[Midshaft clavicle fractures : A systematic review of different treatment approaches]. / Klavikulaschaftfrakturen : Ein systematischer Review zu verschiedenen Therapiekonzepten.

BACKGROUND: The objective of this systematic review was to summarize the current evidence on efficacy and safety of the various treatment options for midshaft clavicle fractures, taking into account fracture type and other variables. MATERIAL AND METHODS: A search for systematic reviews and controlled studies published between 1998 and 2009 was carried out. RESULTS: There is moderate evidence that operative treatment for midshaft clavicle fractures results in a lower rate of fracture non-union and improved patient-oriented outcome compared to non-operative treatment. However, because union rates are generally high and there are complications which are unique to surgical intervention, risks have to be considered and weighed before a decision on treatment is made. The most important risk factors for non-union are major displacement and fracture comminution. Of all surgical procedures the best evidence of efficacy is presently available for plate fixation and elastic stable intramedullary nailing. CONCLUSION: This paper presents an algorithm derived from the current evidence which may be useful for therapy decision-making in the clinical routine.

[Neural tube defects in Austria: Assumption and calculations on the prevention potential through folic acid enrichment and supplementation]. / Neuralrohrdefekte in Österreich: Annahmen und Berechnungen zum Verhinderungspotenzial durch Folsäureanreicherung und-supplemente.

BACKGROUND: Countries with obligatory fortification of food (USA, Canada) document a significant decrease of neural tube defects in newborns. METHODS: In this study the Daly or, respectively, the Wald method was employed for calculating the potential of fortification/and supplementation for prevention in Austria. RESULTS: According to the EUROCAT study, in Austria the overall prevalence of neural tube defects (live birth, still births and induced abortions due to neural defect) is assumed to be 7.95 per 10,000 live and still births, and the prevalence of 3.9 per 10,000 live births - that is 62 or, respectively, 30 in absolute numbers per 78,000 births per year. In 2006, 26 live-born children with neural tube defects were actually reported in Austria by Statistik Austria. CONCLUSION: Different folic acid fortification and supplementation strategies can avoid 1.2-1.4 per 10,000 (9-11 cases) of neural tube defects (live and still births). Folic acid supplements are effective to decrease the amount of neural tube defects, however, only when pregnancies are planned. Thus, evidence-based neural tube defects are more common among lower social groups. An obligatory fortification of food could therefore reach unplanned pregnancies and women facing social problems. A reason to justify this population-based intervention where people need not decide for themselves could be the reduction of social imbalances. There are, of course, advantages and disadvantages of obligatory fortification of food and, therefore, all circumstances have to be taken into consideration.

[Chemonucleolysis and intradiscal electrothermal therapy: what is the current evidence?]. / Chemonukleolyse und intradiskale Elektrotherapie: was ist die gegenwärtige Evidenz?

We evaluated the efficacy and safety of chemonucleolysis and intradiscal electrothermal therapy (IDET) on the basis of the data presented in recently published papers with respect to pain relief, function, and complication rates. Detailed searches for English and German articles published between 2003 and 2008 were performed in a number of electronic databases. Further publications were identified by manual search. For summarizing the evidence, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and the extracted data was checked for completeness and correctness by a second author. The evidence of the efficacy of chemonucleolysis using chymopapain or collagenase is summarized in two recent, high-quality systematic reviews. We found 5 controlled studies evaluating nucleolysis using an oxygen-ozone mixture (O (2)O (3)-nucleolysis). Some of those studies were of limited methodological quality, but all showed the efficacy of O (2)O (3)-nucleolysis in comparison to microdiscectomy or the use of alternative substances. There is hardly any data regarding O (2)O (3)-nucleolysis complications. Regarding IDET, the authors of the 6 identified systematic reviews come to different conclusions about the efficacy of the procedure. The results of the 3 included controlled IDET studies, of which 2 are of high methodological quality, are also conflicting. The complication rates range from 0 to 15 %. In summary, the evidence of efficacy is presently more compelling for chemonucleolysis than for IDET. This may also be because indications for chemonucleolysis are more firmly established. However, safety aspects should be better evaluated and presented in the literature.