Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.@*METHODS@#The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).@*RESULTS@#Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).@*CONCLUSION@#This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

Comparison of Topical Oxygen with Vacuum Assisted Closure in Wound Healing in a Low Resource Setting

The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. METHODS: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. RESULTS: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. CONCLUSION: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward

Hip Arthroscopy for Sequelae of Legg-Calve-Perthes Disease: A Systematic Review / 대한고관절학회지

There is no clear evidence on indications and outcomes of hip arthroscopy in sequelae of Legg-Calve-Perthes disease (LCPD). The aim of the current study was to evaluate current literature on the role and outcome of hip arthroscopy in LCPD. A literature search using four databases was conducted in April 2020, focusing on the role of hip arthroscopy in sequelae of LCPD. A systematic search was carried out in confirmation with the Cochrane Collaboration, Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of nine studies were included in the systematic review. The total number of hip arthroscopies performed for LCPD was 109. The mean age of included patients was 34.8±7.88 years (7-58 years). Recalcitrant hip pain was the main indication for surgery, followed by pain and stiffness. The most common finding in arthroscopy was labral tears, followed by osteochondral lesions of femoral head or acetabulum and intra-articular loose bodies. Consequently, debridement of labrum tears chondroplasty for cartilage defects and osteoplasty for impingement from deformed femoral head (hinged abduction) were commonly performed. A significant improvement in hip function was seen in all studies. Pooled data of Harris hip score showed significant improvement after surgery was conducted.Hip arthroscopy may be beneficial in patients having symptoms of impingement secondary to changes in labrum, femoral head or acetabulum. Limited evidence shows improved function and range of motion after surgery. This treatment has been found to be safe in terms of complication rates and improvement may persist for years.