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14%
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
8%
Synopsis: One hundred and forty hips scheduled for a total hip arthroplasty were randomized to receive a metal-on-polyethylene bearing (n=69 hips) or a ceramic-on-ceramic bearing (n=71 hips).Outcomes of interest included aseptic revision rate, rate of component loosening, rate of periarticular osteolysis, the Western Ontario and McMaster University (WOMAC) osteoarthritis scores, the incidence of ceramic fracture, and implant survivorship.The minimum follow-up time was 20 years.Results revealed significantly greater survivorship, lower aseptic revision rate, lower rate of periarticular osteolysis, and greater functional scores in the ceramic-on-ceramic group compared to the metal-on-polyethylene group (p<0.05 for all). No cases of... Read More »
Conference Report
4%
Synopsis: 90 Swedish patients presenting with a distal radius fracture undergoing open reduction and internal fixation with a volar locking plate were randomized to regional anesthesia (RA) or general anesthesia (GA).The primary outcome of interest was the total opioid consumption in morphine equivalents (OEC) during the first 3 post-operative days.Secondary outcomes included OEC before and after discharge, pain on a Visual Analog Scale (VAS), peak pain score, post-operative nausea and vomiting, grip strength, range of motion, the EQ-5D-3L score, and the Patient-Reported Wrist Evaluation (PRWE) score.Follow up was performed up to 6 months post-operation.Results from the study revealed significantly lower OEC during the first post-operative day, in favour of the RA group.IV and oral+IV OEC before discharge were significantly lower in the RA group, however OEC after discharge was significantly higher in the RA group compared to the GA group.VAS pain during the first 2 post-operative hours was significantly lower in the RA group compared to the GA group, but was significantly higher in the RA group at 24 hours post-operation compared to the GA group.The incidence of nausea 1 day post-operation was significantly lower in the RA group compared to the GA group. No significant differences... Read More »
Level 2 RCT
1%
Synopsis: 2551 patients with an open fracture of the extremity were included in this randomized, 2 by 3 factorial design trial to investigate the effects of irrigation pressure and solution on reoperation rates.The patients were randomized to receive irrigation with either soap or saline at high, low, or very low pressure.After a 12 month follow-up period, the results indicated that the use of saline was superior to the use of soap for the irrigation of open fractures.Additionally, there were no differences between the different pressures, establishing very low pressure as a low-cost alternative in the irrigation of open fractures.The analysis indicated that there was no interaction between irrigation solution and pressure. Read More »
Author verified Level 1 RCT
1%
Synopsis: Femoral neck fractures, a type of hip fracture, are a common and disabling injury, particularly given an ageing population in many countries.Throughout the past half-century, multiple different treatments have evolved for the treatment of these fractures, and these include sliding hip screws, cannulated screws, hemiarthroplasty (HA), and total hip arthroplasty (THA).Given that femoral neck fractures have the potential to compromise blood flow to the femoral head, arthroplasty options have gained prominence in recent years.However, it remains unclear which of the two options (THA or HA) is optimal in this population.Thus, in this definitive, landmark randomized controlled trial, which is by far the largest of its kind to date, the investigators randomized 1495 patients 50 years of age older with a displaced femoral neck fracture to undergo HA or THA.The trial was conducted across 80 centres in 10 different countries.Primary outcome was a secondary hip procedure within 24 months.Secondary endpoints included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health.There was no significant difference between the two groups in terms of revision rate, mortality, serious adverse events, revision procedures, EQ-5D, timed up and go test, or Short-Form 12 scores.There was a trend toward higher dislocation rates in THA, though this was not statistically significant.There was a significant difference in favour of THA on the WOMAC total and sub-scores, though this difference fell below the minimal clinically important threshold.Overall, in the absence of a convincing indication for THA, HA is a comparable treatment for femoral neck fracture which does not result in a significant difference in revision rate.There may be a slightly higher rate of serious adverse events with THA, and slightly better function with THA, though these differences may not reach clinical significance. Read More »
Level 1 RCT
1%
Synopsis: 19 patients who underwent total hip arthroplasty were randomized to postoperative wound treatment using either the current standard of care or negative pressure wound treatment (NPWT) to determine its effects on post-operative seromas and wound healing. Results at 10 days indicated superior wound healing and a reduction in the occurrence of seromas, with only 44% of the NPWT group developing seroma compared to 90% of the standard dressing group. Read More »
Level 2 RCT
1%
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... Read More »
ACE Review
1%
Synopsis: 146 patients with degenerative meniscal tears were randomized to determine the efficacy of arthroscopic partial meniscectomy.Participants underwent either arthroscopic partial meniscectomy or sham-arthroscopic partial meniscectomy, and were assessed for 12 months postoperatively. The results indicated... Read More »
Author verified Level 1 RCT
1%
Synopsis: 8 ACE Reports (all randomized controlled trials) from the OrthoEvidence database were included in this review/meta-analysis examining the effect of arthroscopic surgery and physical therapy in the treatment of degenerative tears of the meniscus and knee osteoarthritis.The purpose of this review was to determine if any differences in outcome were demonstrated between arthroscopy followed by physical therapy versus physical therapy alone, regarding pain, function, satisfaction, adverse events, or osteoarthritis progression.Pain results were pooled at 3 different time point: 2-3 months, 6 months, and 12-24 months postintervention.At short-term (2-3 months) and long-term (12-24 months) follow-up, pain was similar between groups, with no significant difference observed.There tended to be less pain experienced at 6 months following arthroscopy, however this only reached significance in the KOOS pain outcome and the clinical importance of this observation is unknown.Assessments of functional outcome, either pooled or qualitative, suggested no significant difference between groups as well. The rate of... Read More »
ACE Review
1%
Synopsis: 9 studies (8 RCTs, 1 controlled clinical trial) were selected for a systematic review of elderly patients with a proximal humerus fracture.The goal of this study was to determine whether surgical or nonoperative treatment is the optimal intervention in patients over the age of 60.Operative treatments identified in the included trials were the tension band technique, locking plates, pinning and hemiarthroplasty.The results of this review indicated that many studies did not find a significant difference in functional outcomes when comparing locking plates or tension bands to nonoperative treatment at 1 year.There was a significantly better health-related quality of life and Euroqol-5D in patients that received a hemiarthroplasty compared to the nonoperative group for patients with 4-part fractures.Complications were common in the operative treatment groups. This study highlights... Read More »
Level 2 Meta Analysis