Tissue ◽

Primary Outcome ◽

Meta Analysis ◽

Surgical Techniques ◽

Cochrane Library ◽

Secondary Outcome ◽

Ridge Preservation ◽

Hard Tissue ◽

Tissue Changes ◽

Soft Tissue Changes

Although the efficacy of ridge preservation is well-documented, there is a lack of robust evidence regarding the influence of different surgical techniques. Flapless approaches are thought to be better at preserving soft tissue architecture and have been suggested for mild to moderate defects. This review investigates the efficacy of different flapless techniques for ridge preservation in mild to moderate defects with <50% buccal bone loss. PubMed, EMBASE, and Cochrane Library databases were searched to obtain relevant articles published in English from 1974 to December 2019. The primary outcome was horizontal and vertical hard tissue dimensional changes. Soft tissue changes were evaluated as a secondary outcome. The Bio-Col technique, subperiosteal tunnel technique, and hard tissue with autogenous soft tissue graft/collagen matrix technique were identified. Eight studies were included, and quantitative analyses were performed for four studies for the primary outcome variables. The meta-analysis revealed significant reductions for horizontal changes (WMD = 2.56 mm, 95% CI [2.18, 2.95]), vertical mid-buccal (WMD = 1.47 mm, 95% CI [1.04, 1.90]), and vertical mid-lingual (WMD = 1.28 mm, 95% CI [0.68, 1.87]), in favor of flapless ridge preservation techniques. Subgroup analysis based on technique suggest minimal hard tissue differences. The efficacy of flapless ridge preservation techniques on soft tissue changes was inconclusive. In conclusion, flapless ridge preservation techniques are effective for mild to moderate defects. The technique or material used to close the extraction socket does not seem to significantly affect hard tissue changes, while the effect on soft tissue changes warrants further investigation.

Download Full-text

Surgical Modalities of Repair of Intra Articular Fractures of Proximal Interphalangeal Joint: A Meta-analysis

QJM ◽

10.1093/qjmed/hcab105.011 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Heba Diaaey Hussien ◽

Eman Yahya Sadek ◽

Associate Prof. Dr. Khaled Ahmed Reyad ◽

Moaz Fathy Khalifa Fayez

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

International Committee ◽

Proximal Interphalangeal Joint ◽

Articular Fractures ◽

Fracture Dislocations ◽

Iatrogenic Damage ◽

Pip Joint ◽

Baseline Characteristics ◽

Meta Analyses

Abstract Background The proximal interphalangeal (PIP) joints of the fingers are extremely important for gripping things with hands, more specifically, what is called the ‘power grip’. Aim of the Work To compare the different modalities of repair of intra-articular fractures of PIP joint. Materials and Method A systematic review and meta-analysis were performed in accordance to the recommendations of the “Preferred Reporting Items for Systematic Reviews and MetaAnalyses” (PRISMA). PRISMA is reporting checklists for the authors, the editors, and the reviewers of Meta-analyses of the interventional and the observational studies. According to the International committee of medical journal association (ICJME), the reviewers must report their findings according to each of the items listed in those checklists. Results The results of this study includes the search results and data extraction results which includes summary characteristics and baseline characteristics of the included Studies, outcome measures and Complications of the included studies. Conclusion There is no consensus regarding the most effective technique for management of unstable PIPJ fractures. The extension block pinning, closed reduction and percutaneous pinning of the fracture fragments, dynamic distraction and external fixation, open reduction and internal fixation, and hemihamate reconstruction arthroplasty are safe and reliable and reduce the risk of iatrogenic damage when used to treat unstable dorsal fracture-dislocations of the PIP joint.

Download Full-text