Results Of Conservative Treatment Research Articles

Visual outcomes of central retinal artery occlusion: Exploring treatment strategies beyond the conventional time window.

Central retinal artery occlusion (CRAO) is a vision-devastating emergency. However, widely-acknowledged treatment consensus is lacking and prehospital delays commonly occur. Hence, we aimed to investigate the visual outcomes of conservative treatments (CT), local intra-arterial fibrinolysis (LIF) and hyperbaric oxygen (HBO) therapy for non-arteritic CRAO (NA-CRAO) patients beyond the conventional time window. This retrospective comparative study included 99 NA-CRAO patients followed up for over 6 months. The subjects were divided into three groups: the CT (50 patients), LIF (10 patients) and HBO group (39 patients). The primary endpoint was the best-corrected visual acuity (BCVA) change at 6 months compared to baseline. The secondary endpoint was the improvement in BCVA at 1 year and final visits. No heterogeneity regarding demographics was identified. However, the HBO group had a more extended time-to-treatment period (median 6.0 days) and more advanced-stage CRAO cases (41 % stage III) than the CT (median 4.0 days, 14 % stage III) and LIF (median 0.6 days, 20 % stage III) groups. Despite this, the HBO group exhibited a significantly greater BCVA and a higher proportion of patients achieving significant vision improvement than those in the CT group at 6-, 12-month and final exams (51.3 % vs. 24.0 %, P < 0.05). The LIF appeared to improve outcomes more than CT over time without significance. Our study provided a concurrent comparison across 3 approaches and demonstrated that HBO therapy beyond the time window remained more effective in improving vision than CT alone for NA-CRAO patients, which had not been proposed by prior studies.

Systematic Review of Acute Isolated Distal Radioulnar Joint Dislocation: Treatment Options.

Background/Objectives: Acute isolated distal radioulnar joint (DRUJ) dislocations are rare and often misdiagnosed during initial evaluation due to subtle clinical presentation, low index of suspicion, and imaging barriers. Prompt diagnosis and treatment are critical to avoid chronic instability, limited wrist mobility, and osteoarthritis. This systematic review evaluates the functional outcomes of conservative and surgical treatment protocols for acute isolated DRUJ dislocations. Methods: A systematic search of PubMed, Scopus, and Mendeley databases (2000-2024) was conducted following PRISMA guidelines. Inclusion criteria involved adult patients with isolated DRUJ dislocations diagnosed and managed within one week of injury. Studies reporting on underage patients, associated fractures, delayed management, and open injuries were excluded. Data on demographics, injury mechanism, diagnostic methods, treatment protocols, and functional outcomes were extracted and analyzed. Results: In total, 22 cases across 20 studies were included. The majority (90.9%) were males, with a mean age of 37.9 years (range: 20-70 years). Falls and sports injuries were the major causes, with volar dislocations predominating (18/22). The misdiagnosis rate was equal to 18%. Most cases were treated conservatively with closed reduction and immobilization for an average of 4.9 weeks. Operative treatment was performed in 6 cases, mainly following failed closed reductions. Functional outcomes were generally favorable, although the same parameters were not consistently studied in all patients. Overall, 82% (14 of 17 patients) achieved a full range of motion; 88% (14 of 16 patients) reported no pain, and all assessed cases had stable DRUJs at follow-up. Conclusions: This review highlights the rarity and diagnostic challenges of this injury. The functional outcomes of both conservative and operative treatment are generally satisfactory. Conservative treatment should be the first-line approach, with surgery reserved for irreducible or unstable cases. Future research using standardized outcome measures is needed to provide guidance for clinicians.

Conserve or Reverse? Outcomes of Conservative treatment versus Reverse Shoulder Arthroplasty in displaced 3- & 4-part proximal humeral fractures in patients over 60 years.

The optimal treatment of 3- and 4-part proximal humeral fractures in older adults remains controversial. This aim of this study was compare patient reported outcomes following reverse shoulder arthroplasty (RSA) or non-operative management in patients over 60 years old. A retrospective review was undertaken of patients following 3- or 4-part proximal humeral fractures treated with RSA or non-operative treatment with minimum 2-year follow-up. Patient-reported outcome measures were collected including Oxford Shoulder Score (OSS), QuickDASH (QDASH), Subjective Shoulder Score (SSV) and Visual Analogue Score (VAS) pain. Minimal Clinically Important Difference (MCID) thresholds were set for OSS (5), QDASH (8) and SSV (12) points. Patient acceptable symptom state (PASS) threshold of 75% was set for SSV. Comprising the largest study to date, 99 patients (35 RSA: 64 Non-operative) were matched for age, sex and hand dominance, at mean follow-up of 35 months with a median age of 71 at time of injury. The mean OSS was significantly higher for the RSA group (42 vs 36; p=0.048). Similarly, QDASH (14.4 vs 25.4, p=0.046) and SSV (84% vs 70%, p=0.006) were significantly higher in the RSA cohort. Minimal Clinically Important Difference (MCID) thresholds were reached for OSS (8), QDASH (11) and SSV (14). Patient acceptable symptom state (PASS) threshold of 75% for SSV was reached in 88% of RSA patients, compared to 46% in non-operative patients (p=0.003). VAS pain did not have a significant effect on outcomes (1.5 vs 2, p=0.063). Complication rates were higher (51%) in non-operative patients, including 15% mortality at follow-up, compared to 10% in the RSA group with 1.5% mortality. Reintervention rate was 13% within the non-operative group and 1.5% within the RSA group. These results contribute to a growing body of evidence supporting the use of RSA in 3- and 4-part proximal humeral fractures. Highlighting that RSA can offer significant benefits in terms of improved PROMS and patient satisfaction with low complication rates.

Comparative efficacy of operative versus conservative treatment for Rockwood type III acromioclavicular joint dislocation: a systematic review and meta-analysis of randomized controlled trials.

Optimal management of Rockwood type III acromioclavicular joint (ACJ) dislocation is still debated. Our aim is to conduct a meta-analysis of clinical studies evaluating the functional outcomes of operative versus conservative treatment for Rockwood type III ACJ dislocation. We conducted a systematic search across PubMed, EMBASE, Web of Science, and the Cochrane Library, including only randomized controlled trials (RCTs) focusing exclusively on type III ACJ dislocation. A total of 244 patients from four studies were included. Outcomes measured included Constant scores (CS), coracoclavicular distance (CCD), pain, and complication rates. Heterogeneity was assessed and managed to ensure robust conclusions. The pooled results showed no significant difference in long-term functional outcomes, measured by CS, between surgical and conservative treatments (MD: 4.82, 95% CI: -6.42 to 16.06, P = 0.400). Surgical treatment provided better early pain relief and superior CCD at all follow-up points but did not improve long-term outcomes. Complication rates were similar for both treatments, though surgical intervention had a higher incidence of posttraumatic osteoarthritis and hardware-related issues. Conservative treatment resulted in fewer complications and comparable long-term results. Based on the evidence, while surgical treatment may offer early benefits in pain relief and CCD improvement, it does not enhance long-term functional outcomes and is associated with higher specific complication rates. Conservative treatment provides a viable alternative with fewer complications and similar long-term outcomes. These findings highlight the need for individualized treatment plans based on patient-specific factors and suggest further high-quality, long-term studies to refine management strategies for Type III AC joint dislocations.

Case characteristics and surgical efficacy in elderly patients over 65 years of age with cervical spinal cord injury without fracture and dislocation: a retrospective study

ObjectiveThe outcomes of surgical and conservative treatment in elderly patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD) were evaluated over medium- and long-term follow-up periods and the case characteristics were analysed.MethodsData from 39 elderly patients over 65 years of age with CSCIWFD who were admitted to our hospital between January 2010 and June 2022 were retrospectively analysed. Neurological recovery was assessed using the American Spinal Injury Association (ASIA) grading criteria and the Japanese Orthopaedic Association (JOA) score at admission, after surgery, and at the final follow-up. Post-injury imaging data were used to evaluate potential underlying lesions and injury types. In the surgical treatment group, the sagittal and transverse diameters of the cervical spinal canal were measured using magnetic resonance imaging at admission and the final follow-up to effectively assess spinal cord decompression.ResultsAt the final follow-up, the JOA score of the 21 patients who underwent surgical treatment was significantly higher than that of the patients who received conservative treatment (P < 0.001). Additionally, the ASIA grading showed a significant improvement compared to the conservative treatment group (P < 0.003). The sagittal and transverse diameters of the cervical canal in the surgical treatment group were significantly larger at the final follow-up than at admission, indicating surgical decompression (P < 0.001).ConclusionElderly men are the most commonly affected group with CSCIWFD, typically presenting with a history of low-energy trauma. For these patients, active surgical management is recommended following the stress period, assuming their physical condition is suitable. Our results suggest that even in patients with prolonged injury, improvement in neurologic and motor function may be superior to conservative treatment after thorough decompression surgery.

The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD. METHODS: MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up. RESULTS: Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01). CONCLUSION: Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.

Outcomes of Conservative Treatments Evaluations for Lumbar Radiculopathy

Background: Lumbar Radiculopathy (LR) is a condition characterized by motor, reflex and sensory changes, often causing significant pain and disability. Conservative treatments are commonly recommended as initial management options. This study aims to evaluate the outcomes of various conservative treatments for LR. Materials and methods: This prospective cohort study involved 100 patients diagnosed with LR who underwent conservative treatments between January 2023 and December 2023 at our Physical Medicine Department, Institute of Applied Health Sciences (IAHS). Treatments included physical therapy, NSAIDs, epidural steroid injections and activity modification. Baseline data, including demographic information, pain intensity (VAS) functional status (ODI) and quality of life (SF-36), were collected. Follow-up assessments were conducted at 6 weeks, 3 months and 6 months. Primary outcomes were changes in VAS, ODI and SF-36 scores. Secondary outcomes included patient satisfaction and the need for additional interventions. Data were analyzed using descriptive statistics, paired t-tests and ANOVA. Results: The mean age of participants was 45.3 years, with a slight male predominance (56%). At baseline, mean VAS was 7.8, ODI was 45.6 and SF-36 was 62.5. Significant reductions in VAS (2.6), ODI (18.7), and improvements in SF-36 physical (80.3) and mental (81.7) scores were observed at 6 months (p&lt;0.05). Patient satisfaction at 6 months was highest for epidural injections (90%), followed by NSAIDs (85%), physical therapy (80%) and activity modification (70%). The need for additional interventions decreased to 8%. The incidence of adverse events was low, with physical therapy showing the lowest rates. Initial ODI score was a significant predictor of positive outcomes (p=0.03). Conclusion: Conservative treatments for LR are effective in reducing pain and disability and improving quality of life. All treatment modalities showed comparable efficacy, with low adverse event rates, supporting their use as first-line treatments. Initial disability levels should be considered in treatment planning to optimize outcomes. Further research is needed to refine predictive models and enhance individualized treatment strategies. IAHS Medical Journal Vol 7(1), June 2024; 80-85

Exploring the Correlation Between Bone Marrow Edema in the Tibial Plateau and Surgical Preferences in Stage 3 Gonarthrosis Patients

Abstract:* Objective: This research aimed to investigate the association between the presence of bone marrow edema in the tibial plateau and the patient's inclination towards surgery in individuals diagnosed with stage 3 gonarthrosis. Background/Purpose: A cohort of 40 patients with confirmed stage 3 gonarthrosis was enrolled in this study. Magnetic Resonance Imaging (MRI) scans were employed to assess the presence and severity of bone marrow edema in the tibial plateau. Patient demographics, clinical history, and radiographic data were collected. A comprehensive statistical analysis, including chi-square tests and logistic regression, was performed to identify any significant relationships. Results: A statistically significant positive correlation was found between edema and age (r = 0.47, p &lt; 0.01), indicating that as age increases, the presence of edema also tends to increase. No significant correlations were found between edema and BMI (r = -0.06, p = 0.70), or between BMI and age (r = 0.08, p = 0.62). This suggests that, within this sample, BMI does not significantly relate to either edema or age. Patients with more pronounced bone marrow edema were more likely to opt for surgery. Additionally, age and previous conservative treatment outcomes were identified as potential confounding factors influencing the decision-making process. Conclusion: The findings of this research underscore the relevance of bone marrow edema in the tibial plateau as a factor influencing the surgical inclination of stage 3 gonarthrosis patients. Understanding this relationship can contribute to a more personalized approach to treatment decisions in orthopedic practice, allowing healthcare professionals to better plan the interventions based on individual patient characteristics and preferences. Further studies are warranted to explore additional factors that may contribute to the complex decision-making process in managing advanced knee osteoarthritis.

Comparison of Clinical Outcomes of Conservative Treatment, Percutaneous Intralaminar Stabilization of Pars Defect, and Posterolateral Fusion with Interbody Fusion in Spondylolysis

Aim: This study aimed to compare the clinical efficacy of posterior lumbar interbody fusion (PLIF), percutaneous intralaminar screw pars stabilization (PS), and conservative treatment (CT) for symptomatic spondylolysis (SL). Material and Method: A retrospective randomized study was conducted on 45 patients, with 15 in each group (PLIF, PS, and CT), who underwent bilateral L5 SL and were treated between 2017 and 2022. Surgical indications included low back pain lasting &gt;6 months that was unresponsive to CT and without sciatica. The CT group comprised patients with similar pain profiles. Clinical outcomes were measured using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) scores at 0, 1, 3, 6, and 12 months. Results: The study included 65% female patients with a mean age of 52 (PLIF), 44 (PS), and 46 (CT) years. Both the PS and PLIF groups showed significant clinical improvement compared with the CT group (p

Maryland Bridges: A Conservative Approach to Aesthetic Tooth Replacement – A Case Report

Restoring missing central incisors in the mandibular jaw is a challenging esthetic challenge in dentistry, especially for younger patients. Maryland bridges are a highly effective treatment option, restoring oral function and aesthetics, and resulting in high patient satisfaction. These bridges have advantages over conventional fixed dental prosthesis, such as minimal removal of the tooth structure, minimal pulpal trauma risk, and reduced time and cost. Provisional restorations are usually not required. Maryland bridges are cemented to the abutment tooth using electrolytic etching to retain the metal framework. The bond is strengthened after etching, and the development of resin cements has enhanced bridge retention. A missing anterior tooth poses an esthetic, functional, and rehabilitative problem, especially for younger patients. Resin bonded bridges are minimally invasive, offering advantages such as minimal removal of the tooth structure, minimal pulpal trauma risk, and reduced time and cost. This case report describes the fabrication technique for a single missing lower anterior tooth, focusing on conservative, economical, and esthetic treatment outcomes.

Outcomes of clubfoot conservative treatment using the Ponseti technique in an academic hospital in Saudi Arabia

Objectives: Congenital talipes equinovarus (CTEV), commonly known as clubfoot, affects 1–4/1000 births, predominantly males. Without intervention, children face mobility limitations and deformities. Conservative treatment, particularly the Ponseti technique, which boasts a success rate exceeding 90%, is favored despite potential complications. Methods: This study aimed to assess the efficacy of the Ponseti technique through a retrospective analysis of idiopathic CTEV cases. Data on pre- and post-treatment Pirani scores were analyzed across variables including age, sex, number of casts, Achilles tenotomy, surgical intervention, and complications. Participants were categorized based on treatment outcomes to identify contributing factors. Results: Among 42 participants (69 feet), 62% were male, presenting at an average age of 9 weeks and receiving an average of 5.26 casts per patient. Pre-treatment Pirani scores averaged 4.52, significantly decreasing to 0.88 post-treatment. Feet managed without surgery demonstrated greater improvement in Pirani scores (mean change 3.888) compared to those requiring surgery (mean change 2.364), a statistically significant difference (P &lt; 0.001). Acceptable outcomes were observed in 84.06% of feet. Percutaneous Achilles tenotomy was performed in 84% of cases. Surgical intervention was necessary in 15.94% of feet. Casting complications occurred in 14.49% of feet. Conclusion: This study confirms the Ponseti technique’s effectiveness in managing idiopathic CTEV, emphasizing early detection and initiation of conservative treatment. The early findings establish the Ponseti technique as the preferred initial approach for CTEV management.

Comparing Conservative and Early Surgical Treatments for Pyogenic Spondylodiskitis: An International Propensity Score-Matched Retrospective Outcome Analysis.

Pyogenic spinal infections pose therapeutic challenges, with the optimal treatment approach remaining contentious. This study aimed to compare outcomes of conservative vs early surgical treatment (SuT) modalities in primary pyogenic spondylodiskitis through an international cohort analysis. A retrospective outcome analysis was conducted of 392 patients from the United Kingdom and Germany, treated between 2017 and 2022 with primary pyogenic spondylodiskitis. Patients were stratified by treatment modality. Propensity score matching, facilitated by a directed acyclic graph and principal component analysis, was used to balance risk factors between the compared patient cohorts. Primary outcome was mortality rate, while secondary outcomes included hospitalization duration, infection relapse, and neurological status at discharge. The study included 95 patients undergoing conservative treatment, primarily treated in the United Kingdom, and 297 receiving SuT, predominantly in Germany. The mortality rate was notably higher in the conservative group (P < .001), while the surgical cohort experienced a shorter hospitalization duration (P < .01). After propensity score matching, 2 comparable cohorts of 95 patients each emerged. Subsequent analysis revealed a markedly increased mortality in the conservative group (24.2% for conservative treatment vs 4.2% for SuT, P < .001). Neither relapse nor neurological status at discharge showed significant differences between the groups. The study indicates that early surgical intervention may be more effective than conservative management in reducing mortality and hospital stay for patients with primary pyogenic spondylodiskitis. These findings highlight the need for prospective trials and more definitive treatment guidelines.

Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort Study

BackgroundThe aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France. MethodsRetrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared. Results139 patients were included, with a median age of 8 [1–16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients. ConclusionsDiaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence. ClinicalTrialsNCT04862494, April 28, 2021. Level of evidencelevel III treatment study.

Early kyphoplasty in the elderly patient

Prevalence of vertebral compression fractures is over 30 % in the elderly population. The ideal treatment for these fractures remains a subject of debate. The objective in this study is to compare the clinical outcomes of early kyphoplasty and conservative treatment in vertebral compression fractures. Materials and methodsObservational retrospective study of 50 consecutive patients with acute vertebral compression fracture (25 patients treated by kyphoplasty and 25 treated by conservative therapy). Number and location of the fractures, radiographic assessment (Beck Index), symptoms duration, pain intensity (Visual Analog Scale -VAS), patient's functional capacity (Oswestry Disability Index – ODI) and analgesic use and dose were analysed. Both groups were followed for 1 year. ResultsMost of the patients in the sample were women with a mean age of 80,5 years old, both groups being comparable in age and sex (p=1 and p=1 respectively). The mean ASA score for kyphoplasty vs conservative was 2.6 vs 2.5 (p 0,54). VAS at initial diagnosis 8,50 vs 8,80 (p 0,405). VAS two months after initiation of the treatment 4,40 vs 2,40 (p 0,028), and VAS at one year follow-up was 1,80 vs 1,30 (p 0,216). ODI mean scores conservative vs kyphoplasty at initial diagnosis were 69,79 vs 74 (p 0,87) and two months later 31,60 vs15,40 (p 0,03). The mean Beck Index at the diagnosis conservative vs kyphoplasty was 59,20 % vs 61,50 % (p 0,68) and after 1 year 51,80 % vs 57,40 % (p 0,45). In the kyphoplasty group only 1 patient had to be hospitalised during 24 h. Cement leakage was detected in 2 patients without clinical repercussion. In the conservative group 5 patients had home help during their recovery and 3 went to nursing homes. ConclusionKyphoplasty is a minimally invasive surgical procedure with hardly any complications. It offers a faster and greater pain relief to elderly patients than conservative treatment. Early treatment with kyphoplarty allows patients to walk in a short time (early wandering) after the fracture. This treatment avoids long periods of rest and loss of muscle mass. It is a surgical procedure that should be considered as part of the initial therapeutic choices for osteoporotic vertebral fractures. Level of evidenceIV

Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears

BackgroundDegenerative medial meniscus tears are a common pathology in the general population. Recent randomized trials demonstrated non-superiority of arthroscopic partial meniscectomy over conservative management. However, there is a paucity of information regarding the outcomes of combined conservative treatments. HypothesisIt was hypothesized that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy, for degenerative medial meniscus tears, would result in high surgery-free and second injection-free survivorship. MethodsA retrospective review of 671 patients with symptomatic degenerative medial meniscus tears, who received intra- and perimeniscal corticosteroids injection combined with structured physiotherapy, was conducted. An ultrasound-guided injection of Triamcinolone Hexacetonide 20 mg/ml comprised; 1.5 ml intra-meniscal,1.5 ml in the meniscal wall, and 2 ml in the peri-meniscal space, was performed. Surgery free- and a second injection free-survivorship were analysed. Western Ontario and Macmaster University scores (WOMAC), Tegner activity scores, patient satisfaction, return-to-work status and average time to return to work were recorded. ResultsA total of 481 patients who met the inclusion criteria were included. The mean age was 51.1 ± 7.9 years. At five years post-procedure, surgery-free, and second injection-free survivorship of the ipsilateral knee was 83%, and 52%, respectively. A multivariate analysis adjusting survival on parametric risk factors identified that only effusion before steroid injection was an independent risk factor of treatment failure. At a mean follow-up of 4 ± 2 years, there was an improvement in WOMAC scores by 5.2 ± 4.9 for pain, by 2 ± 2 for stiffness, by 7.3 ± 7.4 for function, and by 12.4 ± 12.7 for the global scores. Additionally, there was significant improvement in the Tegner activity scores (All p < 0.001). Knee effusion and advanced osteoarthritis (Kellgren-Lawrence > III) were significantly associated with poorer outcomes; p < 0.003 and p < 0.0004, respectively. ConclusionA combination of intra- and perimeniscal corticosteroid injections and structured physiotherapy for degenerative medial meniscus tears, results in high surgery-free (83%) and second injection-free (52%) survivorship, as well as, effective clinical outcomes and satisfaction at 5 years. Level of evidenceIV; Retrospective Case Series.

Outcome of Conservative treatment of acute appendicitis in young females

Outcome of Conservative treatment of acute appendicitis in young females

Medium-term clinical results in the treatment of supracondylar humeral fractures in children: does the surgical approach impact outcomes?

BackgroundRecent literature has found a consensus in favor of conservative treatment for type II supracondylar humeral fractures (SCHF). This retrospective observational study compares the short- to medium-term functional outcomes of conservative versus surgical treatment in 31 patients with SCHF (Gartland II and III) to assess the potential superiority of one approach over the other.Materials and methodsThirty-one pediatric patients treated for SCHF—19 classified as Gartland II and 12 as Gartland III—were assessed in our department. Eight patients underwent closed reduction and cast immobilization, 22 were treated with closed reduction and percutaneous pinning, and one underwent open reduction and internal fixation with plates. Clinical and functional data were collected during follow-up, including elbow and forearm range of motion (ROM), grip strength, carrying angle, Flynn’s criteria, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe average follow-up was 3.3 years (± 1.4 years). All patients demonstrated good functional recovery. According to Flynn’s criteria, 85% and 81% of the patients achieved a satisfactory outcome in elbow flexion and carrying angle, respectively. No cases of nerve injuries were reported.Four patients developed cubitus varus in the Gartland II group, which was treated with closed reduction and casting with the initial alignment maintained (without a loss of reduction during the first week). However, compared to this group that was conservatively treated, functional and clinical outcomes were significantly better in the group with SCHF Gartland II treated with reduction and pinning (p < 0.05).ConclusionsAlthough some recent studies have demonstrated positive outcomes with conservative treatment for both Gartland IIA and IIB fractures, the short- to medium-term functional results in our study emphasize that superior outcomes were obtained with surgical treatment for Gartland II fractures when compared to those treated conservatively.Trial registration: This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute’s ethics committee (registry no. 3511).Level of evidence: Therapeutic level III

Comparison of Treatment Methods for Carpal Tunnel Syndrome: Surgical vs. Non-Surgical

Introduction Carpal tunnel syndrome (CTS) is a common condition that results from the compression of the median nerve within the carpal tunnel in the wrist. Both surgical and non-surgical treatments are used to manage CTS. While surgery is necessary in some cases, many patients can be treated effectively with conservative methods. This review compares the efficacy of surgical treatment for CTS against various conservative approaches. Aim The study aims to evaluate and compare the outcomes of surgical versus conservative treatments for CTS, focusing on symptom relief, patient outcomes, and long-term prognosis. State of Knowledge The carpal tunnel is a narrow passage in the wrist formed by carpal bones and the flexor retinaculum. Compression of the median nerve within this tunnel leads to CTS, which can be caused by anatomical variations or systemic conditions like diabetes. Symptoms include pain, numbness, and tingling in the hand, which may worsen at night or with repetitive movements. Summary (Conclusions) Surgical treatment, especially decompression, offers superior symptom relief and functional improvement but carries risks of complications. Conservative treatments like wrist immobilization and anti-inflammatory medications are effective for many patients, supporting their use as initial treatment. Further research is needed to optimize CTS management.

Comparison of Surgical and Conservative Treatments for Gartland Type II Supracondylar Humerus Fractures: Evaluation of the Need for Surgical Treatment.

Supracondylar humerus fractures (SHFs) are common pediatric injuries, with type II fractures being a topic of debate regarding optimal treatment. Our goals are to compare the functional and radiographic outcomes of conservative and surgical treatment of type II SHFs and their subgroups and to identify parameters for determining the optimal treatment option. We retrospectively reviewed a total of 55 patients (23 conservative, 32 surgical) between 2010 and 2020. The mean follow-up was 66 months. Neurovascular status, range of motion, complications, and functional scores (Mayo elbow, Quick DASH) were evaluated. We performed radiographic assessment on initial, postreduction, and final follow-up radiographs using the humerocondylar angle (HCA), Baumann angle, and anterior humeral line (AHL). Neither groups nor subgroups showed significant differences in clinical and functional outcomes. HCA was significantly higher in the operative group than in the conservative group. The subgroup analysis revealed that the HCA difference resulted from the difference between the conservative IIb and operative IIb subgroups. None of the patients required a corrective osteotomy, but 1 patient initially treated conservatively underwent operative treatment due to loss of reduction. Reconstructing the sagittal, coronal, and rotational alignment in type II SHFs led to good mid-term results in the range of motion and functional scores for the elbow joint, whether conservative or surgical treatment was used. A limited range of remodeling might be expected in the long term. Level III-retrospective comparative study.

Clinico-Radiological Outcomes of Conservative versus Operative Treatment of Physeal Injuries

Abstract Introduction: Physeal injuries are common in our day-to-day practice, with the utmost importance on early recognition so as to avoid complications such as premature physeal closure or limb length discrepancy. Physeal injuries are often missed, leading to poor outcomes. This study aims to evaluate the operative and nonoperative methods of treating physeal injuries. Materials and Methods: All pediatric patients who presented to the casualty ward with physeal injuries were enrolled, and regional distribution was done. Salter–Harris classification was used to classify the type of physeal injuries. Additional investigations such as computed tomography or magnetic resonance imaging were done where needed. Results: A total of 117 patients were included in the study, out of which 73 were male and 44 were females. Type II Salter–Harris injuries were found to be the most common. Left-sided injuries were common as compared to right-side ones, out of which road traffic accidents was the most common mechanism of injury, followed by slips and falls. About 94.1% were closed injuries, while 5.98% were compounding injuries. Out of 117 patients, 73 were treated conservatively, while 44 were managed operatively. Conclusion: This study illustrated an overall similar success between the surgical and the conservative treatments for pediatric physeal injuries. Due to the higher complication rate reported in the conservative management group, the conservative treatment cannot be considered safer than the surgical treatment. With early recognition and effective treatment of physeal injuries, good results are expected even in intra-articular physeal injuries. Long-term follow-up is important to identify the development of physeal growth disturbances.