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Synopsis: One hundred and twenty patients, between the ages of 45 and 85 years, scheduled to undergo total knee arthroplasty were randomly assigned into one of two groups to compare the postoperative effect of modern general anaesthetic to spinal anaesthetic.Results demonstrated that participants who received modern general anaesthetic treatment experienced significantly less pain postoperatively, less nausea and dizziness, and required less morphine following treatment than patients who received a spinal anaesthetic. Subjects who received... Read More »
Author verified Level 2 RCT
1%
Synopsis: 80 patients undergoing single-bundle ACL reconstruction were randomized to receive a 2-strand free tendon Achilles allograft with a biodegradable interference screw supplemented by a post-tie with a washer screw or a biodegradable interference screw alone.The findings of this study suggest that supplementary fixation with a post-tie resulted in significantly better Lachman test scores and mean side to side differences, when compared to the biodegradable interference screw alone. The use of... Read More »
Level 2 RCT
1%
Synopsis: 43 randomized controlled trials (RCTs) including 6911 patients undergoing surgical operations for intertrochanteric fractures were included in this meta-analysis and systematic review.The purpose of the study was to compare the effects of various internal fixation strategies for the treatment of intertrochanteric fractures. Findings indicated that... Read More »
Level 1 Meta Analysis
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: Sixty adults with orthopaedic injuries requiring painful manipulation were randomized to receive either propofol or midazolam/ketamine.Results indicated that the average recovery time and total sedation time were significantly shorter in patients who received propofol in comparison to those who received midazolam/ketamine. Patients in the... Read More »
Author verified Level 2 RCT
1%
Synopsis: 80 patients undergoing total hip arthroplasty (THA) were randomized to have the acetabular component implanted either using the transverse acetabular ligament (TAL) as a guide or using a conventional freehand technique.The purpose of this study was to compare these two approaches with respect to the anteversion and inclination of the acetabular component.Results indicated that the TAL group had a more accurate mean anteversion when compared to the freehand technique; however this practice did not influence the inclination. Overall, the number... Read More »
Author verified Level 1 RCT
1%
Synopsis: 92 patients undergoing primary total knee arthroplasty for arthritis of the knee were randomized to surgery either under an experienced surgeon or trainee surgeons, both using computer assisted surgery methods.The purpose of the study was to compare 5 year clinical outcomes after total knee arthroplasty between the experienced and trainee surgeon groups, to determine the efficacy of computer navigation.Results indicated that patients treated by trainee surgeons using computer assisted techniques did not display differences in knee scores, coronal alignment, or blood loss. The only difference... 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: 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: 4484 cardiovascularly healthy patients with a clinical diagnosis of osteoarthritis or rheumatoid arthritis were randomized to be treated with either selective cox-2 inhibitor NSAID (celecoxib) or a combination of non-selective NSAID (diclofenac) and a proton pump inhibitor (omeprazole) for at least 6 months.After 6 months of treatment observation period, the rate of clinically significant GI events was 4 times higher in patients receiving diclofenac plus omeprazole over celecoxib. Subjective patient assessment... Read More »
Author verified Level 1 RCT