A systematic review of randomized controlled trials for the prevention of bronchopulmonary dysplasia in infants.

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is the most common cause of pulmonary morbidity in premature infants and is associated with life-long morbidities. Developing drugs for the prevention of BPD would improve public health. We sought to determine characteristics of favorable randomized controlled trials (RCTs) of drugs for BPD prevention. STUDY DESIGN: We searched MEDLINE and EMBASE from 1992 to 2014 using the MeSH terms 'BPD' and 'respiratory distress syndrome, newborn'. We included a Cochrane Library search to ensure inclusion of all available RCTs. We identified RCTs with BPD as a primary or secondary outcome and determined the definition of BPD used by the study. We determined whether a phase I or phase II study-to determine drug safety, efficacy or optimal dose-was performed before the RCT. Finally, we searched the Cochrane Library for meta-analyses for each drug and used the results of available meta-analyses to define a favorable versus unfavorable RCT. RESULT: We identified 2026 articles; 47 RCTs met our inclusion criteria encompassing 21 drugs; 5 of the drugs reduced the incidence of BPD. We found data from phase I or II studies for 16 of the drugs, but only 1 demonstrated a reduction of BPD. CONCLUSION: The majority of the drugs studied in RCTs failed to reduce the incidence of BPD. Performing early-phase studies before phase III trials might provide necessary information on drugs and drug doses capable of preventing BPD, thus informing the development of future RCTs.

Tibial fracture in a basketball player: treatment dilemmas and complications.

A 19-year-old male basketball player suffered a spiral fracture of the tibia with an intact fibula, an uncommon injury in basketball. Treatment options for these injuries include cast immobilization, external fixation, and internal fixation using an intramedullary rod or plates and screws. Numerous complications can occur in these injuries, possibly including interference with healing by the intact fibula. The player was treated with an intramedullary rod, but delayed union ensued. Treatment of the patient's delayed union with closed exchange intramedullary nailing and fibular osteotomy enabled him to return to basketball participation.

Osteoid osteoma of the femoral neck in the young athlete.

The purpose of this paper is to present a progressive diagnostic and management program for osteoid osteoma of the femoral neck in the young athlete. Five young athletes with hip pain secondary to osteoid osteoma are presented. The average age of the patients was 15 years old, with an average followup of 4 years. Radioisotope bone scans, computed axial tomograms, and linear tomograms were valuable diagnostic aids. All five athletes were treated with a limited excisional biopsy via an anterior approach to the femoral neck. Associated treatment modalities, such as bone grafting, internal fixation, and cast immobilization, were not necessary. There were no major complications. The five young athletes returned to sports at an average of 4 months postoperatively. Osteoid osteoma of the femoral neck should be included in the differential diagnosis of hip pain in young athletes. A limited excisional biopsy provided a rapid return to sports for the young athlete without the potential morbidity associated with internal fixation, bone grafting, and cast immobilization.

Metacarpal fractures in the athlete.

Fifty-six fractures of the metacarpal occurring in 53 athletes were studied from September 1985 to December 1986, regarding mechanism of injury, type of fracture, type of treatment, and time lost from sport. Age range of the patients was 8 to 28 years with greater than 77% being in the 14 to 18 year age range, the high school athlete. Twenty-nine of the fractures occurred in football, 14 in basketball, and the remainder were divided between various other sports. The most common mechanism of injury involved falls or hitting an object such as a helmet or another player. Fractures were evenly divided regarding which digit was involved in football, whereas most basketball injuries occurred in the fourth and fifth metacarpal. Fractures were analyzed as to type of radiographic appearance and this was correlated with time lost from competition or participation. No significant difference among fracture type regarding time lost was noted. Forty-six of the fractures (82%) were minimally displaced or undisplaced and were treated by means of simple casting and/or splinting whereas 10 were displaced. Two of the 10 underwent closed reduction and casting; 3 underwent closed reduction and percutaneous pin fixation; and 5 (9%) underwent open reduction internal fixation using AO type plates and screws. All fractures healed primarily clinically and radiographically. The average time lost from practice or competition in this group overall was 13.7 days, (range, 0 to 56 days). Average time lost from basketball was 19.8 days and from football 10.63 days overall. Average time lost from sport in stable fractures treated with casting or splinting was 12.3 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior cruciate reconstruction in the chronically unstable knee using an expanded polytetrafluoroethylene (PTFE) prosthetic ligament.

The purpose of this study is to review 30 patients with failed, multiply operated knees, or knees with gross instability which were reconstructed using the expanded polytetrafluoroethylene (PTFE) prosthetic ligament as a substitute for the ACL. The results were then compared with our experience with the proplast ligament used in a previous clinical series. This prospective review evaluated the patients preoperatively and at regular intervals during the postoperative period. The average followup was 24 months postoperation. Eighty-three percent of the patients had a satisfactory result, scoring greater than 140 points on a 200 point knee grading scale. Objectively, the anterior instability pattern was improved in 87% of the knees. Subjectively, pain of at least a mild degree persisted in 70% of the patients postoperatively. This pain seemed to correlate with articular cartilage changes documented intraoperatively. Major complications occurred in two patients. In conclusion, the PTFE prosthetic ligament was an improvement over the proplast ligament in the reconstruction of the multiply operated, unstable knee. The 83% satisfactory rate with the PTFE was promising compared to a 52% satisfactory rate using the proplast ligament. However, we encourage future long term studies of the PTFE prosthetic ligament in the reconstruction of the ACL in the chronically unstable knee.

Congenital vertical talus: the Riley experience.

This is a retrospective study of seven patients with 10 feet displaying nonparalytic congenital vertical talus treated at Riley Children's Hospital in Indianapolis by open reduction without naviculectomy. Each of the 10 feet underwent an operation for open reduction of congenital vertical talus. The procedure included a peritalar soft tissue release, posterior release of the hindfoot with Achilles tendon lengthening, and transfer of the tibialis anterior tendon into the talar neck. Length of follow-up ranged between 2 and 11 years. Average follow-up time was 6 years and 9 months. Age at time of open reduction ranged from 8 months to 3 years. The clinical follow-up evaluation revealed three excellent, three good, and four fair results. Only one patient underwent a subsequent surgical procedure.

Intertrochanteric fractures after hip surface arthroplasty. A report of two cases.

Intertrochanteric fractures of the femur recently occurred following trauma in two young adult patients who had undergone Indiana Conservative Hip (ICH) surface arthroplasty. Although femoral neck fractures have occurred following ICH surface arthroplasty, these are the only two patients treated by the authors for intertrochanteric fractures following ICH surface arthroplasty.