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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
4%
Synopsis: A total of 207 patients with a flail chest injury or severe chest wall deformity were randomized to receive surgical fixation (n=107) or the non-operative management (n=99).The outcomes of interest were the Short Form 36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, assessed at 1 week, 2 weeks, 6 weeks, 3 months, 6 months, and 12 months follow-up.The results demonstrated that both the PCS and MCS were not statistically significantly different (p=0.25; p=0.98, respectively) between the 2 treatment arms at any of the follow-up periods.Patients who smoked demonstrated worse SF-36 MCS and PCS scores at 1 year. Patients who spent... Read More »
Conference Report
4%
Synopsis: A total of 30 adults with distal third tibia fracture and same-level or more fibula fracture patients who underwent tibial load-sharing reamed intramedullary nailing were randomized into receiving operative fibular plating or nonoperative treatment of the fibular fracture.Outcomes of interest included pain on a Visual Analogue Scale (VAS), Short Form 36 Health Survey Questionnaire (SF-36), the Ankle-Hindfoot Scale, Hospital for Special Surgery (HSS) Knee Disability Scale, incidence of fracture healing, incidence of tibial alignment, and incidence of adverse events.No statistically significant differences were found between treatment groups in VAS pain scores at any follow-up period.The rate of tibial union higher in the plating group compared to the conservative group (92.3% vs.76.9%), and a higher rate of malalignment was reported in the non-operative group.Operative time was statistically significantly longer in the plating group compared to the conservative group (p=0.002). The time to... Read More »
Conference Report
4%
Synopsis: A total of 124 elderly patients with displaced displaced proximal humeral fractures (PHFs) were randomized to receive a reverse shoulder arthroplasty (RA) (n=64) or plate fixation (n=60).The primary outcome of interest was the Constant score at 2-years follow-up.The secondary outcomes of interest were the Oxford Shoulder Score and radiological outcomes.The results demonstrated that a statistically significant difference in Constant scores at 2 years, favour of the reverse shoulder arthroplasty group.Stratified by OTA/AO fracture classification, Constant scores were statistically significantly in favour of the reverse arthroplasty group in type C2 proximal humeral fractures. However in type... Read More »
Conference Report
4%
Synopsis: A total of 850 patients with low-energy intertrochanteric fractures were randomized to receive fracture fixation with an intramedullary nail or sliding hip screw.The primary outcome of interest was health-related quality of life measured via the Euro-Qol-5 Dimensions (EQ-5D) questionnaire, at 1 year post-operation.Secondary outcomes of interest include revision and fracture healing rates, the incidence of adverse events, the Parker Mobility Score, and the Harris Hip score.Fracture healing was measured at 13-weeks follow-up, whilst remaining outcomes were assessed at 1-year post-operation. The results demonstrated... Read More »
Conference Report
2%
Synopsis: 103 patients with fibular fractures proximal to an associated syndesmosis injury were randomized to receive internal reduction and fixation with either a knotless TightRope device or screw fixation.Outcomes of interest included radiographic outcomes, the Foot and Ankle Disability Index (FADI), the EQ-5D quality of life questionnaire, the Olerud-Molander (OM) Ankle score, the rate of unplanned re-operation, the rate of malreduction, and the Work Productivity and Impairment (WPAI) score.Follow up was performed at 3 months post-operation for radiographic outcomes, and up to 12 months for clinical outcomes.Results revealed significantly lower rates of unplanned re-operation and lower rates of malreduction in the TightRope group compared to the screw fixation group.Additionally, patients in the TightRope group had a significantly favourable WPAI daily activity rating at 6 weeks compared to the screw fixation group, although total scores were not significantly different. No significant differences... Read More »
Level 2 RCT
2%
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
2%
Synopsis: A total of 49 children with acute traumatic diaphyseal fractures of the femur were randomized to receive fixation with a titanium elastic nail or intramedullary Kirshner wire (K-wire).The primary outcomes of interest was fracture union (as measured by the modified radiographic union for tibial fractures [mRUST] score), and the incidence of complications leading to unplanned surgery.Secondary outcomes of interest included Pediatric Quality of Life Inventory (PedsQL) scores and recovery milestones ( i.e., time to walking with aids, time to independent walking, time until full activity allowed).Outcomes were assessed at 2- weeks, 6-weeks, 3-months, 6-months, and 12-months post-operation.No statistically significant differences in PedsQL were reported between groups at all time-points; however, improvements from baseline were observed. Similar rates of... Read More »
Conference Report
1%
Synopsis: Use of cemented versus un-cemented implant fixation in total hip arthroplasty (THA) has long been an area of debate. Although cemented components have long had unsurpassed prosthesis survival rate, more and more THAs are being performed with un-cemented components. The current systematic review and meta analysis compared the pros and cons to cemented versus un-cemented fixation to determine which has a better overall performance. The study found that although the performance of un-cemented components is improving, cemented fixation continues to be unparalleled. Read More »
Author verified Level 1 Meta Analysis
1%
Synopsis: 82 patients with 83 displaced bicondylar tibial plateau fractures were randomized to receive standard open reduction and internal fixation with medial and lateral plates or percutaneous and/or limited open fixation and application of a circular fixator.At the 2 year follow-up there was no significant difference in clinical outcomes between the open reduction group and circular fixator group, however, a marginally faster return to function was observed at 6 months in the circular fixator group. Additionally, patients in... Read More »
Level 2 RCT