External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.</p><p><b>METHODS</b>A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.</p><p><b>RESULTS</b>Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).</p><p><b>CONCLUSIONS</b>We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.</p>

Vaginal disinfection before cesarean delivery in preventing postoperative infections: A meta-analysis / 第二军医大学学报

Objective To analyze the efficacy of vaginal disinfection with povidone-iodine before cesarean delivery in preventing postoperative infections. Methods Randomized controlled trials, identified from a systematic search of relevant databases including PubMed, EMBASE, CBM, CNKI, and CQVIP, were screened and evaluated according to standardized criteria. RevMan 5.2 software was used to do the meta-analysis. Results A total of 9 randomized controlled trials with 3 024 participants, with 1 508 in the vaginal cleansing group and 1 516 in the control group, were included in this meta-analysis. The analysis result showed that vaginal disinfection with povidone-iodine before cesarean delivery reduced the incidence of post-cesarean endometritis (RR=0.55, 95%CI 0.36-0.85, P=0.007). The incidence of post-cesarean endometritis was significantly reduced in women with ruptured membranes (RR=0.29, 95%CI: 0.16-0.52, P<0.000 1) and women in labor (RR=0.63, 95%CI 0.41-0.96, P=0.03), but not significantly reduced in the women with intact membranes (RR=0.73, 95%CI 0.50-1.08, P=0.11) or women not in labor (RR=0.79, 95%CI 0.53-1.17, P=0.24). Vaginal disinfection could not help to reduce the incidence of postoperative wound infection (RR=0.80, 95%CI 0.53-1.22, P=0.30) or postoperative fever (RR=0.92, 95%CI 0.76-1.11, P=0.37). Conclusion Vaginal disinfection with povidone-iodine before cesarean delivery can decrease the risk of post-cesarean endometritis, especially for women undergoing cesarean delivery with ruptured membranes or in labor, but vaginal disinfection do not reduce the risk of postoperative wound infection or fever.