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6%
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: 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
2%
Synopsis: Six ACE Reports (5 randomized controlled trials and 1 systematic review/meta-analysis) were identified from the OrthoEvidence database which evaluated the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis.All included studies were randomized controlled trials, and reported clinical and functional assessment at various time points between 1 and 6 months following treatment.Pooled analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Total scores suggested a possible beneficial effect with PRP injection in comparison to saline and a lower effect versus hyaluronic acid.Beneficial effects were also noted for individual subscales of the WOMAC assessment (pain, stiffness, and physical function).However, pooling of OMERACT-OARSI responders and a review of the literature indicated that there was no significant difference between PRP and comparison groups in other functional outcome measures, such as the International Knee Documentation Committee (IKDC) assessment and Knee Injury and Osteoarthritis Outcome Score (KOOS).Furthermore, contrasting results were obtained between two studies reporting function on the Lequesne Index. The discrepancy in... Read More »
ACE Review
2%
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
2%
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
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
1%
Synopsis: 132 patients with a displaced midshaft clavicle fracture were randomized to undergo either nonoperative or operative plate fixation to compare functional and patient-oriented outcomes between these treatments.Results at 6 weeks and at 3, 6, and 12 months displayed better Constant and DASH score results for patients who underwent operative care.Patients were also more satisfied with the function and appearance of their shoulder after plate fixation. The operative treatment... Read More »
Level 2 RCT
1%
Synopsis: 60 patients with completely displaced midshaft clavicular fractures were randomized to operative plate fixation or non-operative sling treatment to assess functional and disability outcomes.Assessment using the Constant shoulder score and the Disabilities of the Arm, Shoulder and Hand score (DASH) indicated no difference between groups over a 12 month follow-up period. However, there was... Read More »
Level 2 RCT
1%
Synopsis: 60 athletes with a symptomatic articular cartilage defect (ACD) or osteochondral defect (OCD) of the knee were randomized to undergo osteochondral autologous transplantation or microfracture procedures. The results of the study indicate that osteochondral autologous transplantation leads to a greater return to sport and maintenance of pre-injury athletic abilities than microfracture procedures. Read More »
Level 2 RCT
1%
Synopsis: This systematic review identified 5 studies (four RCTs and one cohort study: total of 365 patients for all studies) that assessed which treatment modality - surgical or conservative - was the optimal treatment for acute, displaced midshaft clavicle fractures.Results indicated that the surgical treatment led to a better functional outcome (measured with the Constant score) and lower mal- and non-union rates compared to conservative treatment. However, clinical relevance... Read More »
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