What is the best fixation technique for isolated talonavicular arthrodesis? - A systematic review.

Talonavicular arthrodesis is associated with a rate of non-union that ranges from 3 % to 37 %. Various fixation devices have been reported for talonavicular arthrodesis including screws, staples, plates, K-wires and intraosseous fix systems, however there is no definitive gold standard. This systematic review aims to compare clinical outcomes between different fixation devices for talonavicular arthrodesis. METHODS: MEDLINE, EMBASE, CENTRAL and Google Scholar were reviewed for studies reporting on outcomes of different fixation techniques for talonavicular arthrodesis indicated for osteoarthritis, inflammatory and post-traumatic arthritis from 1946 to 2021. The primary outcome measure was union rate. Secondary outcome measures included functional improvement, cost, quality of life and patient satisfaction. RESULTS: 9 articles involving 141 cases of talonavicular arthrodesis were identified. Fusion rates were as follows: screw fixation (n = 75): 87.5 % to 100 %, staple fixation (n = 13): 100 %, intraosseous fix system (n = 16): 100 %, and K-wire fixation (n = 2): 100 %. One study utilised a dorsal locking plate with two supplemented compression screws (n = 9, fusion rate= 100 %) and two studies used a combination of screws with staples (n = 26, fusion rate= 96 %). 7 of 9 studies measured functional outcomes and pain relief with improvement demonstrated in all fixation techniques. Quality of life, satisfaction and cost were inadequately reported amongst the included studies. All studies were rated as serious risk of bias. CONCLUSION: This systematic review consolidates the evidence for outcomes of different fixation techniques for TN arthrodesis, however a definitive judgement regarding the best fixation technique is unobtainable from current clinical evidence, due to lack of high-quality studies. With review of biomechanical studies and the limited clinical data, fixation with plate plus screw is most promising and would warrant further comparative study. LEVEL OF EVIDENCE: IV.

Preoperative Imaging of Costal Cartilage to Aid Reconstructive Head and Neck Surgery: A Systematic Review.

OBJECTIVE: Autologous costal cartilage is used extensively in reconstructive surgery because of its stability, durability, and biocompatibility. The current preoperative evaluation of costal cartilage often only consists of a physical examination. Several studies have highlighted the benefits of preoperative imaging as a tool to ensure optimal graft harvest. This systematic review aims to synthesize the current evidence and establish the efficacy of the various imaging modalities for the assessment of costal cartilage. REVIEW METHODS: The data sources were explored using a search strategy based on the terms ("costal cartilage" OR "ribs" AND "imaging*") combined with Boolean operators. The primary outcome measures were the ability to measure the dimensions of costal cartilages and to detect the presence of calcifications. RESULTS: A total of 28 publications were included in the final review, with 12 case series, 7 case control studies, and 9 cohort studies. Twenty-two studies used computed tomography (CT); 4 studies used x-ray and 2 studies used ultrasonography, whereas no studies used magnetic resonance imaging. Meta-analysis of the data from these studies was not deemed possible. CONCLUSIONS: Our findings suggest that CT is the modality with the strongest evidence base that provides the greatest degree of information. The major benefits of CT are its ability to provide 3-dimensional image reconstruction for surgical planning, ability to detect synchondroses, and assess cartilage quality. Where radiation exposure is less preferable, x-ray and ultrasound (US) may play an important role. X-ray appears to be particularly useful when the main concern is the presence of calcification. The limited studies available indicate that US can provide useful and accurate information on cartilage quality and morphology. Further studies are warranted in exploring the use of US in preoperative planning, particularly in the pediatric population.

Management of periprosthetic breast infection: a systematic review and meta-analysis.

BACKGROUND: The current management of an infected breast implant is varied. This systematic review and meta-analysis aim to synthesise the current evidence and establish the efficacy of the various managements of infected breast implants. METHODS: A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies that report on the management of infected breast implants from 1946 to September 2019. The primary outcome measure was the proportion of patients with successful treatment. RESULTS: Nineteen articles that involve 1044 patients were included. Overall, 29.00% (95% CI = from 11.51% to 50.58%) of the patients with mild infection were treated exclusively with antibiotics, of which, 81.41% (95% CI = from 57.82% to 96.63%) were successfully treated without the need for surgical intervention. Another 39.01% (95% CI = from 21.41% to 58.23%) of the patients underwent surgical salvage of the infected breast implants, of which 84.56% (95% CI = from 74.92% to 92.20%) successfully retained the salvaged implants without infection recurrence. Meanwhile, 35.01% (95% CI = from 27.01% to 43.57%) of the patients underwent explantation of the infected breast implant, of which, only 39.02% (95% CI = from 23.93% to 55.28%) had re-insertion of a new implant on a later date and 4.99% (95% CI = from 1.66% to 9.99%) of these patients had recurrence of infection requiring removal of the infected implant. The commonest complication was capsular contracture, which was reported in 10.78% (95% CI = from 4.41% to 19.49%) of the patients. Changes in the quality of life and cost implications were not reported. CONCLUSION: This study consolidates current available evidence on the management of infected breast implants, which could assist decision-making and improve patient education; however, current data are limited because of the lack of level-1 evidence.