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Synopsis: Acute syndesmotic injures are commonly associated with ankle fractures, and can have long-term implications on patient function and stability.Suture buttons and syndesmotic screws are the two most commonly used techniques to treat these injuries.The authors randomized 97 patients to suture button versus syndesmotic screw fixation.Outcomes included the American Orthoapedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS), Olerud-Molander Ankle score (OMA), pain on walking on a visual analogue scale (VAS), and the EuroQol-5-D (EQ-5D).Follow-up time was five years post-operatively.The suture button had significantly higher AOFAS and OMA scores, significantly less frequent ankle osteoarthritis and better maintenance of reduction.There was no difference in terms of VAS or EQ-5D. Overall, suture button... Read More »
Conference Report
3%
Synopsis: Proximal tibia fractures can be treated with intramedullary nail or locked plating, but it is unclear if one treatment is preferable.The authors randomized 108 adult patients with A1-3 or C1 proximal tibia fractures to undergoing intramedullary nail (n = 52) or locked plating (n = 47).Follow-up was performed to 1 year.Compartment syndrome was more common in the nail group (OR 4.0).There were no significant differences in terms of operative time, malalignment rates, walking ability, stair climbing, pain, use of supports, range of motion, the Short Musculoskeletal Funciton Assessment, bother index, or the Euroqol-5D.Non-union and adverse event rates were also similar between the two groups. Overall, only compartment... Read More »
Conference Report
3%
Synopsis: Previous studies have established the success of non-operative treatment following Achilles tendon rupture.37/60 patients were analyzed in this follow-up study comparing an early weight-bearing protocol to standard weight-bearing protocol during dynamic rehabilitative treatment of acute Achilles tendon ruptures.The primary outcome of interest was the Achilles Tendon Rupture Score (ATRS).Secondary outcomes of interest included heel raise height and work, as well as the return to level (heavy, light but active, sedentary) of work and sporting, and the incidence of re-rupture.Follow up was performed at 4.5 years post-operation.At 4.5 years, there were no significant differences between the early weight-bearing and usual care groups in ATRS score, heel raise height or heel raise work.All 37 patients had return to some level of work by the 4.5 year follow up, and 33/37 patients had returned to some level of sporting activity. Three cases of... Read More »
Level 2 RCT
3%
Synopsis: Open fractures are common and potentially devastating.Their treatment remains focused on early irrigation and debridement.The question of whether negative pressure wound therapy is helpful remains unclear.The authors performed a secondary analysis of patients from the FLOW Trial who had Gustilo II and III lower extremity fractures.A propensity score matching system was applied to assess the risk of developing deep infection.Health-Related Quality of Life was also measured on the Short Form-12 (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS).270 matched pairs were analyzed.Those treated with negative pressure wound therapy had significantly higher risk of deep infection at 12 months and poorer quality of life at 6 weeks, 6 months, and 12 months. Overall, negative pressure... Read More »
Conference Report
2%
Synopsis: In this Cochrane review, the authors performed a systematic review and meta-analysis of six studies (five true RCTs and one quasi-RCT) looking at patients with primary patellar dislocation.Mean age ranged from 19.3 to 25.7 years of age.Follow-up ranged from 2-9 years.Quality of evidence was assessed as very low according to the GRADE criteria.Patients undergoing surgery for primary patellar dislocation had significantly lower risk of recurrent dislocation.Very low quality evidence on functional outcomes found no significant difference between the two groups. Adverse events were... Read More »
Level 1 Meta Analysis
2%
Synopsis: Open reduction, internal fixation of proximal humerus fractures are technically challenging procedures.The authors in this study randomized 83 patients at two university trauma centres to the deltopectoral or deltoid split approaches for the fixation of Neer II and III proximal humerus fractures.Outcomes assessed included the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH), the Constant-Murley score, pain, range of motion, and complications.The authors found significantly better functional and pain scores as well as fewer complications in the deltopectoral group.Only range of motion was better in the deltoid split group. The authors conclude... Read More »
Conference Report
2%
Synopsis: Six studies (626 patients) were included in this meta-analysis comparing surgical repair to conservative management and subacromial decompression for the treatment of rotator cuff tears in elderly patients.The primary outcome of interest was the Constant-Murley score. Results revealed significantly... Read More »
Level 1 Meta Analysis
2%
Synopsis: Infection is of great concern in open fractures.Traditionally, time to irrigation and debridement has been thought to be important, and six hours has been cited as an ideal time target.However, this is based on basic science studies with limited clinical correlation.In this study, the authors performed a secondary analysis of the Fluid Lavage of Open Wounds (FLOW) Trial data.Patients were matched based on propensity scores, and compared both on a dichotomous time scale (<6h vs.>6h) and a continuous time scale.There was no significant association between time and unplanned re-operation in either scenario.Overall, time to irrigation may be less important than traditionally thought. 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: Ninety-four patients with tibial fractures scheduled for an intramedullary nail fixation procedure were randomized to receive the procedure via a suprapatellar approach or infrapatellar approach.The primary outcome of interest was weightbearing ratio between the injured/uninjured limb as measured by the Aberdeen Weight-bearing Test for the Knee (AWT-K).Secondary outcomes of interest included the Irrgang Knee Outcome Symptom, Function and Total scores, the Lysholm score, and pain on a Visual Analog Scale (VAS).Follow up was performed at 4 months, 6 months and 12 months post-operation.Results revealed significantly favourable weight-bearing ratios in the suprapatellar group compared to the infrapatellar group at 4 months post-operation.Furthermore, 12 month Lysholm scores were significantly in favour of the suprapatellar group. Otherwise, no significant... Read More »
Level 2 RCT