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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
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
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: Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee.All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention.Pooled analysis of pain on a visual analog scale indicated that pain relief was significantly better with hyaluronic acid injections at both 3 and 6 months follow-up; however, this finding was strongly influenced by two studies of lower methodological quality. No significant differences between hyaluronic acid and corticosteroid injections were observed in any functional outcome measurement.Due to incomplete or lack of reporting adverse events, an assessment of safety could not be performed along with this review. Furthermore, these findings... Read More »
ACE Review
1%
Synopsis: Sixty patients with hip fractures were randomized to undergo surgical treatment using either an accelerated or the standard treatment protocol, in order to assess the feasibility of a true randomized controlled trial comparing these two approaches.Overall, feasibility targets were attained, with 60 patients recruited in less than 18 months, over 70% of eligible patients undergoing randomization, and 100% rate of 30-day follow-up.Major perioperative complications occurred in 9 and 14 patients in the accelerated and standard groups, respectively. The results justified... Read More »
Author verified 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: 478 patients scheduled for revision total hip or knee arthroplasty were randomized to receive lavage with diluted betadine or normal saline prior to wound closure.Outcomes of interest included the incidence of periprosthetic joint infection (PJI), and the incidence of wound complications excluding PJI. The results from... Read More »
Conference Report
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: Traditionally, patients undergoing total hip arthroplasty (THA) have been advised to avoid certain movements that would put them at risk for dislocation.This has been of particular concern with the posterolateral, which has historically been associated with the highest dislocation rates.In recent years, however, improvements in surgical technique and implants (e.g.larger heads) have dramatically reduced dislocation rates.Thus, it is unclear if hip precautions are still necessary.The authors randomized 408 patients to standard care and patients who still had hip precautions while awake, but had no restrictions on sleeping position.Primary outcome was dislocation at 8 weeks, secondary outcomes were deep infection, pulmonary embolism, deep vein thrombosis, pain, function, and health-related quality of life.There were no significant differences on any outcomes between the two groups. The trial was... Read More »
Level 1 RCT
1%
Synopsis: 9 studies were included in this meta-analysis comparing computer-navigated and conventional TKA with regards to radiological, long-term function and survivorship outcomes.Outcomes of interest included the outlier rate of coronal and sagittal alignment of the femoral and tibial components, the outlier rate of lower extremity alignment, range of motion, the Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, revision rate and rate of aseptic loosening.Results found significantly lower outlier rates of sagittal alignment of the femoral component and coronal alignment of the tibial component in the computer-navigated TKA group compared to the conventional TKA group. No significant differences... Read More »
Level 1 Meta Analysis