Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AimThis network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.MethodsWe searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.ResultsFourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.ConclusionEvidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.     

Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures

IntroductionThis study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures.Patients and methodsPatients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005–2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex.ResultsPlate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/−62 min vs. 102 +/−54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26–7.85).ConclusionPatients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures.     

Is there an impact of cervical plating on the development of adjacent segment degeneration following Smith-Robinson procedure? A magnetic resonance imaging study of 84 patients with a 24-year follow-up

BACKGROUND CONTEXT

Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear.

Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years

Introduction

Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury.

旷置螺钉孔技术在钢板内固定治疗四肢骨干骨折的临床应用

目的：探讨旷置螺钉孔对钢板螺丝钉内固定系统稳定性和骨折愈合的影响。方法：回顾性分析2010年3月-2012年3月收治的60例四肢骨干骨折患者的临床资料,根据是否主动旷置螺钉孔分为旷置组和非旷置组,每组各30例。分析比较两组患者总的疗效,包括：骨痂出现时间、骨折愈合时间（临床愈合、骨性愈合）、内固定失效率（骨不连发生率、钢板断裂发生率）、临床疗效等方面进行比较分析。结果：两组总疗效比较,旷置组优于非旷置组。临床疗效优良率：旷置组为93.3%,非旷置组为80%,两组比较差异有统计学意义（P〈0.05）。术后出现骨痂时间：旷置组为（9.16±1.70）周,非旷置组为（11.20±1.60）周,两组比较差异有统计学意义（P〈0.05）;临床愈合时间：旷置组为（12.82±2.68）周,非旷置组为（15.36±3.66）周,两组比较差异有统计学意义（P〈0.05）;骨性愈合时间：旷置组为（4.51±1.46）个月,非旷置组为（7.06±1.21）个月,两组比较差异有统计学意义（P〈0.05）;术后旷置组骨不连发生率为0,非旷置组为3.3%;旷置组钢板断裂发生率为0,非旷置组为3.3%。结论：合理使用旷置螺钉孔技术对钢板螺丝钉内固定系统稳定性没有显著性影响,符合生物学固定原则;同时,由于有效保护骨折断端的血运,促进了骨折的愈合,减少骨不连、钢板断裂现象,是一种简单可行的操作技术,值得基层医院推广。     

钛重建板修复下颌骨缺损的临床应用

目的：研究钛重建板在修复下颌骨缺损，维持下颌骨连续性和面部形态的临床意义。方法：收集我科自1999～2004年口腔颌面部肿瘤患者，在行根治合并下颌骨部分切除术后，用钛重建板即刻修复，对饮食功能、面部形态恢复及并发症的发生进行回访评价。结果：回访中，对于功能和外形．有21例病人成功维持了下颌骨的连续性，并有20例病人能饮食一般性食物．患者的开口度和开口型基本正常：对于并发症．有2例发生金属外露和1例发生钛重建板折断，均发生在手术半年以后：结论：钛重建板即刻修复下颌骨缺损，在功能和外形方面，大多可以获得良好效果，是一种切实可行的选择性方法。     

上臂内侧切口钢板内固定治疗肱骨干骨折

目的探讨肱骨干骨折采用切开复位钢板内固定治疗的效果。方法回顾性分析自2010-01—2012—01收治的肱骨干骨折165例,其中105例获得随访纳入本研究,根据手术入路的不同将其分为3组：A组上臂内侧切口39例;B组后侧切1：334例：C组前外侧切口32例。结果随访时间均超过12个月,3组骨折均愈合良好,A组愈合时间短于B、C组,差异有统计学意义（P〈0．05）,A、B组皮肤感觉优良率与C组比较差异有统计学意义（P〈0．05）,A、B、C3组间肩、肘功能比较差异无统计学意义（P〉0．05）。结论上臂内侧切口人路钢板内固定治疗肱骨干骨折是可行且安全的。     

Olecranon fractures: factors influencing re-operation

Purpose

We evaluated factors influencing re-operation in tension band and plating of isolated olecranon fractures.

Methods

Four hundred eighty-nine patients with isolated olecranon fractures who underwent tension band (TB) or open reduction internal fixation (ORIF) from 2003 to 2013 were identified at an urban level 1 trauma centre. Medical records were reviewed for patient information and complications, including infection, nonunion, malunion, loss of function or hardware complication requiring an unplanned surgical intervention. Electronic radiographs of these patients were reviewed to identify Orthopaedic Trauma Association (OTA) fracture classification and patients who underwent TB or ORIF.

Results

One hundred seventy-seven patients met inclusion criteria of isolated olecranon fractures. TB was used for fixation in 43 patients and ORIF in 134. No statistical significance was found when comparing complication rates in open versus closed olecranon fractures. In a multivariate analysis, the key factor in outcome was method of fixation. Overall, there were higher rates of infection and hardware removal in the TB compared with the ORIF group.

Conclusions

Our results demonstrate that the dominant factor driving re-operation in isolated olecranon fractures is type of fixation. When controlling for all variables, there is an increased chance of re-operation in patients with TB fixation.