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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
1%
Synopsis: 90 patients scheduled for a total knee arthroplasty were randomized to receive Floseal, tranexamic acid or control for the reduction of peri-operative bleeding.Outcomes of interest included aspirated blood volume, pad weight, incidence of transfusion, drainage volume, hemoglobin decrease, total measured bleeding and range of motion.Follow up was performed for a minimum of 12 months.Results revealed significantly greater drainage output, hemoglobin decrease, total measured bleeding, aspirated blood volume and worse range of motion in the control group compared to the Floseal and tranexamic acid groups. Additionally, the Floseal... Read More »
Level 2 RCT
1%
Synopsis: 60 elderly patients with dementia and a displaced femoral neck fracture were randomized to receive a Quattro dual mobility cup in a total hip arthroplasty procedure or a hemi-arthroplasty procedure.The primary outcome of interest was dislocation rate at 1 year post-operation.Secondary outcomes of interest included reoperation rate, time to surgery, operative time, length of stay and the incidence of mortality at 30 days and 1 year post-operation.Whilst operative time was significantly longer in the total hip arthroplasty group, the incidence of dislocation was significantly lower compared to the hemi-arthroplasty group. No significant differences... Read More »
Level 2 RCT
1%
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: 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: 15 studies (839 patients) were included in this meta-analysis comparing plate fixation to intramedullary nailing for the treatment of humeral shaft fractures.Outcomes of interest included the American Shoulder and Elbow Surgeons (ASES) score, operative time, blood loss, and the incidence of non-union, nerve injury, post-operative infection, re-operation delayed union and shoulder and elbow joint restriction.A sub-group analyses was performed for each type of plate fixation.Pooled results found significantly favourable blood loss and incidence of post-operative infection with intramedullary nailing compared to plate fixation. The subgroup analyses... Read More »
Level 2 Meta Analysis
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
1%
Synopsis: 60 patients with shoulder impingement syndrome were randomized to receive a dual-target (long head of bicep tendon and subacromial bursa) subacromial corticosteroid injection or a standard subacromial corticosteroid injection for the relief of pain and improvement of functional outcomes.The primary outcomes of interest were the Shoulder Pain and Disability Index (SPADI) pain, function and total scores.Secondary outcomes of interest included pain at rest, during the night, and during overhead activities.Follow up was performed at 1 and 3 months post-injection.Results found no significant differences in the improvement of all outcomes from baseline at 1 month post-injection between the two groups. However, the improvement... Read More »
Level 1 RCT
1%
Synopsis: 7 studies containing 395 patients with knee osteoarthritis were included in this systematic review and meta-analysis comparing laser acupuncture treatment to sham laser acupuncture for the relief of pain and improvement of function and quality of life.Outcomes of interest included pain on a Visual Analog Scale (VAS), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis pain, function and stiffness scores, and quality of life questionnaire scores.Outcomes were analyzed at short-term (2 months post-treatment) and long-term (1 year post-treatment) follow ups.Results revealed significantly favourable VAS pain scores at short-term follow up in the laser acupuncture group compared to the sham group. All remaining pooled... Read More »
Level 2 Meta Analysis
<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