Outcome of early versus delayed presentation of proximal femur fractures in children: A prospective cohort study.

OBJECTIVE: We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical-radiological outcomes in paediatric proximal femur fractures having early and delayed presentation. METHODOLOGY: A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48hours of injury; group B: delayed presentation, presented >48hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria. RESULTS: In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value=0.013), VAS score (p=0.045), and limb length discrepancy (p=0.022). Also, there was a statistical difference in AVN (p-value=0.0295) and growth disturbance (p-value=0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value=0.030). CONCLUSION: Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance. LEVEL OF EVIDENCE: III.

Return to sports after ankle reconstruction with tendon grafts in chronic lateral ankle instability: A systematic review and meta-analysis.

Purpose: Anatomic reconstruction using grafts is being performed more frequently in athletes experiencing recurrent chronic lateral ankle instability (CLAI). The purpose of the study was to systematically review the current literature to determine the rates of return to sports (RTS) along with timing in patients with CLAI undergoing ligament reconstruction. Methods: The databases PubMed, Scopus, Cochrane, and Embase were searched based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles quoting on the return to sports rate after lateral ankle reconstruction were included. The rates of return to any sports, return to pre-injury sports, and return to competitive sports along with the timing of return were evaluated and a proportion meta-analysis was performed. Results: A total of 720 patients in 20 studies met our inclusion criteria. The RTS rates for any sports were 95.3%, and 84.3% for pre-injury sports The average time taken for return to sports was 17 weeks. Postoperative functional outcomes, ankle stability, and ROM were significantly improved in comparison to preoperative status. Conclusion: The RTS rates following lateral ankle reconstruction in CLAI showed a high return to any sports, but moderate to high rates for the pre-injury or competitive level of sports. Level of evidence: Level of evidence II.

Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis.

Introduction: Nonunion of long bones is a major complication following fractures that requires a substantial amount of investment both monetary and time from patients and surgeons. The need to comprehensively understand the complications, outcomes and distraction capability is profound, which necessitates a review of current evidence on special fixators used for distraction. The current systematic review aims to study the available literature on distraction osteogenesis using special fixators (Ilizarov and Limb Reconstruction System) in the management of nonunion (infected and non-infected). Methods: Cochrane Library, PubMed, Scopus were searched until January 2022. The review included all original studies which used Ilizarov or Monorail Fixators/LRS in the treatment of nonunion of long bones. The quality of studies was assessed using the Modified Coleman Methodology Score. Results: A total of 35 original studies with Ilizarov (n = 29) and LRS (n = 8) were selected including two comparative studies. The pooled data meta-analysis and the subgroup analysis of these studies found both Ilizarov and LRS fixator yield similar functional outcomes for the treatment of long bones nonunion. Conclusion: The review was conducted to understand the scenario of nonunion in long bones. Pin tract infection is found to be the most common complication followed by adjacent joint stiffness and deformity. In our review we observed that both external fixator time and index were lower in LRS compared to Ilizarov group. Further RCT are required comparing Ilizarov and LRS fixators to effectively comment upon the superiority of the implants.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report.

The foot is an uncommon location for osseous tumors, comprising ∼ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Augmentation with Fibertape Leads to Biomechanically Superior but Similar Clinical Outcomes in ACL Surgeries: Systematic Review and Meta-analysis.

Purpose: The current generation has witnessed significant progress in the field of knee arthroscopy. Suture tapes have gained immense popularity due to perceived improved biomechanical support to the graft while it heals. The purpose of the present systematic review is to analyze the biomechanical construct of suture tapes in ACL repairs and reconstructions along with clinical outcomes. Methods: Cochrane Library, PubMed, and Embase were searched until December 2021. All Biomechanical Studies on animal or cadaver knees that compared construct characteristics of suture tape in ACL repair or reconstruction and clinical studies in English focusing on outcomes following suture tape augmentation in ACL repair or reconstruction were included. The quality of clinical studies using the Modified Coleman Methodology Score (MCMS). Results: A total of 16 studies biomechanical and 23 clinical studies were included in qualitative synthesis, leaving nine biomechanical studies for final quantitative analyses. Suture tape revealed biomechanical superiority in terms of ultimate strength, stiffness, cyclic displacement, and elongation of graft, while comparing ACLR with internal brace to standard ACLR. No significant difference in retear rates was seen in clinical studies. Clinical score(IKDC score) was found similar in both augmented and non-augmented construct. Similar results were obtained in biomechanical studies. Conclusion: The use of suture tape as a ligament augmentation in both ACL reconstruction and ACL repair offers more strength, less elongation or displacement, and is biomechanically stable and sound. There is a lack of data to comprehensively comment upon the clinical superiority of the use of internal augmentation. However, a meta-analysis of the retear rates and clinical outcome score revealed similar outcomes between suture tape augmented and nonaugmented groups.

Technique for Foot Reconstruction with Custom-made Calcaneal Prosthesis in Primary Malignancy - A Case Report / Técnica de reconstrução do pé com prótese de calcâneo feita sob medida em câncer primário - Relato de caso

Abstract The foot is an uncommon location for osseous tumors, comprising ~ 3% of all skeletal tumors, which occur particularly around the calcaneum. Radical surgery creates a void in the foot which adversely affects the ability to salvage it. Calcaneal replacement surgeries are not commonly performed due to factors involving instability of the prosthesis, soft-tissue defects, and resultant failure, which can occur in the postoperative period. Thus, we herein report a rare case of synovial sarcoma arising from the sheath of the tibialis posterior tendon, with secondary involvement of the calcaneus bone. Considering the previous experiences of different surgeons, a custom-made prosthesis was designed with relevant modifications.

Resumo O pé é um local incomum para tumores ósseos, e compreende cerca de 3% de todos os tumores esqueléticos, em especial ao redor do calcâneo. A cirurgia radical cria um vazio no pé, o que afeta de forma negativa a capacidade de resgate do membro. As cirurgias de reconstrução do calcâneo não são comumente realizadas por causa da instabilidade da prótese, defeito de partes moles, e consequente possibilidade de insucesso pósoperatório. Assim, apresentamos aqui um caso raro de sarcoma sinovial originário da bainha do tendão tibial posterior com acometimento secundário do osso calcâneo. Considerando as experiências prévias de diferentes cirurgiões, projetamos uma prótese sob medida com modificações relevantes.

No added benefits of adipofascial flaps over fasciocutaneous flaps except for footwear ease and bulkiness: A systematic review and meta-analysis.

Purpose: The fasciocutaneous (FC) flap or the axial flap consists of skin, subcutaneous tissue, and deep fascia. In the literature today, there is no evidence suggesting that either surgery is superior to the other in terms of outcome and complications. Reviews in the literature currently compare the outcomes of skin closure after Orthopedic surgeries. The meta-analysis aims to compare the clinical outcomes, complication rates, need for re-surgery, and donor site morbidity between the AF flaps and FC flaps. A null hypothesis that stated inferior outcomes of FC flaps along with more complication rates over AF flaps was kept at the start of the study. Methods: Cochrane Library, PubMed, Embase were searched until December 2020. The review included all original studies which compared the outcomes or complications between FC and AF flaps. The quality of studies was assessed using the Minors score. Results: A total of 7 original studies with AF and FC flap procedures of which 136 underwent FC flap and 212 underwent AF flap. The pooled data meta-analysis and the subgroup analysis of these studies found no standardized protocol for reporting the outcomes or the cosmetic outcome of the flap surgery. The adipofascial group showed overall shorter operative time, less bulky flap and ability to wear footwear. Also the complications did not differ in both groups with respect to flap loss, complication following surgery, wound dehiscence, wound closure, donor site complications. Conclusion: The current meta-analysis reveals that there is no added benefit of using AF flaps over the FC flaps. The rates of partial or total flap necrosis along with donor site morbidities and successful wound closure and overall complication rates were similar between the two groups. However, there is evidence to support the superiority of AF flaps over the FC variety with respect to ease of wearing footwear and a less bulky flap. Level of evidence: Level 1 Systematic review and meta-analysis.

Barbed Sutures for Total Hip and Knee Arthroplasty Have Shorter Wound Closure Time and are Cost-Effective in Comparison to Traditional Sutures: A Systematic Review and Meta-analysis of 16 Randomized Controlled Trials.

Purpose: Surgical wound closure is of paramount importance, especially in total joint replacement surgeries wherein correct closure technique not only aids in rapid healing, but with lesser complications, we would be looking at a quicker rehabilitation of the patients. Bidirectional barbed sutures appear to reduce the wound closure time in all the planes and are cost-effective in comparison with traditional sutures. This study is aimed at evaluating the efficacy and superiority of bidirectional barbed sutures in comparison to traditional suturing techniques. Methods: Electronic databases like Embase, PubMed, Cochrane Library, Lilacs were searched up to February 2021. 16 high-quality randomized-controlled trials (RCT) were selected in this study. The search method identified 2168 total knee replacements (TKR) and 229 total hip replacements (THR) among 2397 patients. All the studies compared barbed sutures with traditional wound closure techniques. Data of wound closure time, overall cost, length of hospital stay, overall wound complications, suture-related complications, range of motion data, and knee society scores were collected and further analyzed. Results: The baseline patient characteristics were identical among all the included studies. Compared to traditional sutures a significantly decreased wound closure time in both THR and TKRs (p < 0.00001) and cost (p < 0.00001) was noted, although no statistically significant difference was found in overall complications in THRs (p = 0.95) and TKRs (p = 0.69). ROM (p = 0.54-6 weeks after surgery and p = 0.68-3 months after surgery) and Knee society scores (p = 0.92) in both the groups of patients undergoing TKR. However, the length of hospital stay was prolonged in the barbed suture group (p = 0.01), pinpricks (p = 0.02), and broken sutures (p = 0.02). Conclusions: Novel methods of wound closure such as barbed sutures achieve satisfactory surgical implementation being more efficient in the form of decreasing the overall wound closure time, with comparable wound complication rates and being cost-effective. But the drawbacks like the incidence of broken sutures and pinpricks are more. Overall using barbed sutures in place of traditional sutures may be considered safe and a viable alternative choice for suturing in total joint replacements. Level of Evidence: Level I, Systematic review and Meta-analysis of RCT.

Comparison of functional outcomes and complications of cemented vs uncemented total hip arthroplasty in the elderly neck of femur fracture patients: A systematic review and meta-analysis.

Purpose: The neck of femur fractures in the elderly is a global concern. These fractures impair the quality of living and add to morbidity and mortality. A Multitude of treatment options for the same. This systematic review focuses on evaluating outcomes between cemented and uncemented total hip replacement in the elderly population with neck of femur fractures. Material and methods: The search was conducted in databases PubMed, Embase, Scopus, open grey, and Cochrane following PRISMA guidelines. The studies fulfilling the inclusion criteria were included, scrutinized for data analysis, and also quality appraisal of all the included studies was conducted to be included in this article. Results: A total of 7 studies were included (2 RCT, 5 retrospective studies) comprising 1171 THRs. Data analysis showed a higher HHS in cemented compared to uncemented(p < 0.001). The uncemented group had a significantly higher rate of revision, dislocation, and periprosthetic fracture compared to cemented group(p < 0.001). However, VAS score, loosening rates, and heterotopic ossification were similar in both statistically insignificant groups. Conclusion: Choosing between cemented and uncemented techniques had been a controversy with lesser data due to higher morbidity and mortality. This systematic review provides information regarding functional outcomes and complications in both groups. The cemented group had better outcomes and lesser complications which should be preferred in elderly patients as the conclusion of this study. However, a larger RCT with better follow-up is still required. Level of evidence: Level I, systematic review and meta-analysis.

No Additional Benefits of Tissue Adhesives for Skin Closure in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: This systematic review is aimed to compare the performance of tissue adhesives (TA) as an adjunct or closure method with traditional wound closure methods for cutaneous closure in arthroplasty and evaluate whether they have any added benefits in terms of decreasing wound complications and increasing postoperative patient satisfaction. METHODS: Cochrane Library, PubMed, and EMBASE were searched until February 2021. Randomized controlled trials (RCTs) comparing outcomes of TA with emphasis on skin closure time, in-hospital stay, complication rates, cosmetic scoring systems, and patient satisfaction scores (PSS) compared to subcuticular sutures (SCS) and skin staples (ST) in arthroplasty. The quality of RCTs was assessed using the National Institutes of Health quality assessment tool. RESULTS: Ten RCTs were included. The pooled and the subgroup analysis revealed no significant difference in the wound infection rates, discharge rates, dehiscence rates, and PSS between TA (as an adjunct or closure method) and SCS or ST. TA (as an adjunct or closure method) was significantly (P < .00001) associated with a longer time to closure compared to ST and a shorter time compared to SCS as a closure method. Length of stay was comparable in all groups. CONCLUSION: Using TA in combination with subcuticular sutures or ST or as a cutaneous method of closure does not provide additional benefits in terms of decreased hospital stay, decreased infection rates, or wound discharge rates. The PSS and pain scores of the scars also appear to be comparable to standard wound closure methods. No clear conclusion could be drawn regarding cosmetic scoring systems, because of the paucity of data. LEVEL OF EVIDENCE: Level I (Meta-analysis of RCTs).

Swashbuckler approach for distal femur fractures: A systematic review.

PURPOSE: The review aims to reach a common consensus regarding the swashbuckler approach for distal femur fractures by a systematic review of the available literature and to evaluate the complications, union, and outcomes. METHODS: Electronic database search engines like Cochrane Library, PubMed, Google Scholar, and Scopus were searched until May 2021. Studies comparing the clinical complications, and functional outcome scores of Swashbuckler approach for distal femur were considered. The quality of the articles were evaluated using Methodological Index for Non-Randomized Studies score. RESULTS: Eleven studies were included for the final analysis. An anterior midline incision was used in the majority of studies. Superficial infection was the most common complication seen followed by knee stiffness and deep infections. 66.45% of the patients had excellent/good outcomes. 1.08% had a painful implant and 1.89% had deep infection. CONCLUSION: Swashbuckler approach offers itself as a viable option in cases of distal femur fractures, especially in AO type C. The quadriceps sparing approach provides excellent/good outcomes in approximately 66.45% of the patients.

Comparison of Functional Outcomes, Femoral Rollback and Sagittal Stability of Anterior-Stabilized Versus Posterior-Stabilized Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: Total knee arthroplasty (TKA) has improved leaps and bounds in terms of design to improve clinical outcomes and achieve better rehabilitation of the patients. Ultra-congruent inserts (UC) were designed to replace the need for posterior stabilized (PS) implants. The purpose of this review was to evaluate clinical outcomes, femoral rollback, functional scores, range of motion, sagittal laxity, complication rates, and isokinetic performance between UC and PS TKA among RCTs. METHODS: Electronic databases such as PubMed, Scopus, opengrey, and Cochrane were searched from date of inception up to mid-April 2021, and meta-analysis was performed following PRISMA guidelines. This study analyzed outcomes, femoral rollback, tibial sagittal laxity and isokinetic performance. RESULTS: Ten RCTs identified 852 knees, of which 420 underwent UC TKAs and 432 underwent PS TKA. Compared to UC TKA, a significantly better sagittal stability (p = 0.17) and femoral rollback (p < 0.00001) in PS TKAs was noted, although no statistically significant difference was found in the assessment of the range of motion (p = 0.19) and functional scores. Both the groups had similar isokinetic performance with extensor torque (p = 0.97) and flexor torque (p = 0.37). CONCLUSIONS: We conclude with the current meta-analysis that there are no added benefits for UC over PS inserts and these inserts have a higher sagittal laxity and less femoral roll back in cruciate sacrificing UC knee. But since there are no long-term wear data, UC inserts with CS technique should be used cautiously and may be used only when the PCL cannot be balanced adequately. There is no evidence or only a few to support the superiority of the AS TKA in terms of clinical outcomes or isokinetic performance or femoral external rotation over PS TKA. LEVEL OF EVIDENCE: Level I, Systematic review and meta-analysis of RCTs.