[Clinical Value of Minimally Invasive Bridging for the Lateral Malleolar Fractures in the Open Comminuted Ankle Fractures with Dislocation].

To evaluate the effectiveness of minimally invasive bridging for the lateral malleolar fractures in the open comminuted ankle fractures with dislocation. Methods The clinical data of 24 patients [19 males and 5 females aged 40 to 65 years,mean(47.5±8.6)years] with open comminuted ankle fractures with dislocation who were treated in the Second Hospital of Tangshan from September 2015 to June 2017 were retrospectively analyzed.All patients were treated with minimally invasive bridging for the lateral malleolar fractures.The ankle function after treatment was assessed with the Olerud Molander Ankle(OMA)score. Results All the 24 patients were followed up from 12-26 months [mean:(14.5±2.6)months].Good fracture union was achieved in all patients after 2 - 5 months(mean:3 months).No deep infection,skin necrosis,or bone nonunion occurred after 12 months of follow-up.Only one patient suffered from partial skin necrosis at lateral malleolus,which was cured after changing wound dressings.The OMA score was 93.5(range:85-100)after 12 months(excellent in 19 cases and good in 5 cases). Conclusions Minimally invasive bridging for the lateral malleolar fractures is effective in treating the open comminuted ankle fractures with dislocation.It can obtain good reduction and fixation,reduce complications,and achieve high union rate.

Treatments for the Fifth Metacarpal Neck Fractures: A Network Meta-analysis of Randomized Controlled Trials.

The fifth metacarpal neck fractures (commonly termed boxer's fractures) are the most common type of metacarpal fractures. Many types of treatments are available in clinical practice, some of which have already been compared with other treatments by various researchers. However, a comprehensive treatment comparison is lacking. We estimated the comparative efficacy of different interventions for total complications, through a network meta-analysis of randomized controlled trials. We conducted a systematic search of the literature through October 2015. The outcome measurements were the total complications. We used a Bayesian network meta-analysis to combine direct and indirect evidence and to estimate the relative effects of treatment. We identified 6 RCTs registering a total of 288 patients who were eligible for our network meta-analysis. The literature's quality is relatively high. The median Structured Effectiveness for Quality Evaluation of Study score for the included trials was 33.8. The overall methodological quality was high. Of the 6 studies, all were 2-arm controlled trials comparing active intervention. Among the 4 treatments--conservative treatment (CT), antegrade intramedullary nailing (AIMN), transverse pinning (TP) with K-wires, and plate fixation (PF)--CT had the best rankings (ie, lowest risk of total complications), followed by PF, AIMN, and TP (ie, highest risk of total complications). Furthermore, we also presented the results using surface under the cumulative ranking curve. The surface under the cumulative ranking curve probabilities were 94.1%, 52.9%, 37.3%, and 15.7% for CT, PF, AIMN, and TP, respectively. In conclusion, current evidence suggested that conservative treatment is the optimum treatment for the fifth metacarpal neck fractures because of reduced total complication rates. Moreover, the TP with K-wires is the worst option with highly total complication rates. PF and AIMN therapy should be considered as the first-line choices. Larger and higher-quality randomized controlled trials are required to confirm these conclusions and better inform clinical decision-making.

Meta-analysis for dorsally displaced distal radius fracture fixation: volar locking plate versus percutaneous Kirschner wires.

BACKGROUND: Dorsally displaced distal radius fractures (DDDRF) are frequent injuries in clinical practice. Traditional percutaneous Kirschner wires (K-wire) and open reduction with volar locking plate (VLP) are the two most common surgical fixation techniques used to manage DDDRF. However, there is no current consensual evidence to guide the selection of one technique over the other. Therefore, we undertook a systematic search and meta-analysis to compare clinical outcomes and complications of these two treatment approaches for DDDRF. METHODS: The following electronic databases were searched by two independent reviewers, up to April 2015: PubMed, ScienceDirect and Wiley Online Library. High-quality randomized controlled trials (RCTs) comparing VLP and percutaneous K-wire fixation for DDDRF were identified. Pooled mean differences were calculated for the following continuous outcome variables: disabilities of the arm, shoulder and hand (DASH) score, grip strength and wrist range of motion. Pooled odds ratios were calculated for rates of total postoperative complications, including superficial infection, deep infection, complex regional pain syndrome (CRPS), carpal tunnel syndrome (CTS), neurological injury, tendon rupture, tenosynovitis, loss of reduction and additional surgery to remove hardware. The meta-analysis was completed using RevMan 5.3 software. RESULTS: Seven RCTs, with a total of 875 patients, were included in our meta-analysis. Open reduction internal fixation (ORIF) with VLP fixation provided statistically lower DASH scores, reduced the incidence of total postoperative complications and specifically lowered the rate of superficial infection, when compared, over a 1-year follow-up, to percutaneous K-wire fixation. VLP fixation also provided significantly better grip strength and range of wrist flexion and supination in the early 6-month postoperative period, compared with percutaneous K-wire fixation. CONCLUSION: ORIF with VLP fixation provided lower DASH scores and reduced total postoperative complications, most specifically lowering the risk for postoperative superficial infection compared to K-wire fixation over a 1-year follow-up period. However, superficial pin track infections do not cause clinical debility in the vast majority of cases. Thus, the claim of reduced superficial infection rate may not be clinically important. The only reasonable conclusion that can be drawn is that at present, there is insufficient data even on our meta-analysis to help the clinician make an informed choice.