Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis.

BACKGROUND: Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures. METHODS: This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate. RESULT: Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%).

Development and Validation of Nomogram-Based Prognosis Tools for Patients with Extremity Osteosarcoma: A SEER Population Study.

Objective: Osteosarcoma, usually occurring in the extremities, is the most common malignant bone tumour. The purpose of this study is to develop and validate nomogram-based prognosis tools for survival (OS) and cancer special survival (CSS) of patients with osteosarcoma of the extremities via the application of survival analysis. Materials and Methods: A total of 1427 patients diagnosed with osteosarcoma of the extremities during 2004-2015 were selected from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results- (SEER-) Medicare database. The samples were randomly assigned to either the training set (n = 856) or the validation cohort (n = 571). Kaplan-Meier (K-M) survival analysis was conducted to calculate patients' 1-, 3-, and 5-year OS and CSS rates. Cox proportional hazard ratio (HR) regression models were employed to identify and examine the factors that have a significant impact on OS and CSS with data from the training cohort. Results: The results of univariate and multivariate analyses performed in the training cohort indicated that older age, increased tumour size, higher grade, distant tumour extension, amputation, or no surgery (all HR > 1, P < 0.05) were risk predictors of poor OS and CSS. Subsequently, the independent prognosis signatures were utilised to construct nomograms. The concordance index (C-index), calibration plot, and decision curve analysis (DCA) were simultaneously used to validate the nomograms. The internally validated C-index values of the OS and CSS prediction models for the training set were 0.752 (95% confidence interval [CI]: 0.738-0.765) and 0.754 [95% CI: 0.740-0.768], respectively. Then, the models were validated in the validation cohort population, which also demonstrated the models had good reliability for prognostication. Conclusions: The SEER cohort of patients with osteosarcoma of the extremities can be employed to produce effective tools that can assist in prognosis modelling.

The effect of extracorporeal shock wave on osteonecrosis of femoral head: a systematic review and meta-analysis.

INTRODUCTION: This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. METHOD: Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. RESULT: Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = -19.95; 95% CI: -26.27, -13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). CONCLUSION: ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression.

Strategies for managing the destruction of calcar femorale.

BACKGROUND: The calcar femorale was identified long ago. However, our current understanding of the calcar is insufficient, and its related concepts are sometimes confused. The calcar femoral is an important anatomical structure of the proximal femur, and its function can be overlooked. In trauma, tumors, or other diseases, the calcar femorale can be destroyed or changed pathologically. As a result, the mechanical structure of the proximal femur becomes destroyed, causing pathological fractures. How to address the destruction of the calcar femorale or the damage to the calcar femorale is discussed in this article. MAIN TEXT: Destruction of the calcar femorale is accompanied by many conditions, including trauma, tumors, and other diseases. The types of hip fractures caused by trauma include femoral neck fractures and intertrochanteric fractures. Dynamic hip screws, proximal femoral nail anti-rotation, and multiple parallel cannulate pins can be used in different conditions. When metastatic and primary bone tumors involve the calcar femorale, endoprostheses are widely used. Other diseases, such as fibrous dysplasia and aneurysmal bone cyst are treated differently. CONCLUSIONS: The calcar femorale can redistribute stresses and the destruction of the calcar femorale can lead to an increase in posterior medial stress. Many factors need to be considered when deciding whether to reconstruct the calcar femorale. Effective treatment strategies for managing the destruction of calcar femorale will need first establishing the precise mechanism of the destruction of the calcar and then designing therapies towards these mechanisms. Further investigation to the calcar needs to be carried out.

Extracorporeal shockwave therapy combined with multiple drilling and intramedullary drug injection for treating early-stage Femur Head Necrosis: Protocol for a randomized controlled trial.

BACKGROUND: Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with multiple drilling and intramedullary drug injection, a novel cocktail therapy, as a randomized controlled trial (RCT) model to postulate an alternative therapy for patients with early-stage ONFH. METHODS: Femoral head necrosis patients aged 20 to 60 years with stage ARCO I-II were recruited. One hundred twenty eligible participants were randomized into four groups in a 1:1:1:1 ratio: extracorporeal shock wave therapy combined with multiple drilling and intramedullary drug injection (group EMI), extracorporeal shock wave therapy (group E), multiple drilling combined with intramedullary drug injection (group MI), and multiple drilling ("positive" control group; group M). The primary outcomes included effective rate, subchondral collapse rate of the femoral head, lesion size, and grade of bone marrow edema. Secondary outcomes included the Harris Hip Score and the visual analog scale. All outcomes were measured at the screening visit (baseline) and at the planned time intervals during treatment and follow-up, and the efficacy was statistically analyzed according to the intention-to-treat sub-populations and per-protocol sub-populations. OBJECTIVES: To examine the clinical efficacy of ESWT combined with multiple drilling and intramedullary drug injection to provide a safe and more effective method for treating early-stage ONFH. TRIAL REGISTRATION NUMBER: ChiCTR1900020888; Pre-results.