Interlocking intramedullary nail for forearm diaphyseal fractures in adults-A systematic review and meta-analysis of outcomes and complications.

PURPOSE: The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. METHODS: Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. RESULTS: A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace-Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. CONCLUSIONS: Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353).

Prevalence And Associated Factors Of Irritable Bowel Syndrome Among Healthcare Professionals In Primary Health Care Setting In Al-Madinah, Saudi Arabia

@#This cross-study aimed to determine the prevalence of IBS and its associated factors among 205 healthcare professionals in the primary health care centers in Al-Madinah City. Cluster sampling was used to select 16 primary health centers from the four regions of the city. A self-administered questionnaire was used to collect data about socio-demographics, Hospital Anxiety and Depression Scale (HADS), the Rome IV Diagnostic Questionnaire, dysphoria scale, and performance scale. Mean (SD) age of participant was 34.5 (6.6). Majority were nurses (40%) and Saudi (93.7%). The prevalence of IBS was 16%. Factors associated with IBS in the univariate analysis were nationality(p=0.023) anxiety (p=0.010), depression (p<0.001), performance (p<0.001) and dysphoria (p=0.003). In multivariate analysis, the significant predictor of IBS was depression (aOR=1.3, 95%CI 1.2-1.4, p<0.001). In conclusion, the prevalence of IBS among healthcare professionals in the current study was 16.1%, with predominantly IBS-Constipation subtype. IBS was associated mainly with depression. Future intervention studies are recommended to establish possible causal inferences between psychological morbidities and quality of life domains for rectification on treatment aspects of IBS.