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Synopsis: 6 randomized controlled trials (RCTs) and 9 non-randomized controlled trials were included in the present investigation.The analysis was performed to determine if the fixation of midshaft clavicle fracture with intramedullary nailing could achieve superior surgical outcomes without compromising union rates or safety when compared to plate fixation.Significantly lower blood loss, operative time, surgical wound size, length of hospital stay, and time to union were reported in patients undergoing intramedullary fixation in comparison to plate fixation, as were significantly lower overall and major complications.Union rate, shoulder score, and secondary complications were found to be comparable between groups. However, these results... Read More »
Level 2 Meta Analysis
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Synopsis: 108 patients scheduled for total knee arthroplasty (TKA) were randomized to undergo either a computer-assisted minimally invasive total knee arthroplasty or conventional total knee arthroplasty.The computer-assisted minimally invasive total knee arthroplasty led to improved, early rate of functional recovery before one month. It demonstrated greater... Read More »
Level 1 RCT
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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
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Synopsis: 6 randomized controlled trials (567 patients) were used in this meta-analysis to analyze the safety and efficacy of the addition of steroids to multimodal cocktail periarticular injection (MCPI) treatments during total knee arthroplasty (TKA). Pooled results showed that MCPI with steroids significantly reduced postoperative pain, duration to perform straight-leg raising and length of hospital stay, with no significant effect on ROM, postoperative drainage, or incidence of complications. Read More »
Level 1 Meta Analysis
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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
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Synopsis: 90 patients with knee osteoarthritis requiring total knee replacement were randomized to receive TKA using a minimally invasive surgery, mini-incision mid-vastus technique, a minimally invasive surgery, side-cutting technique, or standard medial parapatellar (conventional) technique.The results indicated that the side-cut minimally invasive technique negatively affects placement of the implant, resulting in malalignment. The mini-incision minimally... Read More »
Level 2 RCT
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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
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Synopsis: Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee.All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention.Pooled analysis of pain on a visual analog scale indicated that pain relief was significantly better with hyaluronic acid injections at both 3 and 6 months follow-up; however, this finding was strongly influenced by two studies of lower methodological quality. No significant differences between hyaluronic acid and corticosteroid injections were observed in any functional outcome measurement.Due to incomplete or lack of reporting adverse events, an assessment of safety could not be performed along with this review. Furthermore, these findings... Read More »
ACE Review
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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
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Synopsis: Orthopaedic surgeries increased by a frequency of 28,200 from 2004 to 2016.Results revealed that the rate of 30-day adverse events increased over time for inpatient surgeries and was stable for out-patient surgeries.However, rate of in-hospital adverse events decreased by 3%.Predictors of higher odds of in-hospital and 30-day adverse events included older age, low income, living in urban areas, and having more co-morbidities.Hospitals with high surgeon volumes were associated with lower odd of in-hospital and 30-day adverse events. Being discharged home... Read More »
Conference Report