Pelvic fracture instability-associated L5 transverse process fracture,fact or myth? A systematic review and meta-analysis

Purpose

Stable or unstable pelvic ring fractures are sometimes associated with L5 transverse process (TP) fractures. This review aimed to determine the effect of L5 TP fractures on pelvic ring fracture stability.

Methods

We searched electronic databases (including MEDLINE, Google Scholar, and SCOPUS) and performed hand searching of English orthopedics journals and conference abstracts until May 2017. We pooled data from five studies, with a total of 278 patients.

Results

Of 28 studies, five were included (four studies involved adult patients, one pediatric population). Of the 278 pelvic fractures (average age 37.33 years; male 132 and female 92), 99 (35.6%) were stable and 179 (64.4%) were unstable (fracture B and C, according to the Tile classification). Sixty-seven (24.1%) were cases with L5 TP, and 211 (75.9%) were cases without L5 TP fracture. The typical causes of injury were road traffic accident (59.2%), fall from height (23.6%), and crush injuries and injuries by heavy objects (17.2%). The pooled odds ratio (OR) of L5 TP between the stable and unstable groups calculated with random effect analysis was 0.418 (0.083–2.108; p = 0.291); after excluding the study on a pediatric population, the pooled OR was 0.349 (0.056–2.159; p = 0.258).

Conclusions

L5 TP fractures may indicate high-energy trauma; however, no relationship between L5 TP fractures and pelvic ring fracture stability exists.

Level of evidence

Prognostic Level IV.

     

Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis

Introduction

Currently there is no consensus if wide resection and curettage in giant cell tumor have effect on local recurrence rate in the presence of a pathological fracture.

Is fusion superior to non-fusion for the treatment of thoracolumbar burst fracture? A systematic review and meta-analysis

Objective

The purpose of this meta-analysis was to compare the efficacy and safety between patients with thoracolumbar burst fracture who underwent posterior fixation alone (non-fusion) and supplemented with fusion.

Does time interval between prostate biopsy and surgery affect outcomes of radical prostatectomy? A systematic review and meta-analysis

International Urology and Nephrology - This study aimed at exploring whether the time interval (TI) between prostate biopsy and surgery affect the outcomes of radical prostatectomy (RP). A...     

Prevalence and incidence of venous leg ulcers—A systematic review and meta-analysis

Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. Published studies are usually reporting different estimates because of disparities in study designs and measurement methods. Therefore, we conducted a systematic literature review and meta-analysis to identify the prevalence and incidence of VLU internationally and to characterise the population as reported in these studies. Studies were identified from searches in Medline (PubMed), CINAHL Complete (EBSCOhost), Embase, Scopus, Web of Science, LiSSa (Littérature Scientifique en Santé), Google Scholar and Cochrane Database of Systematic Reviews up to November 2022. Studies were included if their primary outcomes were reported as a period prevalence or point prevalence or cumulative incidence or incidence VLU rate. Fourteen studies met the inclusion criteria, 10 reporting estimates of prevalence, three reporting both prevalence and incidence estimates and one incidence. All were included in meta-analyses. The results show a pooled prevalence of 0.32% and a pooled incidence of 0.17%. Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study.     

Differences in sensitivity to neoadjuvant chemotherapy among invasive lobular and ductal carcinoma of the breast and implications on surgery–A systematic review and meta-analysis

Meta-analysis of >87,000 patients demonstrates that patients with invasive lobular carcinoma of the breast are far less likely to achieve pCR of the breast or axilla compared to their ductal counterparts, receive less BCS and more frequently return positive margins.BackgroundNeoadjuvant chemotherapy (NACT) facilitates tumour downstaging, increases breast conserving surgery (BCS) and assesses tumour chemosensitivity. Despite clinicopathological differences in Invasive Ductal Carcinoma (IDC) and Invasive Lobular Carcinoma (ILC), decision making surrounding the use NACT does not take account of histological differences.AimTo determine the impact NACT on pathological complete response (pCR), breast conserving surgery (BCS), margin status and axillary pCR in ILC and IDC.MethodsA systematic review was performed in accordance with the PRISMA guidelines. Studies reporting outcomes among ILC and IDCs following NACT were identified. Dichotomous variables were pooled as odds ratios (ORs) with 95% confidence intervals_(CI) using the Mantel-Haenszel method. P-values <0.05 were statistically significant.Results40 studies including 87,303 (7596 ILC [8.7%]and 79,708 IDC [91.3%]) patients were available for analysis. Mean age at diagnosis was 54.9 vs. 50.9 years for ILC and IDC, respectively. IDCs were significantly more likely to achieve pCR (22.1% v 7.4%, OR: 3.03 [95% CI 2.5–3.68] p < 0.00001), axillary pCR (23.6% vs. 13.4%, OR: 2.01 [95% CI 1.77–2.28] p < 0.00001) and receive BCS (45.7% vs. 33.3%, OR 2.14 [95% CI 1.87–2.45] p < 0.00001) versus ILCs. ILCs were significantly more likely to have positive margins at the time of surgery (36% vs 13.5%, OR 4.84 [95% CI 2.88–8.15] p < 0.00001).ConclusionThis is the largest study comparing the impact of NACT among ILC and IDC with respect to pCR and BCS. ILC has different outcomes to IDC following NACT and incorporate it into treatment decisions and future clinical guidelines.     

Clinical periodontal conditions in individuals after bariatric surgery: a systematic review and meta-analysis

The aim of the present study was to perform a systematic review and meta-analysis to assess the influence of bariatric surgery on the clinical periodontal conditions in patients with obesity. This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered at the International Prospective Registry of Systematic Reviews (CRD42018099313). A search was conducted by 2 investigators in the PubMed/MEDLINE, Web of Science, and Cochrane Library databases for relevant articles published up to May 2018. The inclusion criteria were randomized controlled trials, prospective and retrospective studies, observational studies, longitudinal studies, and cohort studies with at least 3 months of follow-up. No language restrictions were imposed. The exclusion criteria were studies that did not evaluate or report the periodontal measurements, cross-sectional studies (without follow-up after surgery), studies that performed periodontal treatment, and those with insufficient periodontal data. The meta-analysis was based on the Mantel-Haenszel method and inverse variance. The quantitative analysis revealed no statistically significant differences with regard to bleeding on probing (P = .9; mean deviation: ?.70; confidence interval = ?11.43 to 10.04) or probing pocket depth (P = .41; mean deviation: ?.46; confidence interval = ?1.55 to .63) before and after intervention. Clinical attachment loss showed a statistically significant difference (P = .0002; mean deviation: .18; confidence interval = .07–.30). It can be concluded that bariatric surgery does not influence bleeding on probing or probing pocket depth, but leads to a worsening of clinical attachment loss.     

Furosemide in indomethacin-treated infants – systematic review and meta-analysis

 This study was designed to assess: (1) whether furosemide modifies the incidence of failure to close a symptomatic patent ductus arteriosus (PDA) in response to indomethacin in premature infants, (2) whether furosemide decreases renal and hydromineral side effects of indomethacin, and (3) whether the effects of furosemide on renal function depend on initial extracellular volume [assessed by blood urea nitrogen (BUN)/creatinine ratio]. We did a systematic review and meta-analysis of all published controlled trials assessing either ductal closure or renal function after randomized allocation to treatment with indomethacin and furosemide versus indomethacin alone. All of the three studies meeting entry criteria were small and had methodological limitations. The number of patients was too small to rule out a 10% risk increase in failure of ductal closure. After the first dose of indomethacin, patients receiving furosemide had higher urine output, fractional excretion of sodium, and osmolar clearance than controls. Among patients with initial BUN/creatinine ratio <20, those on furosemide had a higher glomerular filtration rate (GFR) than controls. Among patients with initial BUN/creatinine of 20–30, those on furosemide had a lower GFR than controls. Thus, dehydration appears to be a contraindication for furosemide administration in premature infants treated with indomethacin for symptomatic PDA. The risk-benefit ratio of administering furosemide in well-hydrated patients treated with indomethacin for symptomatic PDA could only be assessed by a large randomized clinical trial. Received: 1 July 1998 / Revised: 22 September 1998 / Accepted: 23 September 1998     

Does total hip arthroplasty provide better outcomes than hemiarthroplasty for the femoral neck fracture? A systematic review and meta-analysis

Purpose: By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event. Methods: The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: “total hip arthroplasty”, “hemiarthroplasty” and “femoral neck fracture” to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration’ stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event. Results: This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up. Conclusion: Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.     

Does birthweight predict bone mass in adulthood? A systematic review and meta-analysis

Summary  

This systematic review and meta-analysis assessed the strength and magnitude of the association between birthweight and adult bone mass. Higher birthweight was associated with higher bone mineral content of the spine and hip in adult men and women at ages between 18 and 80 years across a range of settings.