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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
2%
Synopsis: This is a follow-up to a previously published multi-centre randomized controlled trial.The authors randomized 461 patients undergoing surgery for distal radius fractures to Kirschner wire fixation versus plate fixation.They report outcomes (function and quality of life) at five years post-operatively.There was no significant difference between the two groups at any of the yearly follow-ups between one and five years as measured on the Patient-Related Wrist Evaluation (PRWE) and EuroQol Five-Dimension Three-Level (EQ-5D-3L). Read More »
Level 2 RCT
2%
Synopsis: Distal radius fractures are at risk of failed reduction following either operative or non-operative treatment.For this reason, many surgeons routinely perform repeated radiographs throughout the follow-up period.It is unclear, however, whether more frequent imaging actually affects management or outcomes.Thus.the authors randomized 386 patients to routine care (X-rays at 1, 2, 6, and 12 weeks) or reduced imaging (X-rays at 1 and 2 weeks).Outcomes were the Disabilities of the Arm, Shoulder and Hand (DASH) score.Secondary outcomes were the Patient-Rated Wrist/Hand Evaluation (PRWHE), EuroQol-5D (EQ-5D), Short-Form 36 (SF-36), Visual Analogue Scale (VAS) for pain and health status.There were no significant differences between the two groups in terms of DASH score, EQ-5D, PRWHE, or VAS pain or health satisfaction.Complication rate was similar between the two groups. Overall, fewer radiographs... Read More »
Level 2 RCT
1%
Synopsis: The authors randomized 123 to treatment for four compared to six weeks of antibiotics.Median patient age was 64 years old, and all patients had undergone hardware removal (including arthroplasty and trauma implants) with no immediate re-implantation. Different antibiotic regimens... Read More »
Level 2 RCT
1%
Synopsis: Distal locking screws in intramedullary nails are a demanding part of the procedure.The authors in this report randomized patients to receive either a traditional distal locking screw, or a new ultradistal locking screw.They randomized 286 patients into the two groups and measured operative time, fluoroscopy use, and one-time locking ratio. The ultradistal screw... Read More »
Conference Report
1%
Synopsis: Meta-analysis identified 20 randomized controlled trials (RCTs) (4508 patients) that looked at the outcomes of arthroplasty procedures (hemiarthroplasty or THA) compared to internal fixation procedures in the treatment of displaced femoral neck fractures. Results showed that arthroplasty produced better outcomes in pain, function, complications, and incidences of reoperation compared to internal fixation procedure, but outcomes in mortality were comparable between the two groups at 1 to 3 years postoperatively. Read More »
Author verified Level 1 Meta Analysis
1%
Synopsis: This meta-analysis identified 10 studies (891 patients) that assessed the use of surgical treatment versus nonsurgical treatment of displaced intra-articular calcaneal fractures (DIACF).The results indicated that surgical treatment was significantly better at recovering the Bohler angle and produced a more stable calcaneal height and width.Also, fewer surgical patients required larger shoe sizes, and a greater number of patients were able to resume pre-injury work. There were no... Read More »
Level 1 Meta Analysis
1%
Synopsis: 81 mobile, independent patients with displaced intracapsular fractures of the femoral neck were randomized to receive total hip arthroplasty or hemiarthroplasty to compare the overall effectiveness of each treatment. After a mean follow-up of 3 years, the patients who received total hip arthroplasty displayed significantly better short term walking distances and Oxford hip scores, and fewer complications when compared with the patients who received hemiarthroplasty. Read More »
Author verified Level 2 RCT
1%
Synopsis: This is a meta-analysis of ten randomized controlled trials comparing operative and non-operative treatment for primary patellar dislocation.A total of 510 patients were included, and outcomes were recurrence (at 24-44 months and 72-86 months), function (at 24-44 months) and revision rate (at 72-84 months).A subgroup analysis was also performed on patients < 16 years old (at 24-168 months).Overall, operative management was significantly favoured in terms of recurrent dislocation and function at 24-44 months.There was a trend favouring surgery for recurrence and revision at 72-86 months, though this was non-significant. Read More »
Level 1 Meta Analysis
1%
Synopsis: The authors conducted a multi-centre, assessor blinded, randomized controlled trial.They randomized 40 patients to two groups.Both groups received a conservative physiotherapy protocol.Patients in the intervention group also received a standard wrist splint. Patients in the... Read More »
Level 2 RCT