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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
4%
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
4%
Synopsis: The use of anticoagulants for lower limb outpatient procedures such as knee arthroscopy is varied, and questions remain.The authors performed a meta-analysis of nine randomized controlled trials. The interventions included low molecular weight heparin (LMWH), Rivaroxaban, and acetylsalicylic acid (ASA), and comparators included no treatment, placebo, and compression stockings.A total of 4290 patients were included.Overall, they found no significant difference between pharmacologic interventions and controls in terms of symptomatic venous thromboembolism (excluding distal deep vein thrombosis (DVT)).There were significantly fewer symptomatic distal DVTs in the treatment group. Overall, the authors... Read More »
Level 1 Meta Analysis
3%
Synopsis: 116 patients with a chronic anterior cruciate ligament (ACL) rupture and scheduled for an arthroscopic ACL reconstruction were randomized to receive preparation of the femoral tunnel via an anteromedial technique or a transtibial technique.Outcomes of interest included anatomical outcomes, bio-mechanical outcomes, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and incidence of graft failure.Follow up was performed up to 2 years post-operation.Results from this study found no significant differences between the anteromedial and transtibial groups in the IKDC subjective score and Lysholm score.Femoral tunnel length and graft angulation in the sagittal and coronal planes were significantly smaller in the anteromedial group compared to the transtibial groups.Absolute improvement in internal rotation was significantly greater in the anteromedial group compared to the transtibial group. The incidence of... Read More »
Level 2 RCT
3%
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
3%
Synopsis: Traditionally, tibial shaft fractures have been fixed with intramedullary nailing using an infrapatellar technique.A suprapatellar technique has been used more recently, but the optimal approach is unknown.A randomized controlled trial was performed comparing suprapatellar to infrapatellar nailing was performed in 45 patients.Outcomes included alignment and operative time.The investigators found that suprapatellar nailing resulted in faster operative times with no difference in overall alignment.Overall, suprapatellar nailing may at the very least offer the advantage of shorter operative time, though it is unclear which approach the surgeons were more experienced with. Read More »
Conference Report
3%
Synopsis: A non-inferiority trial including 356 patients presenting to a general practitioner with traumatic knee complaints were randomized to receive immediate referral for magnetic resonance imaging (MRI) or usual protocol directed by the guidelines provided by the Dutch college of general practitioners.The primary outcome of interest was the Lysholm knee score.Secondary outcomes of interest included the EQ-5D quality of life questionnaire, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), pain on a numeric rating scale (NRS), as well as patient perceived recovery and satisfaction.Follow up was performed at 6 weeks, 3, 6, 9 and 12 months. Results found no... Read More »
Level 2 RCT
2%
Synopsis: 53 polytraumatic patients were randomized to receive surgical rib fixation or conservative treatment for the treatment of flail chest.Outcomes of interest included length of stay outcomes, the incidence of adverse events, mechanical ventilation, and pain at rest, during coughing and during deep breathing. Study results revealed... Read More »
Level 2 RCT
2%
Synopsis: Ankle fractures are one of the most common injuries treated by orthopaedic surgeons.No globally accepted algorithm exists for post-injury imaging.It is unclear whether routine x-rays change management or simply present an extra expense.The authors randomized 247 patients to routine care (X-rays at 1, 2, 6, and 12 weeks) versus a reduced-imaging protocol (radiographs at 6 and 12 weeks only performed if clinically indicated.Outcomes included the Olerud-Molander Ankle Score (OMAS), the American Academy of Orthopaedic Surgeons (AAOS) ankle score questionnaire, the EuroQol 5-Dimensions 3-Level (EQ-5D-3L), and Short Form 36 (SF-36).In addition, pain, number of radiographs and healthcare costs were measured.154 (63%) patients underwent surgery.Patients in the reduced-imaging group had significantly fewer median radiographs (4 vs.5, p < 0.005).OMAS, AAOS, EQ-5D-3L, pain levels, health perception, self-perceived recovery, and complications did not differ between the two groups.Radiography costs were significantly lower in the reduced imaging group (-48 euros per patient).Overall costs were comparable between groups.Overall, a reduced imaging protocol resulted in fewer x-rays and lower radiography costs with no impact on function. Overall costs, however,... Read More »
Conference Report
2%
Synopsis: Paediatric flexible flatfoot is a very common condition which tends to improve over time in many children.During the period of its persistence, however, it can be quite painful and debilitating.The authors randomized patients to receive a customized arch support for 12 weeks or control (no insoles).Outcomes included radiographic outcomes, pain, function, stair ascent time, and overall mobility. Patients with customized... Read More »
Level 1 RCT