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You are viewing the most viewed ACE Reports by Orthopaedic Resident/Interns over the last 30 days in all specialties.
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33%
①
Synopsis:
One hundred and twenty-one patients undergoing a hip arthroscopy procedure were randomized to receive 90 days of automated text messages on post-operative instructions and general health guidance (n=57) or no added intervention (n=64).Outcomes of interest included pain and physical function on the Hip Disability Osteoarthritis Outcome Score (HOOS), patient compliance, and patient satisfaction with the intervention.Results revealed no significant differences between the two groups in pain, physical function, or compliance at 90 days. Patients who received...
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Level 1 RCT
14%
①
Synopsis:
Five hundred thirty-five patients undergoing elective primary Total Hip Arthroplasty (THA) were randomized to cutaneous closure with staples (n=268) or sutures (n=267).The primary outcome was SSI (<6 weeks).Secondary outcomes included prosthetic joint infection (PJI, <1 year), other wound complications (prolonged discharge, dehiscence, necrosis; <6 weeks), and length of stay.Outcomes were assessed during admission, at discharge, then at 2 weeks (removal), 6 weeks, 3 months, and 1 year.Overall, the results of the study revealed a higher—nearly significant—SSI rate with staples and a clearly higher rate of early wound complications, driven by prolonged discharge; PJI did not differ. These findings suggest...
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Level 1 RCT
9%
①
Synopsis:
6 studies (363 patients) examining outcomes of surgical and nonsurgical treatments of undisplaced or minimally displaced scaphoid waist fractures were evaluated through pairwise meta-analysis.An additional 3 trials were also identified for inclusion in a network meta-analysis.Following assessments of fracture union, complications, range of motion, grip strength, and osteoarthritis between patients who underwent either surgical or non-surgical treatment, there was a non-significant trend to increased union with surgical treatment. However this method...
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Author verified Level 1 Meta Analysis
4%
Synopsis:
13 ACE reports (4 reviews/ meta-analyses, 9 RCTs) were included from the OrthoEvidence database that compared operative versus nonoperative or operative versus operative treatments for displaced midshaft clavicle fractures.The findings of this review demonstrated that surgical procedures led to a lower rate of nonunion and malunion with better functional outcome when compared to nonoperative treatment. Comparisons of operative treatments indicated that an optimal surgical procedure - between plate fixation, nailing, and pin fixation - could not be determined based on union rates or functional outcome. The results of...
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ACE Review
4%
①
Synopsis:
One hundred fifty-eight patients with displaced fifth metacarpal neck fractures were treated with either K-wire pinning (KP; n=60), intramedullary pinning (IP; n=50), or combined intramedullary pinning with K-wire pinning (IPKP; n=48).The primary outcome was radiological correction (angulation and shortening).Secondary outcomes included range of motion (TAM), Quick-DASH scores, cosmetic scores, and complication rates.Outcomes were assessed preoperatively, postoperatively, and at 1-year follow-up.Overall, the study found that IPKP achieved significantly better angulation, less shortening, and higher cosmetic scores.Functional outcomes were similar, though stiffness occurred only in the KP and IP groups. These findings suggest...
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Level 1 RCT
4%
①
Synopsis:
The PREPARE Trial was a cluster-randomized, crossover trial part of the PREP-IT program, which compared alcohol-based anti-septic solutions of iodine povacrylex vs.chlorhexidine gluconate in operative fracture patients.THE PREPARE Trial included a total of 8485 patients who underwent fracture fixation: 1700 patients with open limb fractures and 6785 with closed lower-limb or pelvic fractures.Randomization occurred at the hospital level.The primary outcome of interest was the incidence of surgical-site infection, which included superficial incisional infections within 30 days and deep incisional or organ-space infections within 60 days post-surgery.Secondary outcomes included unplanned fracture-related reoperations and serious adverse events.The iodone povacrylex group (77/3205; 2.4%) had a lower incidence of surgical site infections compared to chlorhexidine (108/3272; 3.3%) in closed-fracture patients [OR, 0.74; 95% CI, 0.55 to 1.00; p=0.049].The rates were similar in open-fracture patients between the iodine (54/3272; 6.5%) and chlorhexidine (60/3272; 7.3%) [OR, 0.86; 95% CI, 0.58 to 1.27; p=0.45].In the closed-fracture group, 5.5% in the iodine group and 5.9% in the chlorhexidine group underwent unplanned reoperations [OR, 0.96; 95% CI, 0.77 to 1.20].In the open-fracture group, the figures were 16.1% for iodine and 14.5% for chlorhexidine [OR, 1.16; 95% CI, 0.87 to 1.54]. The results of...
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Level 1 RCT
4%
①
Synopsis:
Ninety-three patients undergoing total knee arthroplasty were randomized to receive either preoperative video-based opioid counseling (n=50) or no such intervention (n=43).The primary outcome of interest was postoperative opioid consumption in morphine milligram equivalents (MMEs).Secondary outcomes included pain levels, opioid-related side effects, and patient satisfaction with pain control.Outcomes were assessed at postoperative days (POD) 3, 7, and 14.Overall, the study revealed that patients in the video group consumed significantly fewer opioids in the first week postoperatively. The findings suggest...
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Level 1 RCT
4%
①
Synopsis:
Eighty-nine patients with pelvic or acetabular fractures were randomized to receive oral clonidine 200 mcg 75–90 min pre-anesthesia (n=45) or placebo (n=44).The primary outcome of interest was blood loss (intra- and postoperative, including hidden loss).Secondary outcomes of interest included postoperative pain (VAS), surgeon-rated visual field quality, hemoglobin (preop, postoperative day 1 and day 3), proportion requiring transfusion, and duration of surgery.Outcomes were assessed up to postoperative day 3.Overall, the results of the study revealed lower intraoperative blood loss, less pain, better surgical field ratings, higher day-3 hemoglobin, and fewer transfusions with clonidine versus placebo, without a difference in postoperative drain output or operative time. These findings suggest...
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Level 1 RCT
4%
①
Synopsis:
Nine hundred fourty one patients with carpal tunnel syndrome (CTS) were randomized to receive initial surgical decompression (n=470) or initial corticosteroid injection (n=471); further interventions were allowed in both arms as needed.The primary outcome was recovery at 18 months (CTS-6 <8).Secondary outcomes included time to recovery, serial CTS-6, upper-limb function (QuickDASH), palmar pain and pain-related limitation, global perception of recovery, satisfaction, additional treatments, and adverse events.Outcomes were assessed through 18 months at prespecified intervals.Overall, the results of the study revealed that 61% in the surgery group versus 45% in the injection group recovered, and median time to recovery was shorter with surgery (9.0 vs 18.0 months).Patients starting with surgery also had better 18-month QuickDASH, global recovery, and satisfaction, while palmar pain was more frequent early after surgery but comparable by later follow-up. These findings suggest...
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Level 1 RCT
4%
①
Synopsis:
One hundred twenty-three patients with Carpal Tunnel Syndrome (CTS) were randomized (unbalanced 3:1) to endoscopic carpal tunnel
release (ECTR) (n=91) or open carpal tunnel release (OCTR)(n=32).The primary outcomes were CTS Symptom Severity Scale scores and nerve/vascular complications assessed by a blinded evaluator.Secondary outcomes included McGill Pain Questionnaire scores, grip and pinch strength, sensory threshold, time to return to work, and long-term satisfaction/re-operation.Outcomes were measured at baseline, 1, 6, and 12 weeks, with long-term contact at a mean of 3.2 years.Overall, the results revealed no between-group differences in primary outcomes at any time and no nerve/vascular complications in either group; ECTR showed transient advantages in grip and pain at 1 and 6 weeks that dissipated by 12 weeks. In conclusion, ECTR...
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Level 1 RCT