Sling and Forget It? A Systematic Review of Operative versus Non-Operative Outcomes for Scapula Fractures.

BACKGROUND: The majority of scapula fractures have historically been treated non-operatively. The current literature describing patient outcomes following scapula fractures is limited. Our objective was to determine differences in outcomes between operatively and non-operatively treated scapular fractures. The goal of our study was to provide an updated and comprehensive systematic review for scapula body, neck, and glenoid fractures focusing on several outcomes including union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and any recorded complications. METHODS: The PRISMA methodology was followed for this systematic review. Articles were obtained from the PubMed/Medline database using the following search terms: scapula body OR scapula neck OR intra-articular glenoid AND fracture. Additional articles were obtained by searching the bibliographies of included references. Studies were included if they contained clinical data on one or more of our study objectives and contained participants with a scapular body, neck, and/or glenoid fracture who were at least 16 years old. A total of 35 papers, with 822 total cases were included. Studies chosen were assessed for level of evidence and reviewed for data pertaining to the current study objectives. All cases of scapula fractures found throughout the literature were analyzed for outcome data. Outcomes studied included union rate, return to work, pain, shoulder active range of motion, strength, functional scores, and recorded complications. RESULTS: The overwhelming majority of scapula fractures go on to union. The majority of patients will eventually return to work. Persistent post-injury pain is unfortunately common. Shoulder range of motion and strength are decreased when compared to the contralateral shoulder. Non-operative glenoid fractures have the lowest reported functional scores. Malunion, need for additional surgeries, and post-traumatic arthritis were the most common complications. CONCLUSION: When treating scapula fractures, orthopedic surgeons must consider the specific fracture pattern, as well as patient specific goals. Risks and benefits of both operative and non-operative management should be discussed with the patient including the exceptionally low non-union rate regardless of treatment option and that persistent pain following injury is unfortunately common.

Do Early Weight-Bearing and Range of Motion Affect Outcomes in Operatively Treated Ankle Fractures: A Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review was performed to answer the following questions: (1) Does early weight-bearing (WB) after ankle fracture (AF) open reduction internal fixation (ORIF) affect outcomes? (2) Does early WB after AF ORIF cause an increase in complications? (3) Does early ankle motion after AF ORIF affect outcomes? and (4) Does early ankle motion after AF ORIF cause an increase in complications? DATA SOURCES: Articles from 1970 to 2020 were found using the PubMed database. STUDY SELECTION: Level I studies of adult patients with operatively treated ankle fractures were selected. A total of 1130 cases across 20 studies fit the participant criteria. DATA EXTRACTION: Studies were reviewed for data pertaining to the current study questions. DATA SYNTHESIS: The meta-analysis used logistic regression and standardized mean difference. RESULTS: Based on the current literature, early WB in operative ankle fractures with stable fixation showed no difference in outcomes when compared with delayed WB protocols. Early WB after ORIF did not significantly increase complications. Early ankle motion after AF ORIF did not have significant standardized mean differences between range of motion and immobilization outcomes. Early range of motion before wound healing may lead to an increase in complications [pooled odds ratio: 3.11, 95% confidence interval (CI): 1.64-5.90] but did not show an increase in infection. CONCLUSIONS: The authors recommend that early WB at 2 weeks postoperatively can be safely considered for ankle fractures when stable fixation has been obtained. Early ankle motion before wound healing is not recommended due to increased wound complications, without improvement in long-term results. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis.

OBJECTIVES: This meta-analysis was performed to answer the following questions: (1) What is the expected outcome of sternoclavicular (SC) dislocations left untreated? (2) What are the indications for closed reduction of SC dislocations? (3) What are the indications for open reduction of SC dislocations? and (4) Does the evidence support the need for a cardiothoracic surgeon to be available for the open reduction of a SC dislocation? DATA SOURCES: Articles were obtained from the database EBSCOhost and supplemented by hand searching of bibliographies of included references. A search using the following terms: SC joint AND (dislocation OR injuries OR vascular injury OR cardiovascular surgeon) of the English-language literature from 1970 to 2018 on the topic of SC joint dislocations was performed. STUDY SELECTION: Studies were included if they contained clinical data on one or more of our study objectives. Articles were included if they contained participants presenting with an acute (<3 week old) SC joint dislocation who were 16 years of age or above. A total of 92 cases fit this participant criteria. DATA EXTRACTION: Studies chosen based on the inclusion and exclusion criteria were assessed for level of evidence and were then carefully reviewed for data pertaining to the current study questions. Data from individual articles were recorded in a spreadsheet program and grouped appropriately. DATA SYNTHESIS: Individual cases of acute SC joint dislocations reported in the literature were noted by the authors. The cases were organized into a spreadsheet, which allowed for the calculation of total patients treated and with what treatment option. Complications that followed treatment were also noted, allowing for a quantitative analysis of patient outcome. CONCLUSIONS: Based on the current body of literature, closed reduction should be attempted in the acute setting and open treatment performed in cases of failed closed reduction in posterior SC dislocations. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.