Significant Difference In Functional Outcome Research Articles

Does platelet-rich plasma enhance fusion in transforaminal lumbar interbody fusion? A prospective clinico-radiological comparative study

Abstract Background: Several animal studies have shown that platelet-rich plasma (PRP) is effective in enhancing bone fusion. However, the role and efficacy of PRP in spinal fusion surgery remain uncertain. The objective was to evaluate the efficacy of PRP in bone fusion and to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) with and without PRP. Materials and Methods: This prospective study was done on 50 patients who underwent TLIF surgery for various spinal pathologies. Patients were divided into the control group (underwent TLIF with interbody cage and local bone grafts alone) and the study group (underwent TLIF with interbody cage, local bone grafts, and PRP). Functional outcome was evaluated using visual analog score (VAS) and Oswestry disability index (ODI). Radiological outcome was assessed by Bridwell’s grading system for fusion on computed tomography scan at the end of 2 years. Results: The average bone fusion rate was significantly higher in the PRP group compared to the control group; however, the average duration of fusion was not statistically significant. There was no difference in VAS and ODI at 1 and 2 years. There was also no significant difference in lower back pain, leg pain, and numbness in both groups at the end of 1 year. Conclusion: Although there is no statistically significant difference in functional outcome between both groups, local application of PRP along with autologous bone grafts increases bone fusion rates with good clinical and radiological outcomes.

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Efficacy of Lumbar Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy in Individuals with Spine Surgery: A Retrospective Comparative Study

Introduction: Transforaminal epidural steroid injections (TFESI) have demonstrated their efficacy in both short-term and long-term treatment of radicular pain with their targets being the anterolateral epidural space and dorsal root ganglion. Although the evidence for transforaminal injections in treating radiculitis secondary to discherniation and lumbar stenosis is strong, evidence is limited regarding its effect on axial pain and in patients with failed back surgery syndrome (FBSS). Methodology: 61 patients were registered in this retrospective comparative study who underwent lumbar TFESI for lumbosacral radiculopathy from March 2021 to March 2022. All patients were assessed for difference in pain relief, disability and functional outcome at baseline and at the time of follow up using NRS, ODI & PROMIS. As a secondary objective the patients were divided into two groups those with previous history of spine surgery (Group A) and non-operated patients (Group B) to Compare the mean levels of pain relief, functional outcome and disability in spine surgery patients compared to non-operated patients. After Ethical committee approval and informed consent from patient baseline scores (NRS, ODI & PROMIS) were accessed from the MRD and follow up scores were obtained by sending a questionnaire across to the patient by email. The average follow up time was 1 year and 4 months (Mean). Results and Observations: A minimum clinically important difference (MCID) of >2.0 was selected for the change in NRS to further determine the proportion of responders who experienced a clinically significant reduction of pain. Success in achieving MCID is defined by ≥3 t score change for all PROMIS instruments. Success in achieving MCID for ODI is defined as at least 30% score change at follow up from baseline score. There is no significant difference in pain relief, disability improvement, functional outcome as assessed by NRS, ODI & PROMIS between the two groups. In this study the success in achieving MCID for NRS was 70% in Group A and 63% in group B and overall 67% indicating that total 41 patients (67%) had significant reduction in NRS after TFESI. In this study success of achieving MCID for ODI was 38.7% among Group A which was comparable to 23.3% among Group B and the difference was not statistically significant. The overall success of achieving MCID for ODI was total 19 patients (31.1%) indicating only 31% patients had significant improvement in disability post TFESI. There is no significant difference in functional outcome as assessed by PROMIS instruments between the two groups. For PROMIS PF, PI, SD the success of achieving MCID was greater than 70% overall and for both the groups. Conclusion: There is no doubt regarding the efficacy and therapeutic effect of TFESI in axial lumbosacral pain/radicular pain in non-operated patients. This study demonstrates the success rate of TFESI in spine surgery patients (FBSS) as well by utilizing PROMIS as an outcome measure and by use of a control group demonstrating improved Physical Function, less pain interference & improved sleep.

Long-Term Outcomes Following Freehand Minimally Invasive Aspiration for Deep Supratentorial Intracerebral Hemorrhage: A Multicenter Cohort Study.

The aim of this study was to compare the therapeutic effects of non-navigated freehand minimally invasive aspiration and conservative medical care in patients with deep supratentorial intracerebral hemorrhage (ICH). We analyzed data from a prospective multicenter cohort study. Propensity score matching was performed to adjust for possible confounding factors. A total of 122 patients with first-onset deep supratentorial ICH with a volume ≥ 20ml were enrolled. All patients were followed up at 30days, 90days, and 1year. The mortality rate, functional outcomes, complications, and treatment costs were compared between the two groups. After propensity score matching, 122 patients with a mean age of 56.0years were included, 77.9% of whom were male. The median ICH volumes were 45.5ml in the surgery group and 48.0ml in the conservative group. The mortality rate at 30days was significantly lower in the surgery group than in the conservative group (P = 0.0127). There were no significant differences in functional outcomes at the 90-day and 1-year follow-ups between the two groups (P > 0.05). There was no significant difference in complications, including recurrent bleeding (6.6% vs. 4.9%), pulmonary infection (57.4% vs. 41.0%), deep venous thrombosis (9.8% vs. 11.5%), heart failure (1.6% vs. 6.6%), and cerebral infarction (4.9% vs. 3.3%), between the two groups. For deep supratentorial ICH, non-navigated freehand minimally invasive aspiration was safe and reduced short-term mortality but did not effectively improve long-term functional outcomes.

Bankart Repair Versus Bristow-Latarjet Procedure in Treating Anterior Shoulder Dislocation: A Systematic Review

Introduction: Anterior shoulder dislocation affects an estimated 11/100,000 individuals annually, primarily involving the inferior glenohumeral ligament and causing recurrent instability. Surgical approaches like anatomical labral repair and the Bristow-Latarjet procedure are common for managing these issues. This systematic review aimed to compare the clinical and functional outcomes of Bankart repair and the Bristow-Latarjet procedure in treating anterior shoulder dislocation. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Google Scholar, Science Direct, and the Cochrane Library, resulting in 154 studies. From these, 4 studies were selected: two retrospective cohorts, one prospective cohort, and one case-control, encompassing 414 patients. Among them, 257 patients underwent the Bristow-Latarjet procedure, while 157 received Bankart repair. Inclusion criteria covered English-language studies evaluating clinical outcomes such as SSV, WOSI, Rowe scores, movement loss, and arthropathy rates, with no demographic restrictions, while non-English studies were excluded. Quality evaluation employed classifications by the Oxford Center for Evidence-based Medicine, GRADE criteria, and AHRQ for assessing evidence strength, bias, and quality. Results: The systematic review selected 4 studies from the 154 identified, incorporating a total of 414 patients. Of these, 257 underwent the Bristow-Latarjet procedure, and 157 received Bankart repair. The studies comprised two retrospective cohorts, one prospective cohort, and one case-control study. Conclusion: The review revealed no significant difference in functional outcomes between Bankart repair and the Bristow-Latarjet procedure for anterior shoulder dislocation. The choice between these methods depends largely on surgeon preference and technological accessibility. However, more comprehensive, high-quality studies are needed to better guide the selection between these procedures. Keywords: Anterior shoulder dislocation; Glenohumeral ligament; Bankart repair; Bristow-Latarjet procedure.

Abstract 13065: Comparative Efficacy of Endovascular Mechanical Thrombectomy With and Without Intravenous Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis of Randomized Trials

Background: Current guidelines states that intravenous tissue plasminogen activator (tPA) should be administered to eligible acute ischemic stroke (AIS) patients even if endovascular mechanical thrombectomy (EMT) is being considered. However, there is still uncertainty regarding the superiority of EMT with tPA over direct EMT. Aim: This meta-analysis seeks to provide a comprehensive evaluation of the comparative effectiveness of EMT with and without tPA in treating AIS. Methods: We performed a systematic literature search using PubMed, EMBASE, Cochrane, Web of Science, and clincialtrials.gov. Relevant articles from inception until April 10th, 2023, were scrutinized. The primary outcome of interest was functional independence assessed by the modified Rankin Score between 0-2 at 90 days. Secondary outcomes included all-cause mortality within 90 days, successful recanalization defined as extended thrombolysis in cerebral infarction score of 2b to 3, and safety outcome, i.e., the occurrence of symptomatic intracranial hemorrhage (sICH). Results: Our analysis included 6 RCTs involving 2334 patients. The pooled analysis of the primary outcome revealed no significant difference between EMT with tPA and direct EMT [OR, 1.08 (95% CI, 0.87-1.34), p=0.41]. All-cause mortality [OR, 0.93 (95% CI, 0.74-1.16), p=0.42] and sICH [OR, 1.22 (95% CI, 0.91-1.62), p=0.14] also did not significantly differ between the two groups. However, the results for successful recanalization [OR, 1.35 (95% CI, 1.01-1.80), p=0.04] indicate that patients who underwent EMT with tPA had a 35% significantly higher likelihood of achieving successful recanalization. Conclusion: Our meta-analysis found no significant difference in functional outcome, all-cause mortality, or sICH between EMT with tPA and direct EMT. However, EMT with tPA was associated with a higher likelihood of successful recanalization, suggesting its potential benefit in improving recanalization rates in AIS.

Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial

BackgroundPostoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications. MethodsParticipants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications. ResultsA total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18–65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group. ConclusionThis study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively. Level of evidenceTherapeutic Level I.

Salvage Cryoablation for Recurrent Prostate Cancer Following Primary External Beam Radiotherapy or Primary Cryotherapy: A Propensity Score Matched Analysis of Mid-term Oncologic and Functional Outcomes.

Local prostate cancer recurrence following radiotherapy (XRT) or cryoablation (CRYO) may be addressed with salvage cryotherapy (SCT), although little is known about how the primary treatment modality affects SCT results. Oncologic and functional outcomes of patients who underwent SCT after primary XRT (XRT-SCT) or cryoablation (CRYO-SCT)were studied. Data was collected using the Duke Prostate Cancer database and the Cryo On-Line Data (COLD) registry. The primary outcome was biochemical progression-free survival (BPFS). Urinary incontinence, rectourethral fistula, and erectile dysfunction were secondary outcomes. The Kaplan-Meier log-rank test and univariable/multivariable Cox proportional hazards (CPH) models were utilized to evaluate BPFS between groups. 419 XRT-SCT and 63 CRYO-SCT patients met inclusion criteria, that was reduced to 63 patients in each cohort after propensity matching. There was no difference in BPFS at 2 and 5 years both before (P=.5 and P=.7) and after matching (P=.6 and P=.3). On multivariable CPH, BPFS was comparable between treatment groups (CRYO-SCT, HR=1.1, [0.2-2.2]). On the same analysis, BPFS was lower in D'Amico high-risk (HR 3.2, P < .01) and intermediate-risk (HR 1.95, P < .05) categories compared to low-risk. There was no significant difference in functional outcomes between cohorts. Following primary cryotherapy, salvage cryoablation provides comparable intermediate oncological outcomes and functional outcomes compared to primary radiotherapy.

Medial patellofemoral ligament reconstruction appears to be a better treatment than repair, proximal realignment, or conservative management for primary patellar dislocation: A network meta-analysis.

The purpose of this study was to compare the functional outcomes and re-dislocation rates of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair, combined proximal realignment (CPR), and conservative management for primary patellar dislocation by conducting a systematic literature search of the available studies. The hypothesis was that MPFL repair and MPFL reconstruction would be better options for treating primary patellar dislocation. Randomized controlled trials or prospective studies of primary patellar dislocation treated with MPFL reconstruction, MPFL repair, CPR, or conservative management were identified from the MEDLINE, EMBASE, and the Cochrane Library databases through December 31, 2021. A total of 626 patients met the prespecified inclusion criteria. The methodological quality of each study was assessed using a risk of bias table, Detsky quality index, and Newcastle-Ottawa Scale. The end-point data collected included comparisons of the mean in functional scores on knee outcomes scales and the number of patients who experienced re-dislocation. A network meta-analysis of the relevant literature was performed to investigate which treatment showed better outcomes. In total, 10 trials were included in this study. There was no statistically significant difference in the subgroup analysis in terms of the functional outcomes among MPFL reconstruction, MPFL repair, CPR, and conservative management. However, MPFL reconstruction showed statistically significantly better outcomes than MPFL repair, CPR, or conservative management in terms of the re-dislocation rate. Additionally, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair even though there was no significant difference (0.24, 95% confidence interval: 0.02-2.91). Using a network meta-analysis, this meta-analysis showed that there was no significant difference in functional outcomes in a subgroup analysis. In re-dislocation subgroup analysis, MPFL repair and MPFL reconstruction produced significantly better results than other treatments. Also, surface under the cumulative ranking curve percentage showed that MPFL reconstruction had a lower probability of re-dislocation than MPFL repair.

Optimizing femoral component rotation in TKA: The role of posterior condylar angle and condylar twist angle

PurposeFemoral component rotation (FCR) is crucial in total knee arthroplasty (TKA). Currently, the optimal method to select FCR is unknown due to patient anatomy variation. Addressing the variability of femoral component rotation is critical to optimizing TKA outcomes and patient satisfaction. In this study, we aimed to identify outlier frequency and evaluate malrotation risk reduction by setting anatomic limits for FCR selection. MethodsOne hundred patients with end-stage knee osteoarthritis requiring TKA were included and categorized as normal rotation, internal rotation outlier, and external rotation outlier based on their expected FCR calculated intraoperatively using the modified gap balancing technique with a tensioning device. The computed FCR was then referenced to their Posterior Condylar Angle (PCA) and Condylar Twist Angle (CTA). The postoperative FCR and 1, 2-, and 5-years functional scores were also measured. ResultsSeventy-one knees (71%) were within the limits of PCA and CTA. The combined outlier frequency is 29%. The mean computed FCRs are 4.4° (±1.5), −1° (±2.6), and 8.0° (±3.4) for the normal, internal rotation, and external rotation groups, respectively. Whereas after setting the limits, the postoperative FCRs are 3.1° (±1.5), 3.9° (±1.7), and 2.5° (±1.4) for the three groups, respectively. The relative risk reduction against malrotation was 65%. At 1, 2, and 5 years post-TKA, all groups showed significant functional improvement, with no significant differences in functional outcomes between the normal and outlier groups. ConclusionThe use of lower and upper limits for selecting the FCR based on CTA and PCA can be a valuable approach to reducing malrotation risk and achieving satisfactory functional outcomes in TKA. Addressing the individual patient's anatomic limits contributes to improved TKA outcomes and patient-specific component alignment, thus enhancing the overall success of the procedure.

Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia

BackgroundThis study evaluated the efficiency and safety of transurethral enucleation with bipolar energy (TUEB) using a spatula loop according to prostate volume. MethodsWe retrospectively evaluated 398 patients who underwent TUEB for benign prostatic hyperplasia at a single tertiary hospital between August 2018 and December 2022. The patients were divided into three groups according to estimated prostate volume (ePV): ≤40 mL (n = 67), 40–80 mL (n = 200), and ≥80 mL (n = 131). To compare the efficiency of TUEB, perioperative parameters including TUEB and enucleation efficiencies, were calculated as enucleated tissue weight per operation time and enucleated tissue weight per enucleation time, respectively. Preoperative and postoperative functional outcomes such as the International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and post-void residual urine volume (PVR), were also compared. ResultsThe IPSS total score, voiding sub-score, Qmax, and PVR improved after TUEB in all groups (all p < 0.05). The TUEB and enucleation efficiencies increased with increasing ePVs (all P < 0.001). When comparing the three prostate volume groups, there were no significant differences in functional outcomes within 12 months after TUEB (all-Bonferroni adjusted P > 0.017). A total of 57 patients experienced adverse events after TUEB, with no significant differences between the three groups (p = 0.507) ConclusionAs prostate volume increases, the perioperative efficiency of TUEB is enhanced. Meanwhile, small prostates did not show significant differences in the improvement of functional outcomes and complications in comparison with larger prostates.

A prospective study to analyze the functional outcome of the femoral neck system in femoral neck fractures

Abstract Background: In 2017, a new fixation device called the femoral neck system (FNS), manufactured by DePuy Synthes orthopedics company of Johnson &amp; Johnson, was introduced to manage femoral neck fractures. The primary objective of this study was to present our firsthand experience with this device in treating femoral neck fractures and to evaluate its clinical outcomes. Materials and Methods: With ethical committee approval, we conducted a prospective study involving patients aged 18 years or older but no more than 60 years. The study included a final sample size of 30 participants, selected based on specific inclusion and exclusion criteria. Patient records were reviewed to collect data on blood loss, fracture type, internal fixation methods, and the duration of clinical follow-up. Continuous variables were analyzed, and their mean values, standard deviations, and ranges were reported. The clinical assessment of patients was carried out using the Harris hip score and postoperative X-rays at regular intervals. Results: In our study, the gender distribution among the patients showed that 60% were females and 40% were males. The patient’s average age was 44.12 years, with a standard deviation of 2 years. The functional outcomes of patients treated with FNS using the hospital for special surgery (HSS) method were compared at different postoperative time points: 6 weeks, 3 months, and 12 months. The statistical analysis revealed significant differences in functional outcomes at these time intervals. During the study, two cases of postoperative complications were observed among the patients. These complications were addressed through specific interventions, namely bipolar hemiarthroplasty and shoe raise to correct limb shortening. Conclusion: Our study demonstrated that FNS yielded positive outcomes, significantly improving the HSS scores. Additionally, we observed that FNS was associated with minimal intraoperative blood loss in the cases we examined.

A meta-analysis of closed reduction percutaneous pinning and open reduction with pin fixation of pediatric humeral lateral condylar fracture.

To compare the effectiveness and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation to treat the pediatric humeral lateral condylar fracture. Studies comparing closed reduction percutaneous pinning vs. open reduction with pin fixation for treating pediatric lateral humeral condyle fractures were found by searching Pubmed, Embase, the Cochrane Library, and Web of Science databases, including randomized/non-randomized controlled, retrospective case-control, and prospective cohort studies. Furthermore, quality evaluation and data retrieval were conducted after the literature review. A meta-analysis was performed using RevMan 5.4 software to compare both groups' outcome measures. This Meta-analysis incorporated eight studies with 856 cases. The Meta-analysis found no significant difference in functional outcomes, superficial infection, deep infection, poor fracture union, avascular necrosis of the humeral capitulum, or lateral spur formation between groups. However, the status of unaesthetic scars in the closed reduction percutaneous pinning group was superior. For pediatric humeral lateral condylar fracture surgical therapy, the efficacy and safety of closed reduction percutaneous pinning vs. open reduction with pin fixation were not significantly different; closed reduction percutaneous pinning offered the benefit of eliminating unaesthetic scar. However, further high-quality research is required to verify the conclusions of this Meta-analysis. https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023392451.

Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression.

Obesity is associated with increased surgical complexity and postoperative complications in spine surgery. Minimally invasive procedures have been shown to lessen some of the increased risk in obese patients. This study investigated whether utilization of a working channel endoscope can further mitigate obesity-associated challenges in spinal surgery. A retrospective review of a single-surgeon database was conducted for all adult patients undergoing full-endoscopic unilateral laminotomies for bilateral decompression between November 2015 and March 2021. Data collected included body mass index, in operating room preparation time, procedure time, length of hospital stay, use of analgesics, complications, and quality of life measured by Oswestry Disability Index. Our cohort included 174 patients. Of these, 74 (42.5%) were obese. The average age was 63.6years. In-operating room preparation time was 70.0 ± 1.7min for obese patients and 64.4 ± 1.5min for non-obese patients (p = 0.02). There was no difference in operative time, durotomy rates or other perioperative complications between obese and non-obese patients. Hospital length of stay trended toward longer in the obese group, but did not reach significance. A greater percentage of obese patients were still using both narcotic and non-narcotic pain medications 2weeks after surgery. There was no significant difference in functional outcomes between groups. Full-endoscopic unilateral laminotomies for bilateral decompression are safe and effective in both non-obese and obese patients. The use of an endoscope can partially mitigate obesity-related morbidity in lumbar decompression. However, obesity is significantly related to increased postoperative analgesic use.

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis.

This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1min, CI 5.76-22.33, p < 0.001) and intra-operative blood loss (MD 92.30mL, CI 13.49-171.12, p = 0.02), favoring intramedullary fixation. Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.

A comparative study of outcome of tension band wiring and hook plating in fracture olecranon

Background: Olecranon fractures are common upper limb fracture accounting for 40% of the fractures around elbow. Anatomic reduction and restoration of the joint surface is required for good outcome and to prevent post-traumatic arthritis. This study was directed towards the functional results and complications of surgical management of olecranon fracture treated with hook plate fixation and tension band wiring. Methods: This prospective comparative study was done at a tertiary care centre from 2019 to 2022. This study consisted of 30 patients of fracture olecranon of which 15 were treated with tension band wiring and 15 with hook plate. All patients were followed up with minimum follow up of six months and evaluated for their functional outcome using Mayo elbow performance score. Results: In this study, the average age was 34 years in TBW group and 37 years in hook plate group. The mean Mayo elbow performance score after 6 months in TBW group was 88.33 (excellent) and in plate group was 90 (excellent). Superficial infection was present in 2 patients of the TBW group. Elbow stiffness was present in 2 patients of TBW group. Hardware impingement was present in one patient in each of TBW group and plate group. Conclusions: To achieve early movements and to prevent complications like traumatic arthritis and joint stiffness we need a perfect anatomical reduction in intra-articular fractures of the olecranon. This study showed no significant difference in functional outcome with both the techniques, but the complications are more with TBW.

A comparative study of functional outcome between DHS and PFN in Basicervical femur fracture

Objective: To study and compare the functional outcome of Dynamic Hip Screw vs. Proximal Femoral Nail in basicervical fracture of femur. Materials and Methods: A prospective randomized and comparative study of 18 months duration was conducted on 28 patients admitted in the Department of Orthopaedics in our hospital with Basicervical femur fracture. These patients were randomly treated by a Dynamic hip screw or Proximal femoral nail. The parameters studied were functional outcome in terms of Harris hip score at 4 and 12 weeks, total duration of operation, length of incision and amount of blood loss during surgery. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Results: The average age of our patient in DHS group is 53.642±12.923 years and in PFN group is 67.285±11.424 years. The average blood loss was 115 ml and 192 ml in PFN and DHS group, respectively. The average operating time for the patients treated with PFN was 73 min as compared to 101 min in patients treated with DHS. The average HHS at 4 weeks was 53.071±12.639 and 48.428±9.120 in DHS and PFN group respectively. The average HHS at 12 weeks was 69.571±9.928 and 68.928±8.080 in DHS and PFN group respectively. Both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the PFN group has less blood loss, smaller incision and less operating time compared to DHS group. In both DHS and PFN group patients have similar HHS at 4 weeks and 12 weeks. There is no significant difference in functional outcome in terms of HHS.

April 2023 Stroke Highlights.

April 2023 Stroke Highlights.

Functional Outcome of Preoperative Exercises on Range of Movements Following TKA: A Prospective Comparative Study

Background. The range of motion prior to total knee arthroplasty (TKA) is a key determinant of the postoperative range of motion. The chance that the accompanying stiffness of the extensor mechanism may lead to limited flexion following surgery increases with how restricted the preoperative range of motion was. It would make sense to enhance knee ROM before surgery in order to optimize flexion following TKA. Final flexion following TKA is affected by a number of factors, although preoperative range of motion is the most important.&#x0D; The aim of the study to evaluate the functional performance and efficacy of the preoperative exercise programme on the osteoarthritic knee during the exercise period, following arthroplasty, during immediate postoperative recovery, and at 1, 3, 6 and 12 months after surgery.&#x0D; Methods. For the study, 156 patients with knee arthritis were collected over a period of one and a half years. In this prospective study, they were divided into a treatment group and a control group. Preoperative knee exercise was given to 78 patients for at least one month. Prior to and following the treatment groups workouts, all patients were observed. The time in days before reaching 90 of knee flexion and the length of the hospital stay were the data that were gathered. At 4 weeks, 3 months, 6 months, and 1 year, each subject had their knee ROM and KSS reevaluated.&#x0D; Results. Knee workouts were unquestionably helpful in achieving early knee flexion up to 90 in comparison to that of the control group. When the treatment group was compared to the control group, knee flexion to about 90 and more was attained in about 4 weeks; this difference was statistically significant (p0.01). However, there were no appreciable variations in the knee range of motion achieved on long-term follow-up for 6 months and a year.&#x0D; Conclusion. In conclusion, prehabilitation significantly improves the KSS for the treatment group both before surgery and three months after surgery. Exercises done before to surgery help patients recover more quickly from TKA and may speed up the process of achieving a good flexion and extension range of motion. However there is no significant difference in functional outcome after one year post surgery in both groups.

Functional outcomes of patients with ischaemic stroke with known atrial fibrillation not on therapeutic anticoagulation.

Anticoagulation significantly reduces the risk of ischaemic stroke in patients with atrial fibrillation (AF). There are a proportion of patients with known AF who remain off anticoagulation. Aims This study aims to retrospectively compare the baseline characteristics, treatments and functional outcomes between patients with ischaemic stroke and known AF based on their anticoagulation status. A single-centre, retrospective review of consecutive patients with an ischaemic stroke and a known history of AF was conducted. Two hundred four patients with an ischaemic stroke had documented AF prior to the index admission, of which 126 were anticoagulated. Median admission National Institutes of Health Stroke Scale score was lower for anticoagulated patients, though not statistically significant (5.1 vs 7.0, P = 0.09). Median baseline modified Rankin score (mRS) did not significantly differ. Nonanticoagulated patients were more likely to have large vessel occlusions (37.2% vs 23.8%, P = 0.04) and more likely to receive intravenous thrombolysis (15.4% vs 1.6%, P < 0.01). There was no difference in rates of endovascular clot retrieval between groups (P > 0.05). Unfavourable functional outcome at 90 days (mRS ≥ 3) did not significantly differ between groups (P = 0.51). A total of 38.5% of nonanticoagulated patients had no documented reason for this. Of the patients who survived the index admission, 81.5% of patients who were not anticoagulated on admission received anticoagulation. Baseline anticoagulation was associated with milder stroke severity in ischaemic stroke patients with known AF. There was no significant difference in functional outcomes at 90 days between groups. Larger observational studies are required to further assess this cohort.