Complications following open reduction and internal fixation versus external fixation in treating unstable distal radius fractures: Grading the evidence through a meta-analysis.

BACKGROUND: The common fixation techniques for unstable distal radius fractures include open reduction and internal fixation (ORIF) with plates and closed reduction and external fixation (EF). There is controversy over the choice of surgical approach in treating unstable distal radius fractures. HYPOTHESIS: This meta-analysis was performed to compare complication rates in patients treated with ORIF or EF for unstable distal radius fractures and to develop GRADE (grading of recommendations, assessment, development, and evaluation)-based recommendations for using the procedures to treat unstable distal radius fractures. MATERIALS AND METHODS: A systematic search of all the studies published was conducted using the Pubmed, ScienceDirect, Embase, BIOSIS, Springer, Cochrane Library databases. The randomized controlled trials (RCTs) that compared ORIF with EF in treating adult patients with unstable distal radius fractures and provided data regarding the complication were identified. The demographic characteristics and adverse events were manually extracted from all of the included studies. RevMan 5.1 was used for data analysis. PRISMA guidelines were followed. RESULTS: Sixteen studies that included a total of 1280 patients met the inclusion criteria. Compared with ORIF, EF results in higher incidence of total complications, infection and malunion. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DISCUSSION: This meta-analysis indicates that ORIF and EF are both effective procedures for treating unstable distal radius fractures. ORIF may be superior to EF in the treatment of unstable distal radius fractures. Because of the low quality evidence currently available, high-quality RCTs are required. LEVEL OF EVIDENCE: Level II: low-powered prospective randomized trial meta-analysis.

[Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

Objective: To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Methods: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis. Results: Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively (infection(I(2)=0%, RR=0.27, 95% CI 0.16-0.45, Z=4.92, P<0.000 01) and total complications(I(2)=0%, RR=0.71, 95% CI 0.59-0.85, Z=3.65, P=0.000 3) ), DASH scores(I(2)=37%, MD=-5.67, 95% CI -8.31--3.04, Z=4.22, P<0.000 1) and volar tilt(I(2)=78%, MD=2.29, 95% CI 0.33-4.24, Z=2.30, P=0.02)(P<0.05) at the end of follow-up period were noted. There were no statistically significant differences observed between two approaches with respect to the clinical outcomes (grip strength, flexion, extension, pronation, supination, radial deviation and ulnar deviation) and radiographic outcome(radial length) at the end of follow-up period(P<0.05). Conclusion: Both open reduction and internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of volar tilt for treatment of distal radius fractures.

[Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

Objective: To make a systematic assessment of the complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Method: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed.The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion.The quality of included trials was evaluated.RevMan 5.0 was used for data analysis. Result: A total of 17 studies involving 1 402 patients were included.There were 687 patients with open reduction and internal fixation and 715 with external fixation.The results of Meta-analysis indicated that there were statistically significant differences with regard to the postoperatively total complications, infection, malunion, tendon rupture (I2=8%, RR=0.77(95%CI 0.65-0.91, Z=3.10, P<0.05). There were no statistically significant differences observed between two approaches with respect to nounion, re-operation, complex regional pain syndrome, carpal tunnel syndrome, neurapraxia, tendonitis, painful hardware, scar(P>0.05). Conclusion: Postoperative complications are present in both open reduction and internal fixation and external fixation.Compared with external fixation, open reduction and internal fixation is lower in total complications postoperatively, infection and malunion, but external fixation has lower tendon rupture incidence.

Conservative versus surgical treatment for type II odontoid fractures in the elderly: Grading the evidence through a meta-analysis.

BACKGROUND: Odontoid fractures are common C-spine fractures in the elderly. However, the optimal treatment of odontoid fractures in the elderly is, still subject to controversy. HYPOTHESIS: Surgical treatment has several advantages on conservative treatment, such as reduced mortality and lower incidence of non-union. This meta-analysis was performed to identify the efficacy of conservative treatment compared with surgical treatment and provides recommendations for using these procedures to treat type II odontoid fractures in the elderly. MATERIALS AND METHODS: A systematic search of all studies published was conducted using the PubMed, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) that compared conservative treatment with surgical treatment and provided data on clinical effects were identified. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.1 was used for data analysis. RESULTS: Twelve studies involving 730 patients met the inclusion criteria. There were 441 patients with conservative treatment and 289 with surgical treatment. The results of meta-analysis indicated that no difference with regard to the mortality was noted (P > 0.05) between the two procedures. However, there was statistically significant difference with respect to the non-union numbers (P < 0.05) between the two procedures. DISCUSSION: Conservative treatment and surgical treatment are both effective procedures for treating type II odontoid fractures in the elderly. Compared with surgical treatment, there is no significant difference in mortality; With respect to non-union numbers, conservative treatment numbers are higher than surgical treatment. Due to the poor quality of the evidence currently available, high quality RCTs are required. Level of evidence Level II: low-powered prospective randomized trial meta-analysis.

c-Met and RON expression levels in endometrial adenocarcinoma tissue and their relationship with prognosis.

OBJECTIVE: To investigate the potential relevance of c-Met and RON gene expression in patients with adenocarcinoma of the endometrium and analyze the relationships among the c-Met and RON expression, clinicopathological characteristics, and patient survival. MATERIALS AND METHODS: The study included 60 cases diagnosed with endometrial adenocarcinoma with more than five-years follow-up. Total RNA from formalin-fixed paraffin-embedded tissues of 60 adenocarcinomas of the endometrium and normal endometrium tissues were isolated for c-Met and RON quantitative analysis by real-time real-time polymerase chain reaction (RT-PCR). RESULTS: The c-Met and RON expression in endometrial adenocarcinoma was significantly higher than that in normal endometrial tissues (p < 0.01), with average up-regulated levels of 3.94 ± 1.88 and 2.74 ± 0.88, respectively. Moreover, high c-Met expression was significantly correlated with the histological stage (p = 0.017), and high RON expression was related to histological stage (p = 0.035), muscle invasion (p = 0.006), and lymph node metastasis (p = 0.018). Multivariate Cox regression analysis revealed that the co-expression of c-Met and RON was an independent prognostic factor for adenocarcinoma of the endometrium and was significantly associated with decreased overall survival (HR = 3.571, p = 0.014). CONCLUSION: The co-expression of c-Met and RON is associated with a poor prognosis in endometrial adenocarcinoma and is an independent prognostic marker for endometrioid adenocarcinoma.

Parathyroid hormone therapy accelerates recovery from immobilization-induced osteopenia.

Previous reports have shown that bone mass and architecture will partially recover by remobilization (RM) in immobilization (IM)-induced osteopenia. The aim of this study was to test whether PTH can accelerate the recovery during RM from the IM-induced osteopenia. Six-month-old Sprague-Dawley female rats were divided into aging and IM groups. The right hindlimb of rats was immobilized against the abdomen by elastic bandages for 18 weeks, then groups of rats were further IM or RM for 2, 10 and 20 weeks and given 30 or 80 micrograms hPTH (1-38)/kg/d s.c. Secondary spongiosa of proximal tibial metaphyses (PTM) were studied. Immobilization reduced the trabecular area, number and thickness at the first 18 weeks post IM, then plateaued. Ten weeks of RM restored 40% trabecular bone from IM controls due to thickening of the trabeculae. However, the trabecular area was still -14% and -13% lower than that of aging controls at 10 and 20 weeks. Two weeks of 30 micrograms PTH/kg/d in IM rats restored the bone to aging control levels, two weeks of 30 micrograms PTH/kg/d in RM rats and of 80 micrograms PTH/kg/d in both RM and IM rats added extra bone. Extending the treatment to 10 and 20 weeks, the same amount of total bone was added to both IM and RM rats. These findings indicate PTH is a powerful agent that can accelerate the recovery and add extra bone to osteopenic cancellous bone in both IM and RM rats.

[A tablet of Tripterygium wilfordii in treating lupus erythematosus].

Twenty-three cases of lupus erythematosus, including 15 cases of SLE and 8 cases of DLE treated with Tripterygium wilfordii (TW, three tablets thrice a day, each tablet contains 5 gm of crude TW) were reported. As controls, 19 cases of SLE were treated with prednisone alone at the same time. 9/15 cases in the former group and 6/19 in the latter got improvement after treatment. There was no significant difference between the two groups (P greater than 0.10). However, TW had beneficial effects to remission of arthralgia (7/10 in the former group and 7/15 in the latter group) and erythematosus rash (6/8 in the former group and 5/12 in the latter). Clinically, four out of eight cases of DLE improved after treatment with TW. TW had some toxic effects, such as decrease of peripheral blood leukocyte and kidney damage. Since the toxic dose and effective dose could be quite close, special attention should be paid when the drug was being used, especially on those patients with nephropathy. So the authors suggested that the indication of TW could include the patients of DLE and SLE without nephropathy.

[Observation on the treatment of systemic lupus erythematous with a Gentiana macrophylla complex tablet and a minimal dose of prednisone].

Sixty-two cases of systemic lupus erythematous (SLE) treated with Tab. Gentiana macrophylla complex 5 tablets three times per day or 10 tablets twice per day and prednisone 10-30 mg per day were reported. As controls, 19 cases of SLE were treated with prednisone alone at the same time. The results showed complete remission in 86.46% (50/62) cases in the observation group and 31.57% (6/19) cases in the control group. Eight cases of SLE treated with Tab. Gentiana m. complex alone also achieved complete remission in 6 cases and improvement in 2. There was very significant statistical difference between the two groups (P less than 0.001). The Tab. Gentiana m. complex was more effective on the improvement of nephropathy, arthralgia, erythema and restoration of ESR, LE cells and CH50, C3 than prednisone alone. No apparent side effects of Tab. Gentiana m. complex were found in this observation.

[Studies on the chemical constituents of Aconitum szechenyianum Gay].

Five constituents were isolated from Aconitum szechenyianum Gay. The structures of these compounds were identified as beta-sitosterol (I), aconitine (II), 3-acetylaconitine (III), songorine (IV) and a new compound whose structure was elucidated to be szechenyine (V) on the basis of UV, IR, 1HNMR, 13CNMR and Mass spectra.