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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
7%
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
7%
Synopsis: A secondary analysis of the Fluid Lavage of Open Wounds (FLOW) Trial database was performed to assess the effectiveness of antibiotics alone in treating superficial surgical site infection in patients who were operatively treated for open fractures.A logistic binary regression analysis was performed to identify any factors associated with antibiotic treatment failure.Of the 139 patients who received antibiotics alone for superficial surgical site infection, 97 (69.8%) were successfully treated.Delay in diagnosing superficial surgical site infection was associated with a higher odds of treatment failure (OR=1.05 per week of diagnosis delay [95%CI 1.004, 1.099], p=0.03). Age, sex, fracture... Read More »
RCT
5%
Synopsis: Of a total of 1441 participants with low-energy displaced femoral neck fractures in the HEALTH trial, 117 patients who required revision surgery within 24 months of sustaining a fracture were included in this secondary analysis.This analysis investigated surgical and patient predictive factors for the need of revision.Factors of interest included age, body mass index (BMI), major comorbidities, independent ambulation, type of surgical approach, length of operation, use of femoral cement, femoral head size, and degree of femoral stem offset. The analysis demonstrated... Read More »
RCT
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
4%
Synopsis: A total of 100 patients presenting to the emergency room with an isolated, closed, distal radius fractures were randomized to receive a clamshell (n=50) or sugartong splint (n=50).The outcomes of interest included radiographic measures of tilt, inclination, and height, as well as the the Disabilities of the Arm, Shoulder and Hand (DASH) score for functional assessment.A marginally higher DASH score was observed in the sugartong group (mean 109; SD 16) compared to the clamshell splint group (mean 106, SD 24).The average change in radiographic tilt, inclination, and height in the clamshell splint group was 1.1 degrees (SD 1.1), 1.8 degrees (SD 2.1), and 1.5 degrees (SD 0.97), respectively. The average change... 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 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
3%
Synopsis: A total of 58 patients with a displaced, distal humerus fracture undergoing bicolumnar plate fixation were randomized to receive a simple decompression (n=31) or anterior transposition (n=27) of the ulnar nerve.The ulnar nerve-related outcomes of interest included Jamar grip and pinch strength, the Semmes-Weinstein monofilament test, Jebsen test of hand function, and return to work and activities.Outcomes were assessed up to 2 years post-operation.No statistically significantly differences were observed in all outcomes between the two interventions 3 months post-operation.However, all outcomes did improve with time relative to baseline scores.Multivariable analysis demonstrated that triceps-sparing and tricep split approaches were predictive of a decrease in the tip pinch score (p=0.0146, p=0.0233, respectively) and grip strength (p=0.04, p=0.0013, respectively). Furthermore, tricep-sparing and... Read More »
Conference Report
3%
Synopsis: A total of 2520 patients in the FAITH and HEALTH trials with hip fractures were included in this sub-analysis assessing the incidence of venous thromboembolism (VTE) and factors associated with VTE.The primary outcome of interest was the incidence of VTE in the hip fracture population.Secondary outcomes of interest included timing of VTE, prophylaxis prescribed, and factors associated with VTE.64 patients (2.5%) reported a VTE event, the majority (n=61; 95.3%) occurring post-operation.VTE events were reported 6 weeks before and after sustaining a fracture (54.7%, 45.3%; respectively).The most common methods of pre-operative prophylaxis were low-molecular weight heparins (46%) and mechanical ventilation (18%).The most common method of post-operative prophylaxis was low-molecular weight heparin (73%).Age, comorbidity treatment, post-operative thromboprophylaxis, and increased time to surgery were not associated with an increase in VTE incidence. Arthroplasty was associated... Read More »
RCT