scholarly journals Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

2019 ◽  
Author(s):  
Yan-Hui Li ◽  
Tiecheng Yu ◽  
Wenjing Shao ◽  
Yanwei Liu ◽  
Dong Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intramedullary Nailing ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Library ◽  
Functional Score ◽  
Transfusion Rate ◽  
Intertrochanteric Fractures ◽  
Intraoperative Bleeding ◽  
Distal Locking

Abstract Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, distal locking procedure during nailing gradually raised controversy. A systematic review and meta-analysis of clinical trials was performed to summarize the existing evidence with the aim at determining the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. Methods: Appropriate articles were identified using the most common public databases such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and also considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies comparing distal locking with unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding the methodological quality, patient demographics and all clinical outcomes were extracted independently by two reviewers. Patients were then divided into locking and unlocking group. Results: This study included 9 articles, a total of 1978 patients with a similar baseline. The results showed that the unlocking group had shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture compared with the distal locking group. No significant difference was found in safety-related outcomes including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. Efficacy-related outcomes including nonunion, delayed healing rates, and Harris functional score were also not significantly different between the two groups. Conclusions: Our pooled analysis demonstrated that the distal unlocking of the stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes in terms of complications and function.

scholarly journals Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yan-Hui Li ◽  
Tiecheng Yu ◽  
Wenjing Shao ◽  
Yanwei Liu ◽  
Dong Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intramedullary Nailing ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Library ◽  
Functional Score ◽  
Transfusion Rate ◽  
Intertrochanteric Fractures ◽  
Intraoperative Bleeding ◽  
Distal Locking

Abstract Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, a distal locking procedure during nailing gradually raised controversy. In this study, a systematic review and meta-analysis of clinical trials was performed to summarize existing evidence, aiming to determine the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. Methods: Appropriate articles were identified using the most common public databases, such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies, comparing distal locking and unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding methodological quality, patient demographics, and clinical outcomes were extracted independently by two reviewers. Subsequently, patients were divided into a locking and unlocking group.Results: This study included 9 articles, comprising a total of 1978 patients with a similar baseline. The results showed that the unlocking group had a shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture when compared with the distal locking group. No significant differences were observed in safety-related outcomes, including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. In addition, efficacy-related outcomes including nonunion, delayed healing rates, and the Harris functional score were not significantly different between the two groups. Conclusions: Our pooled analysis demonstrated that distal unlocking of stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes regarding complications and function.

scholarly journals Comparison between Minimally Invasive Plate Osteosynthesis and Conventional Open Plating for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Enzhe Zhao ◽  
Rui Zhang ◽  
Dou Wu ◽  
Yao Guo ◽  
Qiang Liu
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Cohort Studies ◽  
Functional Outcome ◽  
Plate Osteosynthesis ◽  
Meta Analysis ◽  
Operation Time ◽  
Cochrane Library ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Clavicle Fractures

Objective. The aim of this study was to compare the functional outcome and complications in midshaft clavicle fractures receiving minimally invasive plate osteosynthesis and conventional open plating. Methods. Relevant studies were searched in the databases of Medline, EMBASE, Cochrane Library, Ovid, and Web of Science from inception to March 1, 2019. Pooled data were analyzed with Cochrane Collaboration’s Review Manager 5.3. Results. A total of 7 studies were included, of which 2 were randomized controlled trials, 3 were retrospective cohort studies, and 2 were prospective cohort studies including 316 patients. No statistical differences in functional outcome (weighted mean difference [WMD] = 0.99, P=0.12), operation time (WMD = −10.44, P=0.07) and time to bone union (WMD = −0.23, P=0.70) were observed between the two groups. However, minimally invasive plate osteosynthesis reduced rates of skin numbness (odds ratio (OR) = 0.25, 95% CI : 0.13 to 0.48; P<0.0001) and complications (OR = 0.33, 95% CI : 0.16 to 0.71; P=0.005) compared with conventional open plating. Conclusion. This systematic review and meta-analysis found no differences in terms of functional outcomes, operation time, and fracture healing time between minimally invasive plate osteosynthesis and conventional open plating. However, minimally invasive plate osteosynthesis had apparent advantages in rates of skin numbness and complications.

scholarly journals Coblation versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Mohammad Karam ◽  
Ahmad Abul ◽  
Abdulwahab Althuwaini ◽  
Talal Alenezi ◽  
Ali Aljadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Operation Time ◽  
Secondary Outcome ◽  
Intraoperative Bleeding ◽  
Post Operative Pain ◽  
Delayed Hemorrhage ◽  
Significant Difference

Objective To compare the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage and post-operative pain were primary outcome measures. Secondary outcome measures included return to normal diet, effects on tonsillar bed, operation time and administration of analgesia. Fixed and random effects models were used for the analysis. Results Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.25, P = 0.0007) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. For secondary outcomes, coblation group had improved outcomes in terms of administration of analgesia, diet and tonsillar tissue recovery and thermal damage. No significant difference was reported in terms of operation time. Conclusions Coblation is a superior option when compared to bipolar technique for pediatric patients undergoing tonsillectomy as it improves post-operative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis

2017 ◽  
Vol 85 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Akbar Nouralizadeh ◽  
Nasser Simforoosh ◽  
Hamidreza Shemshaki ◽  
Mohammad H. Soltani ◽  
Mehdi Sotoudeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Operation Time ◽  
Mean Difference ◽  
Transfusion Rate ◽  
Stone Clearance ◽  
Significant Difference ◽  
Tubeless Pcnl

Background: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Methods: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. Results: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). Conclusions: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

scholarly journals Management for lumbar spinal stenosis: Protocol for a network meta-analysis and systematic review

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902097521
Author(s):  
Fei-Long Wei ◽  
Ya Liu ◽  
Cheng-Pei Zhou ◽  
Si-Guo Sun ◽  
Kai-Long Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Meta Analysis ◽  
Operation Time ◽  
Evaluation Framework ◽  
Adult Patients ◽  
Leg Pain ◽  
Cochrane Library ◽  
Lumbar Spinal

Introduction: Lumbar spinal stenosis (LSS) is caused by structural changes of the spine, which lead to several severe symptoms, including back pain, leg pain, numbness and tingling in the legs, as well as reduced physical function. However, there is little evidence suggesting whether a patient with LSS should be treated with surgery. If surgery is recommended, which type of surgery benefits the patient most? To answer these questions, we will conduct a network meta-analysis and a systematic review to compare surgical and nonsurgical interventions in terms of efficacy as well as safety in adult patients with LSS. Methods and analysis: We will search the PubMed, Cochrane library, and EMBASE databases for articles published prior to October 10, 2019. We will search for randomized controlled trials assessing surgical and nonsurgical interventions for adult patients with degenerative LSS without any language restrictions. The primary outcome measures will be pain and disability. The secondary outcomes will include adverse events (number of events or number of people with each type of adverse event), reoperations, complications, blood loss and operation time. We will obtain the full texts of the potentially relevant studies and independently assess them. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. A random-effects network meta-analysis will be performed to analyze all the evidence under the frequentist framework, and the ranking results will be presented. We will generate plots depicting the network geometry using Stata. The network meta-analysis will be performed according to the Bayesian framework. Ethics and dissemination Ethics approval is not required. The research will be published in a peer-reviewed journal.

Is It Better to Routinely Use Tourniquet for Knee Arthroscopic Surgery: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (09) ◽  
pp. 866-874 ◽  
Author(s):  
Jinyou Wang ◽  
Wennan Xu ◽  
Jiayin Lv
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Arthroscopic Surgery ◽  
Operation Time ◽  
Current Evidence ◽  
Postoperative Blood Loss ◽  
Cochrane Library ◽  
Significant Difference

AbstractThe use of tourniquet in knee arthroscopic surgery is a routine technique and provides convenience for the operation. However, the adverse effects caused by tourniquet during the operation are noticed by more and more researchers. The purpose of our study was to perform a systematic review and meta-analysis to assess the effects of tourniquet use in knee arthroscopy. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched databases like PubMed, Cochrane library, EMBASE, and Web of Science from inception of the database up to November 20, 2018, using the keywords “ anterior cruciate ligament,” “meniscectomy,” “arthrocopy,” etc. to identify randomized clinical trials. A total of 16 randomized controlled trials involving 1,132 participants fulfilled the inclusion criteria with 582 patients in tourniquet group and 550 patients in nontourniquet group. Compared with tourniquet group, nontourniquet group had less postoperative blood loss and less consumption of analgesic. There was no significant difference between the two groups in intraoperatively arthroscopic visualization, postoperative pain score, postoperative quadriceps muscle strength, and operation time. Our study suggested that compared with tourniquet use, arthroscopic surgery of the knee without tourniquet did not appear to have any disadvantage, and the current evidence was more inclined not to use tourniquet as a routine procedure during the knee arthroscopic surgery.

scholarly journals Tonsillectomy Outcomes for Coblation Versus Bipolar Diathermy Techniques in Adult Patients: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 014556132199499
Author(s):  
Abdulmalik Alsaif ◽  
Mohammad Alazemi ◽  
Narvair Kahlar ◽  
Mohammad Karam ◽  
Ahmad Abul ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Operation Time ◽  
Adult Patients ◽  
Secondary Outcome ◽  
Bipolar Diathermy ◽  
Intraoperative Bleeding ◽  
Delayed Hemorrhage

Introduction and Aims: There is no consensus on the optimal tonsillectomy technique in adult patients. The study aims to identify all studies comparing the outcomes of coblation versus bipolar diathermy in adult patients undergoing tonsillectomy. Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were hemorrhage and postoperative pain. Secondary outcome measures included return to theatre, analgesia, intraoperative bleeding, diet, tonsillar healing, and operation time. Fixed-effects modeling was used for the analysis. Results: Six studies were identified enrolling a total of 1824 patients. There were no significant differences in terms of reactionary hemorrhage (OR = 1.81, P = .51), delayed hemorrhage (OR = 0.72, P = .20), or postoperative pain (mean difference = −0.15, P = .45); however, there is a general trend favuring coblation. For secondary outcomes, no significant differences noted in terms of intraoperative bleeding, diet, and cases returning to theatre. Analgesia administration was either insignificant or higher in the coblation group. The coblation group had longer operation time and greater healing effect on tonsillar tissue. Conclusions: There were no significant differences in outcomes for coblation and bipolar diathermy for adult tonsillectomy patients in this systematic review and meta-analysis.

scholarly journals Direct anterior versus posterolateral approaches for clinical outcomes after total hip arthroplasty: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Wang Chen ◽  
Jian-Ning Sun ◽  
Ye Zhang ◽  
Yu Zhang ◽  
Xiang-Yang Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Operative Time ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Direct Anterior Approach ◽  
Harris Hip Score ◽  
Cochrane Library

Abstract Objective The main objective of our study was to compare the intraoperative and postoperative outcomes of direct anterior approach (DAA) with posterolateral approaches (PLA). Methods We searched Cochrane library, Web of Science, and PubMed for literatures comparing DAA with PLA. On the basis of inclusion and exclusion criteria, relevant literatures were selected. Two members independently screened qualified literatures, evaluated the literature quality, and extracted data information. Results Eighteen randomized controlled trials (RCTs) and non-RCTs totaling 34,873 patients (DAA = 9636, PLA = 25237) were contained in this systematic review and meta-analysis. The results showed that DAA were reduced in terms of length of hospital stay (weighted mean difference (WMD) = −0.43, 95% confidence interval (CI) −0.78 to −0.09, P = 0.01), LLD (WMD = −2.00, 95% CI −2.75 to −1.25, P < 0.00001), PE/DVT (WMD = 0.36, 95% CI 0.15 to 0.85, P = 0.02), dislocation (WMD = 0.42, 95% CI 0.30 to 0.59, P < 0.00001) and visual analog scale (VAS) (WMD = −0.57, 95% CI −0.91 to −0.23, P = 0.0009) compared with PLA; however, DAA compared with the PLA was increasing in terms of operative time (WMD = 14.81, 95% CI 7.18 to 22.44, P = 0.0001), intraoperative blood loss (WMD = 105.13, 95% CI 25.35 to 184.90, P = 0.01), fracture (WMD = 1.46, 95% CI 1.00 to 2.11, P = 0.05), and Harris hip score (HHS) (WMD = 1.19, 95% CI 0.77 to 1.61, P < 0.00001). Conclusions DAA was preferable effectiveness to PLA in early pain relief and functional recovery; however, PLA has a shorter operation time, intraoperative less blood loss and fracture. Trial registration Registration ID, CRD42020151208

scholarly journals Can tranexamic acid reduce the blood transfusion rate in patients undergoing percutaneous nephrolithotomy? A systematic review and meta-analysis

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091756
Author(s):  
Zhenghao Wang ◽  
Xiao He ◽  
Yunjin Bai ◽  
Jia Wang
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Percutaneous Nephrolithotomy ◽  
Selection Process ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
Transfusion Rate ◽  
Substantial Impact

Objective A systematic review and meta-analysis was conducted to explore the efficacy of tranexamic acid (TXA) in reducing transfusion events in patients undergoing percutaneous nephrolithotomy (PCNL). Methods PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases from January 1980 to October 2019 were searched for randomized controlled trials (RCTs) that assessed TXA efficacy in reducing transfusion events during PCNL. Intervention treatments include using TXA compared with placebo (or no intervention) for patients who underwent PCNL. The search strategy and study selection process were managed in accordance with the PRISMA statement. Results Six RCTs are included in the meta-analysis. Overall, TXA intervention groups showed a significant reduction in blood transfusion events (RR = 0.34; 95% confidence interval [CI] = 0.19 to 0.62), hemoglobin decrease (MD = −0.80; 95% CI = −1.32 to −0.28), operative time (MD = −12.62; 95% CI = −15.62 to −9.61), and length of hospital stay (MD = −0.73; 95% CI = −1.36 to −0.10) compared with control groups after PCNL. However, TXA had no substantial impact on the rate of stone clearance (RR = 1.10; 95% CI = 1.00 to 1.21). Conclusions TXA can effectively reduce the transfusion rate and blood loss during PCNL.

Sign in / Sign up

Export Citation Format

Share Document