Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis.

PURPOSE: Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis. RESULTS: Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = - 24.66, p < 0.05), intraoperative bleeding (MD = - 10.37, P < 0.05), fluoroscopy exposure (MD = - 2.15, P < 0.05) and intraoperative drilling frequency (MD = - 2.42, P = < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times. CONCLUSIONS: Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.

Iron deficiency without anaemia: a diagnosis that matters.

Iron deficiency anaemia (IDA) currently affects 1.2 billion people and iron deficiency without anaemia (IDWA) is at least twice as common. IDWA is poorly recognised by clinicians despite its high prevalence, probably because of suboptimal screening recommendations. Diagnosing IDWA relies on a combination of tests, including haemoglobin and ferritin levels, as well as transferrin saturation. Although the causes of iron deficiency may sometimes be obvious, many tend to be overlooked. Iron sufficiency throughout pregnancy is necessary for maternal and foetal health. Preoperative IDWA must be corrected to reduce the risk of transfusion and postoperative anaemia. Oral iron is the first-line treatment for managing IDWA; however, intravenous supplementation should be used in chronic inflammatory conditions and when oral therapy is poorly tolerated or ineffective. This review considers the causes and clinical features of IDWA, calls for greater awareness of the condition, and proposes diagnostic and management algorithms.