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9%
Synopsis: 29 studies were included in this meta-analysis comparing operative and non-operative treatment for acute Achilles tendon ruptures.The primary outcome of interest was the rate of re-rupture.Secondary outcomes included the rate of complications, functional outcomes, time to return to sports and time to return to work.The results revealed a significantly lower rate of re-rupture, but a higher rate of complications, in the operative group compared to the non-operative group.Similar findings to the primary analyses were observed in the sensitivity analyses based on early and late weight bearing status, high quality studies and studies conducted after the year 2000.There were no significant differences in re-rupture rate in studies utilizing accelerated functional rehabilitation. There was no... Read More »
Level 1 Meta Analysis
9%
Synopsis: 220 patients with isolated pertrochanteric femoral fractures were randomized to receive surgical intervention with a short or long cephalomedullary nail.Primary outcomes of interest included the Short Form 36 (SF-36) questionnaire and the Harris Hip Score.Secondary outcomes of interest included implant failure, peri-implant failure, mortality, operative time, estimated blood loss and the incidence of re-operation.Outcomes were assessed up to 12 months post-operation.Results revealed significantly favourable 3 month Harris Hip scores, lower operative time and lower estimated blood loss in the short nail group compared to the long nail group. No significant differences... Read More »
Level 2 RCT
7%
Synopsis: 7 studies were included in this meta-analysis comparing carpal tunnel release (CTR) with vs, without a flexor retinaculum release (FRR) for the treatment of carpal tunnel syndrome (CTS).Outcomes analyzed included grip strength, symptom severity score (SSS), functional status score (FSS), and complications. The results from... Read More »
Level 2 Meta Analysis
6%
Synopsis: Five randomized controlled trials were included in this meta-analysis which sought to investigate the efficacy of mesenchymal stem cell injections in patients with knee osteoarthritis.Included studies featured various control groups, including placebo injection, hyaluronic acid injection, and no injection, as well as various concomitant treatments, including high tibial osteotomy, microfracture, platelet rich plasma injection and hyaluronic acid injection.Accordingly, clinical heterogeneity was assumed.Data was pooled from 12-24 month time points. Analyses on visual... Read More »
Level 2 Meta Analysis
5%
Synopsis: Forty-nine thousand, five hundred and ninety-seven patients aged 60 years or older from Ontario who underwent either total hip arthroplasty or hemi-arthroplasty for the treatment of displaced femoral neck fractures were included in this retrospective study examining clinical outcomes and associated factors with each procedure.A matched cohort of 9,238 patients was used to compare clinical outcomes.Outcomes of interest included the risk of hip dislocation, revision surgery, and death.Results of the study found a higher risk of 1-year revision surgery and dislocation in the total hip arthroplasty group compared to the hemi-arthroplasty group. The risk of... Read More »
Conference Report
3%
Synopsis: One hundred and fifty-one patients with knee osteoarthritis (OA) who received either cooled radiofrequency ablation (CRFA; n=76) therapy or intra-articular corticosteroid (IAS; n=4/75) injections were included in this 12 month follow-up study.After 6 months, patients in the IAS group were offered the opportunity to cross over to CRFA therapy (n=58/75).The primary outcomes of interest included the proportion of patients with at least a 50% reduction in numeric rating scale (NRS) pain score at 12 months.Secondary outcomes of interest included the change in Oxford Knee Score (OKS), the global perceived effect of improvement, opioid consumption, and the incidence of adverse and serious adverse events.Follow-up was performed at 12 months from the point of randomization; patients who crossed-over to CRFA at 6 months were therefore monitored for another 6 months.Results demonstrated that 65% of patients in the CRFA group and 49% of patients in the cross-over group experienced a minimum 50% reduction in NRS pain score from baseline.Moreover, NRS pain scores and OKS scores were significantly improved from baseline in the CRFA and cross-over group.The mean opioid consumption was not significantly different from baseline in the CRFA group.Also, 75% of patients in the CRFA group and 57% of patients in the cross-over group perceived an improvement in health at final follow-up. A total of... Read More »
Level 2 RCT
1%
Synopsis: 42 patients with degenerative or rheumatoid arthritis of the knee undergoing unilateral total knee arthroplasty (TKA) were randomised to receive either a multimodal analgesia protocol involving ropivacaine and morphine, or self-administered morphine only for postoperative pain management.The primary outcome was morphine consumption. The results indicated... Read More »
Level 2 RCT
<1%
Synopsis: 177 patients scheduled for total knee arthroplasty were randomized to one of three groups for postoperative analgesia with an adductor canal block: continuous ACB, single-shot ACB or single-shot ACB plus intravenous dexamethasone.Patients were assessed primarily for cumulative opioid consumption, as well as pain scores, at 12, 24 and 48 hours after surgery.Results demonstrated significantly greater cumulative opioid consumption after 12 and 24 hours in the continuous ACB group compared to the single-shot ACB group.Cumulative opioid consumption was significantly greater in the continuous ACB group compared to the single-shot ACB plus IV dexamethasone group after 12 hours. Differences between groups... Read More »
Conference Report
<1%
Synopsis: A total of 304 patients with isolated, unstable distal radius fractures who received either receive surgical care (n=187) or casting (n=117) were included in this study.Patients who opted for surgical treatment were randomized to receive either internal fixation with volar plate, external fixation, or percutaneous pinning.Patients who preferred conservative management received casting.The primary outcome of interest included the 24-month Michigan Hand Outcomes Questionnaire (MHQ) Summary score.Secondary outcomes of interest included MHQ domain scores.Outcomes were measured up to 24 months post-treatment.In all patients, the mean MHQ Summary score at 24 months was 86 [95%CI 83, 88] and the mean MHQ ADL score at 24 months was 88 [95%CI 80,88], representing good hand function and return to activities of daily living.No statistically significant differences in any of the MHQ domains at 24 months post-treatment.Internal fixation with volar plate had statistically significantly higher MHQ ADL and satisfaction domain scores compared to the other 3 interventions (p<0.0001) at 6 weeks post-treatment.Patients who underwent external fixation scored significantly lower in these 2 domains compared to the casting and internal fixation with volar plate groups. The external fixation... Read More »
RCT
<1%
Synopsis: 60 patients undergoing non-cemented total hip arthroplasty and receiving standard pain treatment in the form of local infiltration analgesia (LIA) were randomized to receive either placebo or a postoperative solution of local infusion analgesia (LINFA). Postoperative assessments of pain, opioid consumption, and length of hospital stay indicated similar results for both groups. Read More »
Author verified Level 1 RCT