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Lecoultre Y, Beeres FJP, Link BC, Pretz F, Tillmann F, Babst R, van de Wall BJM. Cement augmentation for proximal humerus fractures: a meta-analysis of randomized trials and observational studies. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02520-z. [PMID: 38589503 DOI: 10.1007/s00068-024-02520-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION It is unclear if elderly patients treated with plate osteosynthesis for proximal humerus fractures benefit from cement augmentation. This meta-analysis aims to compare cement augmentation to no augmentation regarding healing, complications, and functional results. METHODS PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate. Stratified analyses were performed for types of complication (implant-related or systemic). Secondary outcomes include re-interventions, hospital stay, operation time, functional scores, and general quality of life. RESULTS Five observational studies and one randomized controlled trial with a total of 541 patients were included. The overall complication rate was significantly lower in the augmented group (15.6% versus 25.4%, OR 0.54 (95%CI 0.33-0.87)). This was caused by a reduction of implant-related complications (10.4% vs. 19.9%, OR 0.49 (95%CI 0.28, 0.88)). No difference in humeral head necrosis was found. Data on re-intervention, hospital stay, and operation time was limited but did not show significant differences. No impact on functional scores and general quality of life was detected. CONCLUSION This meta-analysis shows that cement augmentation may reduce overall complications, mainly by preventing implant-related complications. No difference was detected regarding need for re-intervention, functional scores, general quality of life, and hospital stay. This is the first meta-analysis on this topic. It remains to be seen whether conclusions will hold when more and better-quality data becomes available.
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Affiliation(s)
- Yannic Lecoultre
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Fabian Pretz
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Franz Tillmann
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Lecoultre Y, Danek J, Rompen IF, van de Wall BJM, Haefeli PC, Beeres FJP, Babst R, Link BC. Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies. Arthroplasty 2023; 5:20. [PMID: 37024967 PMCID: PMC10080809 DOI: 10.1186/s42836-023-00173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Intraoperative fluoroscopy (IFC) is gaining popularity in total hip arthroplasty (THA), with the aim to achieve better component positioning and therefore eventually reduced revision rates. This meta-analysis investigated the benefit of IFC by comparing it to intraoperative assessment alone. The primary outcome was component positioning and the secondary outcomes included complications and revision rates. METHODS PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates for radiographic cup position, offset/leg length difference and outliers from a safe zone were pooled across studies using random effects models and presented as a weighted odds ratio (OR) with a corresponding 95% confidence interval (95% CI). RESULTS A total of 10 observational studies involving 1,394 patients were included. No randomized trials were found. IFC showed no significant reduction in acetabular cup position (inclination and anteversion), offset, leg-length discrepancies, revision (none reported) or overall complication rates. CONCLUSION The current meta-analysis found no differences in cup positioning, offset, leg length discrepancy, the incidence of complications or revision surgery. It should be acknowledged that the included studies were generally performed by experienced surgeons. The benefit of intraoperative fluoroscopy might become more evident at an early phase of the learning curve for this procedure. Therefore, its role has yet to be defined.
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Affiliation(s)
| | - Jan Danek
- Luzerner Kantonsspital, Lucerne, 6000, Switzerland
| | | | | | | | | | - Reto Babst
- Luzerner Kantonsspital, Lucerne, 6000, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, 6000, Switzerland
| | - Björn C Link
- Luzerner Kantonsspital, Lucerne, 6000, Switzerland
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Kusen JQ, Beeres FJP, van der Vet PCR, Poblete B, Geuss S, Babst R, Knobe M, Wijdicks FJG, Link BC. Inter-rater agreement in pPOSSUM scores of geriatric trauma patients: a prospective evaluation. Arch Orthop Trauma Surg 2022; 142:3869-3876. [PMID: 35031826 DOI: 10.1007/s00402-021-04275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Risk prediction models are widely used in the perioperative setting to identify high-risk patients who may benefit from additional care and to aid clinical decision-making. pPOSSUM is such a prediction model, however, little is known about the inter-rater agreement when scoring subjective parameters. This study assessed the inter-rater agreement between clinicians of different specialties and work-level when scoring 30 clinical case reports of geriatric hip fracture patients with pPOSSUM. METHODS Eighteen clinicians of the department of Surgery (three specialists, four residents), Anaesthesiology (four specialists, two residents) and Emergency Medicine (three specialists, two residents) who were familiar with the pPOSSUM scoring system were asked to calculate the scores. The kappa statistic and the statistical method of Fleiss were used to analyse inter-rater agreement. RESULTS The response rate was 100%. Among surgeons, Anaesthesiologists and Emergency department doctors (ED), the overall mean kappa values were 0.42, 0.08 and 0.20, respectively. Among surgery, anaesthesiology and ED residents the overall mean kappa values were 0.21, 0.33 and 0.37, respectively. Within the department of Surgery, Anaesthesiology and Emergency Medicine the overall mean kappa values were 0.23, 0.12 and 0.22, respectively. An overall mean kappa value of 0.19 was seen among all specialists. All residents had an overall mean kappa value of 0.21 and all clinicians had an overall mean kappa value of 0.21. CONCLUSION The overall inter-rater agreement of clinicians and interdisciplinary agreement when scoring geriatric hip fracture patients with pPOSSUM was low and prone to subjectivity in our study. A higher work-experience level did not lead to better agreement. When pPOSSUM is calculated without clinical assessment by the same clinician, caution is advised to prevent over-reliance on the pPOSSUM risk prediction model. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jip Q Kusen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Puck C R van der Vet
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Beate Poblete
- Department of Anaesthesiology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Steffen Geuss
- Department of Emergency Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland
| | - Franciscus J G Wijdicks
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Björn C Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalsstrasse, CH-6000, Lucerne, Switzerland.
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Graafland M, van de Wall BJM, van Veelen NM, van Leeuwen R, Hoepelman RJ, Knobe M, Link BC, Babst R, Beeres FJP. Long-term follow-up of patients with displaced scapular fractures managed surgically and non-operatively. Injury 2022; 53:2087-2094. [PMID: 35184818 DOI: 10.1016/j.injury.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Controversy remains on which patients with displaced scapula fractures benefit from surgery. This retrospective cohort study aims to compare and describe long-term patient-reported outcomes of patients with displaced scapula fractures treated both surgically and conservatively. METHODS This study included patients with intra- and extra-articular scapula fractures, treated between 2010 and 2020 in a Swiss level 1 trauma centre. The decision to operate was based on standardized criteria for fracture displacement. Patients with isolated Bankart lesions (Ideberg 1) and process fractures (AO type 14-A) were excluded. Primary outcomes were functional patient reported measures (DASH score) and quality of life (EQ5D score). Secondary outcomes were complications, radiological union, satisfaction with treatment, pain and range of motion. RESULTS Out of 486 cases, 74 patients had displaced scapula fractures. Forty patients were treated surgically and 34 were treated conservatively. Significantly more patients with intra-articular fractures and high-energy trauma were treated surgically. Fifty percent returned the questionnaires after a mean follow-up of 47 months (± SD 36). The mean DASH score of this group was 12 (SD 15.6), with a mean of 14.7 (SD 15.9) in the surgery group and 9.8 (SD 14.6) in the non-operative group (p = 0.7). Multivariate analysis did not show statistically significant correlating factors. No significant differences in quality of life were observed. Patients rated their treatment with a mean of 8.6/10 (SD 1.8). Among surgically treated patients, 19 underwent a deltoid sparing procedure with significant shorter time to union than those that underwent deltoid release (23 vs. 49 weeks, p<0.01). Complications occurred in 3/28 surgically treated patients and all three required a reoperation. CONCLUSION In this cohort, functional results after conservative and surgical treatment were similar, despite more complex fractures and more intra-articular fractures being treated surgically. Osteosynthesis of both intra- and extra-articular scapula fractures is safe and leads to good functional results, furthermore, new minimal invasive techniques may lead to faster bone healing and return to work and sports.
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Affiliation(s)
- M Graafland
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Dept. of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - B J M van de Wall
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Dept. Health Science and Medicine, University of Lucerne, Switzerland
| | - N M van Veelen
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - R van Leeuwen
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - R J Hoepelman
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - M Knobe
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - B C Link
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - R Babst
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Dept. Health Science and Medicine, University of Lucerne, Switzerland
| | - F J P Beeres
- Dept. of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland.
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Beeres FJP, van Veelen N, Houwert RM, Link BC, Heng M, Knobe M, Groenwold RHH, Babst R, van de Wall BJM. Response to letter to the editor on: "Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies". Eur J Trauma Emerg Surg 2022; 48:2685-2686. [PMID: 35274152 DOI: 10.1007/s00068-022-01943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland.
| | - Nicole van Veelen
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Roderick Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, USA
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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van de Wall BJM, Beeres FJP, Rompen IF, Link BC, Babst R, Schoeneberg C, Michelitsch C, Nebelung S, Pape HC, Gueorguiev B, Knobe M. RIA versus iliac crest bone graft harvesting: A meta-analysis and systematic review. Injury 2022; 53:286-293. [PMID: 34756411 DOI: 10.1016/j.injury.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reamer-Irrigator-Aspirator (RIA) of long bones is increasingly being used as an alternative to iliac crest harvesting for bone-grafts. This meta-analysis compares both harvesting techniques with regard to donor site morbidity, healing potency and implantation site morbidity. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR) with corresponding 95% confidence interval (95%CI). RESULTS A total of 5 studies were included. RIA carries a lower risk for chronic pain (0% versus 14.2%, OR 0.08, 95% CI 0.02 - 0.35) and infection (1% versus 5.9%, OR 0.29, 95% CI 0.09- 0.9) at the donor site compared to iliac crest harvesting. Iliac crest bone-harvesting has an inherent additional risk of neuropraxia of the lateral femoral cutaneous nerve and numbness of the scar which is not encountered in RIA harvesting. Risk for other reported complications such as hematoma and iatrogenic fractures appear equal in both groups. The clinical healing potential of both bone grafts, in terms of union rate (OR 1.53, 95%CI 0.62 - 3.75) at the implantation site and time-to-union (MD 0.44 months, 95%CI -1.72 - 0.83), seems equal. CONCLUSION The main difference between RIA and iliac crest bone graft harvesting is the considerable higher risk of chronic pain of the pelvic procedure. Although risk for infection was also higher for the iliac crest group, the absolute difference is relatively small. Evidence suggests an equal healing potential of the grafts themselves irrespective of harvesting method.
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Affiliation(s)
- Bryan J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland; University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, 6002 Luzern, Switzerland.
| | - Frank J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Ingmar F Rompen
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Reto Babst
- University of Lucerne, Department of Health Sciences and Medicine, Frohburgstrasse 3, 6002 Luzern, Switzerland
| | - Carsten Schoeneberg
- Alfried Krupp Hospital, Department of Orthopedic and Trauma Surgery, Alfried-Krupp-Strasse 21, 45131 Essen, Germany
| | - Christian Michelitsch
- Kantonsspital Graubünden, Department of Trauma Surgery, Loëstrasse 170, 7000 Chur, Switzerland
| | - Sven Nebelung
- RWTH Aachen University Hospital, Department of Radiology, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8006 Zürich, Switzerland
| | - Boyko Gueorguiev
- AO Research Institute Davos Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
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Beeres FJ, Diwersi N, Houwert MR, Link BC, Heng M, Knobe M, Groenwold RH, Frima H, Babst R, Jm van de Wall B. ORIF versus MIPO for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Injury 2021; 52:653-663. [PMID: 33223254 DOI: 10.1016/j.injury.2020.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with open reduction internal fixation (ORIF) for humeral shaft fractures regarding non-union, re-intervention, radial nerve palsy, time to union, operation duration and functional outcomes. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing MIPO with ORIF for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Subgroup analysis was performed stratified by study design (RCTs and observational studies). RESULTS A total of two RCT's (98 patients) and seven observational studies (263 patients) were included. The effect estimates obtained from observational studies and RCT's were similar in direction and magnitude. MIPO carries a lower risk for non-union (RD: 5%; OR 0.3, 95% CI 0.1-0.9) and secondary radial nerve palsy (RD 5%; OR 0.3, 95%CI 0.1- 0.9). Nerve function eventually restored spontaneously in all patients in both groups. Results were inconclusive regarding re-intervention (RD 7%; OR: 0.7, 95%CI 0.2-1.9), infection (RD 4%; OR 0.4, 95%CI 0.1-1.5), time to union (MD -1 week, 95%CI -3 - 1) and operation duration (MD -13 minutes, 95%CI -38.9 - 11.9). Functional shoulder scores (SMD 0.01, 95%CI -0.3 - 0.3) and elbow scores (SMD 0.01, 95%CI -0.3 - 0.3) were similar for the different operative techniques. CONCLUSION MIPO has a lower risk for non-union than ORIF for the treatment of humeral shaft fractures. Radial nerve palsy secondary to operation is a temporary issue resolving in all patients in both treatment groups. Although both treatment options are viable, the general balance leans towards MIPO having more favorable outcomes.
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Affiliation(s)
- Frank Jp Beeres
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Nadine Diwersi
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marijn R Houwert
- University Medical Center Utrecht, Department of Trauma Surgery, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Marilyn Heng
- Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Department of Orthopedic Surgery, Boston, USA
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Rolf Hh Groenwold
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, the Netherlands
| | - Herman Frima
- Northwest Hospital group, Department of Trauma Surgery, Wendelaarstraat 58, 1814 GS Alkmaar, the Netherlands
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Bryan Jm van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Bleeker NJ, van de Wall BJM, IJpma FFA, Doornberg JN, Kerkhoffs GMMJ, Jaarsma RL, Knobe M, Link BC, Babst R, Beeres FJP. Plate vs. nail for extra-articular distal tibia fractures: How should we personalize surgical treatment? A meta-analysis of 1332 patients. Injury 2021; 52:345-357. [PMID: 33268081 DOI: 10.1016/j.injury.2020.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/06/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment for distal diaphyseal or metaphyseal tibia fractures is challenging and the optimal surgical strategy remains a matter of debate. The purpose of this study was to compare plate fixation with nailing in terms of operation time, non-union, time-to-union, mal-union, infection, subsequent re-interventions and functional outcomes (quality of life scores, knee- and ankle scores). METHODS A search was performed in PubMed/Embase/CINAHL/CENTRAL for all study designs comparing plate fixation with intramedullary nailing (IMN). Data were pooled using RevMan and presented as odds ratios (OR), risk difference (RD), weighted mean difference (WMD) or weighted standardized mean difference (WSMD) with a 95% confidence interval (95%CI). All analyzes were stratified for study design. RESULTS A total of 15 studies with 1332 patients were analyzed, including ten RCTs (n = 873) and five observational studies (n = 459). IMN leads to a shorter time-to-union (WMD: 0.4 months, 95%CI 0.1 - 0.7), shorter time-to-full-weightbearing (WMD: 0.6 months, 95%CI 0.4 - 0.8) and shorter operation duration (WMD: 15.5 min, 95%CI 9.3 - 21.7). Plating leads to a lower risk for mal-union (RD: -10%, OR: 0.4, 95%CI 0.3 - 0.6), but higher risk for infection (RD: 8%, OR: 2.4, 95%CI 1.5 - 3.8). No differences were detected with regard to non-union (RD: 1%, OR: 0.7, 95%CI 0.3 - 1.7), subsequent re-interventions (RD: 4%, OR: 1.3, 95%CI 0.8 - 1.9) and functional outcomes (WSMD: -0.4, 95%CI -0.9 - 0.1). The effect estimates of RCTs and observational studies were equal for all outcomes except for time to union and mal-union. CONCLUSION Satisfactory results can be obtained with both plate fixation and nailing for distal extra-articular tibia fractures. However, nailing is associated with higher rates of mal-union and anterior knee pain while plate fixation results in an increased risk of infection. This study provides a guideline towards a personalized approach and facilitates shared decision-making in surgical treatment of distal extra-articular tibia fractures. The definitive treatment should be case-based and aligned to patient-specific needs in order to minimize the risk of complications.
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Affiliation(s)
- N J Bleeker
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland.
| | - B J M van de Wall
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland
| | - F F A IJpma
- Dept. of Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - J N Doornberg
- Dept. of Orthopaedic Trauma Surgery, Flinders Medical Centre, Adelaide, Australia
| | - G M M J Kerkhoffs
- Dept. of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - R L Jaarsma
- Dept. of Orthopaedic Trauma Surgery, Flinders Medical Centre, Adelaide, Australia
| | - M Knobe
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland
| | - B C Link
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland
| | - R Babst
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland
| | - F J P Beeres
- Dept. of Orthopaedic and Trauma Surgery, Lucerner Kantonsspital, Lucerne, Switzerland
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van de Wall BJM, Baumgärtner R, Houwert RM, Link BC, Heng M, Knobe M, Groenwold RHH, Babst R, Beeres FJP. MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies. Eur J Trauma Emerg Surg 2021; 48:47-59. [PMID: 33452548 DOI: 10.1007/s00068-020-01585-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/27/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with nail fixation for humeral shaft fractures regarding healing, complications and functional results. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for randomized clinical trials (RCT) and observational studies comparing MIPO with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Analyses were repeated stratified by study design (RCTs and observational studies). RESULTS A total of 2 RCTs (87 patients) and 5 observational studies (595 patients) were included. The effects estimated in observational studies and RCTs were similar in direction and magnitude for all outcomes except operation duration. MIPO has a lower risk for non-union (RD 7%; OR 0.2, 95% CI 0.1-0.5) and re-intervention (RD 13%; OR 0.3, 95% CI 0.1-0.8). Functional shoulder (SMD 1.0, 95% CI 0.2-1.8) and elbow scores (SMD 0.4, 95% CI 0-0.8) were better among patients treated with MIPO. The risk for radial nerve palsy following surgery was equal (RD 2%; OR 0.6, 95% CI 0.3-1.2) and nerve function recovered spontaneously in all patients in both groups. No difference was detected with regard to infection, time to union and operation duration. CONCLUSION MIPO has a considerable lower risk for non-union and re-intervention, leads to better shoulder function and, to a lesser extent, better elbow function compared to nailing. Although nailing appears to be a viable option, the evidence suggests that MIPO should be the preferred treatment of choice. The learning curve of minimal-invasive plating should, however, be taken into account when interpreting these results.
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Affiliation(s)
- Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland.
| | - Ralf Baumgärtner
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - R Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Björn C Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Harvard Medical School Orthopaedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, USA
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland
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van de Wall BJM, Ochen Y, Beeres FJP, Babst R, Link BC, Heng M, van der Velde D, Knobe M, Groenwold RHH, Houwert RM. Response to Yin et al regarding: "Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies". J Shoulder Elbow Surg 2021; 30:e32-e33. [PMID: 32956777 DOI: 10.1016/j.jse.2020.07.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Yassine Ochen
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, MA, USA
| | | | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Marijn Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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van de Wall BJM, Beeres FJP, Knobe M, Link BC, Babst R. Minimally invasive plate osteosynthesis: An update of practise. Injury 2021; 52:37-42. [PMID: 33228999 DOI: 10.1016/j.injury.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
Since its conception in 1989, minimally invasive plate osteosynthesis (MIPO) has gained widespread popularity. It has been studied in over forty countries with most of the publications originating from Asia, Europe and North America. This review aims to describe the scientific path of MIPO from the very beginning to where it stands in current day times; study the pattern and contributing factors influencing its global spread. Finally, the up to date evidence is discussed with regard to several anatomical regions in which MIPO is mostly used. In the meantime, MIPO treads steadily towards accomplishing the same or better outcomes for more and more indications with the goal to leave a smaller surgical footprint to allow for undisturbed bone healing.
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Affiliation(s)
- Bryan J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland.
| | - Frank J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Matthias Knobe
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Björn C Link
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - Reto Babst
- Lucerne Cantonal Hospital, Department of Orthopaedic and Trauma Surgery, Spitalstrasse 16, 6000 Luzern, Switzerland
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van de Wall BJM, Ochen Y, Beeres FJP, Babst R, Link BC, Heng M, van der Velde D, Knobe M, Groenwold RHH, Houwert MR. Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. J Shoulder Elbow Surg 2020; 29:1493-1504. [PMID: 32249144 DOI: 10.1016/j.jse.2020.01.072] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/19/2019] [Accepted: 01/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs). METHODS The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures. RESULTS A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I2 = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I2 = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I2 = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs. CONCLUSION This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.
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Affiliation(s)
- Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Yassine Ochen
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Björn C Link
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, MA, USA
| | | | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijn R Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Roth F, Cagienard F, Link BC, Hodel S, Lehnick D, Babst R, Beeres FJP. Primary or secondary wound healing of the pin sites after removal of the external fixator: study protocol for a prospective, randomized controlled, monocenter trial. Trials 2020; 21:205. [PMID: 32075685 PMCID: PMC7031911 DOI: 10.1186/s13063-020-4087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Temporary fixation with an external fixator is used for numerous indications in orthopedic trauma surgery. It is unclear whether primary wound healing or secondary open-wound healing after removal of the external fixator should be advocated for the pin site. This study compares primary wound closure with secondary wound healing for the pin site. The primary aim is to compare pin-site infection rates. The secondary aim is to compare time to wound healing and esthetic outcome. The hypothesis was that primary wound closure does not lead to more infections than secondary wound healing. Methods and design This is a prospective, randomized controlled, blinded, monocenter study based on a non-inferiority design. To obtain an equal patient population and groups, all pin-entry sites of the patients are treated alternately at the time of removal of the external fixator with primary wound closure and secondary wound healing. Patients are randomized according to whether the proximal pin-entry site is treated with wound closure or by secondary open-wound healing, from which the further sequence develops. The pre- and postoperative protocol is standardized for all pin-entry sites. A photo documentation of the pin-entry sites takes place 2 and 52 weeks postoperatively during the routine clinical follow-up visits. Further controls take place at 6, 12 and 26 weeks after pin removal. The primary outcome was to demonstrate the non-inferiority of primary wound closure compared to secondary wound healing in terms of postoperative wound infections according to the Center of Disease Control and Prevention (CDC) definitions. The secondary outcomes are time to complete wound healing (days) and esthetical outcome (subjective preference of patients and Vancouver Scar Scale score). Discussion This study aims to answer how to deal with the pin site after removal of the external fixator. To date, no routine and generally accepted protocol exists for the management of pin sites after removal of the external fixator. This prospective, randomized controlled, blinded monocenter trial should determine whether primary wound closure or secondary wound healing should be advocated after removal of the external fixator. Trial registration ClinicalTrials.gov, ID: NCT03842956. Registered retrospectively on 13 February 2019.
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Affiliation(s)
- Franz Roth
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland.
| | - Flavio Cagienard
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland
| | - Björn C Link
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland
| | - Sandro Hodel
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland
| | - Dirk Lehnick
- Clinical Trial Unit Central Switzerland and its Head of Biostatistics and Methodology, Lucerne, Switzerland
| | - Reto Babst
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland
| | - Frank J P Beeres
- Lucerne Cantonal Hospital, Orthopedic and Trauma Surgery, Lucerne, Switzerland
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van de Wall BJM, Theus C, Link BC, van Veelen N, van de Leeuwen RJH, Ganzert C, Babst R, Beeres FJP. Absolute or relative stability in plate fixation for simple humeral shaft fractures. Injury 2019; 50:1986-1991. [PMID: 31431330 DOI: 10.1016/j.injury.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Minimal invasive plating (MIPO) techniques for humeral shaft fractures appear to have fewer complications and higher union rates compared to open reduction and internal fixation (ORIF). It is questionable if this also applies to simple humeral shaft fractures, as simple fractures are generally treated with absolute stability which cannot be obtained with MIPO. This raises the question whether biology or biomechanics is more important in fracture healing. This study was developed to investigate the biomechanical part of this equation. The aim of the study was to compare relative stability to absolute stability in simple humeral shaft fractures with regard to fracture healing METHODS: This was a retrospective study of all patients treated with plate fixation for AO/OTA type A1-B3 humeral shaft fractures. Patients were categorized into two groups: absolute stability and relative stability. Both groups were compared with regard to time to radiological union and full weight bearing RESULTS: Thirty patients were included in the relative-stability-group with either an AO/OTA type A (n = 18) or type B (n = 12) humeral shaft fracture and a mean age of 55 (SD 21) years. A total of 46 patients were included in the absolute-stability-group: 27 patients had a type A and 19 type B fracture. The mean age in this group was 45 (SD 19) years. Median follow-up was 12 months (IQR 8-13). Minimally invasive approach was used in 15 (50%) patients in the relative stability group. Time to radiological union was significantly shorter in the absolute-stability-group with a median of 14 (IQR 12-22) versus 25 (IQR17-36) weeks and HR 2.60 (CI 1.54-4.41)(p < 0.001). This difference remained significant after correction for type of approach (adjusted HR 3.53 CI 1.72-7.21) (p 0.001). There was no significant difference in time to full weight bearing. The addition of lag screws in the absolute stability group did not influence time to radiological healing or full weight bearing. CONCLUSION Absolute stability for simple humeral shaft fractures leads to a significantly shorter time to radiological union compared to relative stability. The addition of lag screws to gain interfragmentary compression does not reduce fracture healing time.
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Affiliation(s)
- B J M van de Wall
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland; University Medical Center Utrecht, Department of Traumatology, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - C Theus
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - B C Link
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - N van Veelen
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - R J H van de Leeuwen
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - C Ganzert
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - R Babst
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland
| | - F J P Beeres
- Lucerne Cantonal Hospital, Department of Orthopedics and Trauma, Spitalstrasse 16, 6000 Luzern, Switzerland.
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Osinga R, Bodmer ES, Link BC, Fritsche E, Haug M, Hug U. [Long-term outcome after surgical treatment of breast asymmetry: analysis of the patient's perspective in 51 cases]. HANDCHIR MIKROCHIR P 2014; 46:330-5. [PMID: 25412242 DOI: 10.1055/s-0034-1394426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Literature provides 3 studies only investigating the long-term outcome after surgical correction of breast asymmetry. The goal of this study was to analyse from a patient's perspective, which factors influence postoperative satisfaction most. PATIENTS AND METHODS All patients undergoing surgical treatment for breast asymmetry between 2000 and 2009 were included. With help of the visual analogue scale the patients conducted a subjective assessment of their own long-term result using the following parameters: overall satisfaction, symmetry, size, shape, scarring and sensitivity. Anthropometric measurements of the breasts followed. RESULTS 51 patients (80% follow-up) were seen 2-11 (mean 5±2.5) years postoperatively. The following mean values were recorded for overall satisfaction 8.31 (±1.91), symmetry 7.86 (±2.25), size 8.42 (±1.93), shape 8.12 (±2.03), scarring 7.82 (±1.94) and sensitivity 7.92 (±2.19). Overall satisfaction increased significantly with good scores for the parameters symmetry [p=0.01] and shape [p=0.048]. Neither size [p=0.46] nor scarring [p=0.69] nor sensitivity [p=0.34] had a statistically significant influence on overall satisfaction. Furthermore, overall satisfaction did not depend on the surgical technique, preoperative size, preoperative asymmetry, age of the patient at time of surgery, period of time between the operation and the assessment, resected weight (absolute and difference between left and right) or on postoperative symmetry of the nipple areola complex. CONCLUSION In our patients, long-term overall satisfaction after surgical correction of breast asymmetry was primarily dependent on symmetry and shape. Size, scarring and sensitivity did not have a statistically significant influence on postoperative overall satisfaction. This also applied to preoperative size, preoperative extent of asymmetry, age of the patient at time of surgery, surgical technique and the time span between the operation and the assessment.
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Affiliation(s)
- R Osinga
- Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Spitalstrasse, Luzern
| | - E S Bodmer
- Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Spitalstrasse, Luzern
| | - B C Link
- Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Spitalstrasse, Luzern
| | - E Fritsche
- Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Spitalstrasse, Luzern
| | - M Haug
- Universitätsspital Basel, Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Basel
| | - U Hug
- Luzerner Kantonsspital, Klinik für Hand- und Plastische Chirurgie, Spitalstrasse, Luzern
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Reichelt U, Duesedau P, Tsourlakis MC, Quaas A, Link BC, Schurr PG, Kaifi JT, Gros SJ, Yekebas EF, Marx A, Simon R, Izbicki JR, Sauter G. Frequent homogeneous HER-2 amplification in primary and metastatic adenocarcinoma of the esophagus. Mod Pathol 2007; 20:120-9. [PMID: 17143264 DOI: 10.1038/modpathol.3800712] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
HER-2 is the target for antibody based treatment of breast cancer (Herceptin). In order to evaluate the potential role of such a treatment in esophageal cancers, HER-2 amplification and overexpression was investigated in primary and metastatic cancers of the esophagus. A tissue microarray was constructed from 255 primary esophageal cancers (110 adenocarcinomas and 145 squamous cell carcinomas), 89 nodal and 33 distant metastases. Slides were analyzed by immunohistochemistry (HercepTest; DAKO) and fluorescence in situ hybridization (FISH; PathVysion; Vysis-Abbott) for HER-2 amplification and overexpression. Amplification was seen in 16/110 (15%) adenocarcinomas and in 7/145 (5%) squamous cell carcinomas. There was a strong association between HER-2 amplification and overexpression, especially in adenocarcinomas (P<0.0001, log rank). There was a 100% concordance of the HER-2 results in primary tumor and corresponding metastases in 84 analyzed pairs. Amplification was typically high-level with more than 10-15 HER-2 copies per tumor cell. Amplification was unrelated to survival, grading, pT, pN, pM or UICC stage. We conclude that esophageal adenocarcinomas belong to those cancer types with relevant frequency high-level HER-2 gene amplification clinical trials or individual case studies investigating the response of metastatic HER-2-positive esophageal cancers to Herceptin((R)) should be undertaken. The strong concordance of the HER-2 status in primary and metastatic cancers argues for a possible response of metastases from patients with HER-2-positive primary tumors to Herceptin.
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Affiliation(s)
- Uta Reichelt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
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