RESUMO
BACKGROUND: The impact of patient sex on outcomes after medial patellofemoral ligament ligament reconstruction (MPFLR) has not been well studied. PURPOSE: To conduct a systematic review to determine sex-based differences in outcomes after MPFLR for patellar instability and the proportion of studies examining this as a primary or secondary purpose. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was performed using the PubMed, Cochrane Library, PubMed Central, Ovid, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, were performed on humans, consisted of patients who underwent MPFLR with allograft or autograft, evaluated at least 1 of the selected outcomes comparing male and female patients, and had statistical analysis available for relevant findings. Excluded were case reports, review studies or systematic reviews, studies that did not evaluate at least 1 sex-specific outcome, studies that included other injuries associated with patellofemoral instability injury, cadaveric studies, and those in which patients underwent concomitant procedures. RESULTS: The initial search yielded 3470 studies; 2647 studies remained after removing duplicates. Of the 401 studies that underwent full-text review, 10 met all inclusion criteria and were included for quantitative analysis. A meta-analysis could not be performed given the heterogeneity within the data set. Of the 2647 studies evaluated in this study, only 2 (0.08%) studies examined the impact of patient sex on MPFLR outcomes as a primary purpose and only 8 (0.30%) studies explored it as a secondary purpose. CONCLUSION: Only 0.38% of the articles compared outcomes between male and female patients after MPFLR. The limited data available were too heterogenous to draw any concrete conclusions about the impact of patient sex on outcomes after MPFLR. Further research in this area is warranted, as findings may influence treatment plans and improve patient outcomes.
RESUMO
BACKGROUND: McFarland fracture is the eponym for a rare Salter Harris III or IV fracture involving the medial distal tibia. These fractures can be difficult to diagnose without a high index suspicion and appropriate radiographic imaging. These fractures may result in significant growth disturbances to the pediatric patient. When diagnosed and treated acutely, these fractures can be managed with cast immobilization and close follow up. If diagnoses in a delayed fashion they can result in significant morbidity including prolonged casting and possible surgical treatment. CASE REPORT: In this case report we discuss a pediatric patient with a delayed presentation McFarland fracture which was initially diagnosed and treated as an ankle sprain. He required a prolonged course of treatment and we describe his clinical progression. We review the literature regarding this fracture pattern including history, acute management and outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: McFarland fractures are rare Salter Harris III fractures of the medial malleolus. These ankle fractures affect patients nearing skeletal maturity and may be difficult to diagnose without the appropriate orthogonal X-ray imaging. Also, a missed diagnosis can lead to unnecessary morbidity to the patient. If diagnosed acutely, these fractures can be easily treated with immobilization but if allowed to become chronic they require prolonged periods of casting and possibly even surgical intervention. A patient with a specific constellation of symptoms and history should raise suspicion for these injuries and prompt a thorough workup.
