Rates and risk factors for failure of reduction in closed reduction in developmental dysplasia of the hip: a systematic review and meta-analysis.

Objective: In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required ('failure of reduction'). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH. Methods: We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group). Results: We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0-24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26-32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21-177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27-5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13-4.56) in group 0-36. Conclusion: Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses.

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

[Effects of therapeutic suggestions on the recovery of patients undergoing major orthopaedic surgery]. / Az ortopédiai nagymutétek során alkalmazott terápiás szuggesztiók hatása a beteg gyógyulására.

INTRODUCTION AND AIM: Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients' recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient-physician communication. METHOD: In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery. RESULTS: Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p<0.001] and 4th [0.97 (0.23; 1.7); p = 0.011] postoperative day and less transfusion had to be administered (OR: 2.37; p = 0.004). However, there was no difference between the two groups in the postoperative need of medications, in the length of hospitalisation and in the frequency of complications. Conslusion: Our results indicate that the administration of therapeutic suggestions in the perioperative period may be beneficial for orthopaedic surgery patients. Orv Hetil. 2018; 159(48): 2011-2020.

The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and nonrandomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery. After searching the databases from January 1980 to September 2016, a total of 62 RCTs were included with a pooled sample size of 4,908. Psychosocial interventions significantly reduced postoperative pain (Hedges' g = 0.31 [95% confidence interval = 0.14, 0.48]), and preoperative and postoperative anxiety (g = 0.26 [0.11, 0.42] and g = 0.4 [0.21, 0.59], respectively). Furthermore, psychosocial interventions improved recovery (g = 0.38 [0.22, 0.54]). However, no significant effects were found for postoperative analgesic use (g = 0.16 [-0.01, 0.32]) and quality of life (g = 0.14 [-0.05, 0.33]). Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The results indicate that psychosocial interventions, especially patient education and relaxation training, may reduce perioperative side effects and improve recovery in patients undergoing orthopedic procedures, but the quality of evidence is generally low. More well-powered, high-quality studies are needed to increase confidence. PERSPECTIVE: In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative pain, perioperative anxiety, and recovery were found, suggesting that psychosocial interventions, especially patient education and relaxation techniques, are useful in improving clinical care.

[Ultrasonographic diagnosis of distal pediatric forearm fractures]. / Gyermekkori csuklótáji törések diagnosztikája ultrahanggal.

INTRODUCTION AND AIM: The aim of our prospective study was to evaluate the effectivity of sonographic diagnosis of pediatric wrist fractures and analyzing the results of two pediatric musculoskeletal centers. METHOD: Between 2011 January and 2015 December 467 children aged 0-15 with closed wrist injuries and open growth plates were sonographically and radiologically evaluated by an orthopaedic surgeon or a resident in trainee. Sonography was performed immediately after physical examination with linear probes of 7-14 Mhz frequency. Results were compared to conventional two plane wrist x-rays. RESULTS: We found 97 sensitivity and 96 specificity of the sonographic evaluation. Fractures with dislocations and more serious clinical consequences were never missed. CONCLUSION: Musculoskeletal ultrasound is a very effective tool in daily routine for diagnosing or excluding pediatric wrist fractures. Orv Hetil. 2017; 158(24): 944-948.

The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol.

AIMS: Pain and anxiety are commonly reported among those undergoing orthopaedic surgery. Improvement in anxiety and pain control might be achieved by supplementing standard care with psychological interventions. However, the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic reviews in orthopaedic surgeries. The present study aimed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery, to identify the most effective intervention types and to evaluate potential moderators. METHODS: We will perform a systematic review and meta-analysis to address the study aims. PubMed, PsycINFO, CINAHL and ProQuest Dissertations & Theses will be searched between 1980 and 2015. Prospective controlled clinical trials completed in adults, contrasting standard care and standard care supplemented with psychosocial methods, will be eligible for inclusion. Effectiveness will be assessed through the outcomes of postoperative pain intensity, analgesic requirement, perioperative anxiety, quality of life and postoperative recovery. The results of a random-effect meta-analysis will be reported. To aid implementation of best practice, moderating effects of the type and timing of psychosocial intervention, type of surgical intervention and type of anaesthesia will be evaluated through meta-regression. Sensitivity analyses and subgroup contrasts will follow as necessary. DISCUSSION: Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of Positive Suggestions on the Need for Red Blood Cell Transfusion in Orthopedic Surgery.

This study examined whether positive suggestions applied without a hypnotic induction in the perioperative period reduces the need for red blood cell transfusions in patients who underwent total hip or knee arthroplasties with spinal anesthesia. No hypnotic assessment was performed. Ninety-five patients were randomly assigned to the suggestion group (n = 45) and to the control group (n = 50). Patients in the suggestion group received verbal suggestions before and audiotaped suggestions during the surgery for reducing blood loss, anxiety, postoperative pain, and fast recovery. Our study showed that using positive suggestions in the perioperative period significantly decreases the necessity for transfusion.

Examples of positive suggestions given to patients undergoing orthopaedic surgeries.

In the Department of Orthopaedic Surgery in the University of Debrecen, Debrecen, Hungary, we examined the effectiveness of positive suggestions used in the perioperative period in hip and knee arthroplasties performed under spinal anaesthesia. The goal of the suggestions was to reduce the need for red blood cell transfusion and for analgesics, and to increase the patients' satisfaction. The objective of this article is to present our method with concrete examples of positive suggestions which were given first before the surgery (via personal conversation), then during the operation as well (via audiotaped method). We hope that our article will contribute to the wide-spread awareness of this relatively easy to learn communication method.

[Orthopaedic relevance of baby carrying]. / A babahordozás ortopédiai és traumatológiai vonatkozásai.

Recently, various ways of carrying a baby have become popular again. Different methods and options of infant carrying are largely influenced by current fashion trends. The term of baby carrying refers to carrying the infant close to the caregiver's body with special devices, which aid attachment parenting. The authors often face the question in the pediatric orthopedic clinic: what kind of carrying method to recommend to the parents. In this article the authors briefly present the different means of carrying devices and they review the literature regarding orthopedic consequences of baby carrying. For the healthy development of a child, position and correct support of the hips and the spine are essential, whereas the carrier's spinal protection is also an important aspect. After reviewing the literature, the authors conclude that baby carrying with an adequate device has advantages from orthopaedic point of view.

Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast.

We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.