RESUMO
Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle' d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2-79%), HO was 20% (95% CI, 2-45%), and AVN was 3% (95% CI, 0-16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0-27%) and Merle d' Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3-38%); ORIF group had the highest AVN rate (11%; 95% CI, 0-92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0-100%) and lowest HO rate (2%; 95% CI, 0-28%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.
RESUMO
PURPOSE: This study assessed the ability of resonance frequency measurements to differentiate the stability of implants with different lengths and diameters, and in different densities of bone. Another objective was to identify an alternative parameter capable of quantifying dental implant stability, thus facilitating greater sensitivity for efficacious detection of compromised or failing implants. MATERIALS AND METHODS: Implants of two different diameters (4 and 5 mm) and six different lengths were individually placed in synthetic bone blocks of three different densities (15, 40/20, and 40 pounds per cubic foot) in combination with two different abutments (short and tall) to evaluate their stability. Resonance frequency measurements were obtained via Osstell ISQ and experimental modal analysis (EMA). The resonance frequency measurements were further confirmed via finite element analysis (FEA) using commercially available software ANSYS. RESULTS: Resonance frequencies measured via Osstell ISQ and EMA did not change with respect to the length of the implants. The FEA also confirmed the measured results. FEA simulations further indicated that angular stiffness at the neck of the implant (ie, the base of the abutment) varied considerably with respect to the implant length and diameter. Moreover, the calculated angular stiffness was independent of the type of abutment used. CONCLUSION: The results obtained from resonance frequency analyses did not accurately represent dental implant stability. Changes to implant length and diameter did not affect resonance frequencies. In contrast, angular stiffness at the neck of the implant represented a superior index for quantifying dental implant stability. It not only successfully differentiated stability of implants of both varying lengths and diameters, but also produced quantitative data that was independent of the type of abutments used.
