Joseph P. Corkum

Systematic review of the best evidence in intramedullary fixation for metacarpal fractures

BackgroundIntramedullary (IM) fixation has been described as a reliable method of treatment for certain fracture patterns but has not been widely adopted into practice. The purpose of this study was to evaluate the literature comparing IM fixation to other forms of treatment for metacarpal fractures.MethodsA systematic review was performed to identify studies investigating the treatment of metacarpal fractures using IM fixation. Inclusion and exclusion criteria were predetermined. Two reviewers independently identified appropriate articles for review based on the criteria. Primary outcome measures were range of motion (ROM) (Styf et al., Rev Chir Orthop Reparatrice Appar Mot 74(Suppl 2):268–270, 2008) and complications. Secondary outcomes included loss of reduction, grip strength, Disabilities of arm, shoulder and hand (DASH) scores, radiographic measures and pain scores.ResultsEight studies were eligible for review. Studies were of level II–IV evidence, and captured a total of 435 patients. The ROM post-operatively was found to be greater in the IM group in half of the studies. IM fixation trended toward higher complication rates in one study, but no differences were statistically significant. IM fixation fared similarly or superiorly to its competitor in each of the secondary outcomes. A formal meta-regression analysis was not possible given the heterogeneity of studies.ConclusionsIM fixation may have a role in the treatment of certain metacarpal fractures. No conclusive recommendations can be made based on the available studies included in this literature search. Further study of this technique and its applications using high level evidence is warranted.

Early Failure of a Polyethylene Acetabular Liner Cemented Into a Metal Cup

In 2002, a patient underwent revision total hip arthroplasty for polyethylene wear. The acetabular cup was well fixed, and it was decided to cement a new polyethylene liner into the existing cup. In 2006, the patient presented with inability to weight bear and easy subluxation of the hip. Revision surgery was performed, and all components were examined postoperatively. Investigation with microcomputed tomography revealed that the liner had plastically deformed at the superior pole resulting in the hip instability. The reasons for this are suspected to be related to the abducted nature of the original cup and an uneven cement mantle. This report suggests that cementation of polyethylene liners into metal cups has limitations and is not appropriate in all circumstances.

The Impact of Time of Mobilization After Split Thickness Skin Graft on Lower Extremity Wound Healing—Systematic Review and Meta-analysis

Systematic Review registration : Prospero CRD42017070990.

Sensory outcomes following brachial plexus birth palsy: A systematic review

BACKGROUND Brachial plexus birth palsy (BPBP) affects approximately 1.5 in 1000 live births and can lead to significant functional impairment and reduced quality of life. To date, studies have focused on grading motor function and strength to assess patient outcomes, with less attention paid to sensory recovery. The authors aimed to systematically review the current literature on sensory outcomes following BPBP. METHODS A systematic review of the best evidence available assessing sensory outcomes following BPBP was conducted. Two independent reviewers used a predefined search strategy to query Cochrane, MEDLINE, EMBASE, and Web of Science databases. Articles written in English reporting sensory outcomes in patients with BPBP, such as tactile sensation, pain, and proprioception, were included for review. A kappa score was calculated to ensure reviewer agreement. RESULTS Twenty-nine reports with 1647 cases were included. Tactile sensation was most frequently assessed (75.9%), followed by pain (44.8%) and proprioception (17.2%). Among all cases included in the analysis, 75.8% of articles were found to have patients with suboptimal results in sensory outcomes. The majority of articles (86.2%) were case series or case reports; no level 1 or 2 evidence studies were identified. CONCLUSION Sensory outcomes are underreported following BPBP, and significant deficits and neuropathic pain are not uncommon and likely underappreciated in this patient population. The current report underscores the need for prospective studies that look beyond motor recovery alone and evaluate sensory outcomes following BPBP.

Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review

PURPOSE To determine the role of night orthosis use after surgical correction of Dupuytren contracture. METHODS We searched MEDLINE, EMBASE, CINAHL, AMED, OTSeeker, and CENTRAL for articles published from inception of the databases to August 2015. Assessment was undertaken by 2 independent reviewers (O.A.S. and S.A.). Methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa instrument. RESULTS Seven studies met the standard for inclusion in this review. A total of 659 patients across these 7 studies were included in the analysis, with follow-up ranging from 3 to 72 months. None of the included studies assessed recurrence. The analysis revealed no significant improvement in range of motion of hand joints for patients who received a static night orthosis after Dupuytren surgery compared with patients without an orthosis. Similarly, no differences were found in patient-reported functional status across the 2 groups. CONCLUSIONS The current literature does not appear to support the use of static night orthosis in addition to hand therapy after surgical correction of Dupuytren contracture. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Health Literacy Among Surgical Patients: A Systematic Review and Meta-analysis

Health literacy is the extent to which patients are able to understand and act upon health information. This concept is important for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to perioperative instructions, and make complex care decisions about interventions. Our review aimed to determine the prevalence of limited health literacy of the surgical patient population. A search of MEDLINE and EMBASE was performed from inception until January 14th 2017 for experimental and observational studies reporting surgical patients’ health literacy measurement. Overall pooled proportion of surgical patients with limited health literacy was calculated using a random-effects model and methodologic quality was assessed. A total of 40 studies representing 18,895 surgical patients were included in our quantitative synthesis. Pooled estimate of limited health literacy was 31.7% (95%CI 24.7–39.2%, I2 99.0%). There was low risk of bias among the majority of the 51 studies included in the qualitative synthesis. Statistical heterogeneity could not be fully accounted for by methodologic quality or patient and surgical characteristics. However, some of the heterogeneity was accounted by measurement tool [combined proportions with the REALM and NVS of 35.6 (95%CI 31.5–39.9, I2 73.0%)]. A number of different health literacy measurement tools were used (19 overall). Our review demonstrates a high prevalence of limited health literacy among surgical patients with considerable heterogeneity. Our findings suggest the importance of recognizing and addressing surgical patients with limited health literacy and the need for standardization in measurement tools.

Abstract: The Impact of Delaying Breast Reconstruction on Patient Expectations and Health Related Quality of Life

METHODS: A retrospective study of patients who underwent immediate breast reconstruction by means of pre-pectoral (Group 1) and sub-pectoral (Group 2) tissue expander placement was performed. Patients in each group were matched for age, BMI, history of neoadjuvant radiotherapy, and type of ADM. Of note, patients in Group 1 received perioperative antibiotic prophylaxis for less than 24 hours while patients in Group 2 received antibiotic prophylaxis for at least 1 week.

Visual Estimation of Dupuytren’s Flexion Contractures—A Prospective Comparative Trial

Purpose: Surgeons and resident physicians in a clinic setting often visually estimate Dupuytren flexion contractures of the hand to follow disease progression and decide on management. No previous study has compared visual estimates with a standardized instrument to ensure measurement reliability. Methods: Consecutive patients consulted for Dupuytren flexion contractures of the hand had individual joint contractures estimated in degrees (°) by both a resident physician and staff surgeon. Estimates were compared with goniometer measurements to generate intraclass correlation coefficients (ICCs), and residents and surgeons were compared based on their accuracy. Results: Twenty-eight patients enrolled in this study, which provided a total of 80 hand joints for analysis. Resident physicians achieved an ICC of 0.42, which indicates poor reliability. The hand surgeon achieved an ICC of 0.86, which indicates high reliability. The surgeon also had better accuracy than the residents. Conclusion: Hand surgeons should be mindful of the limitations of visual estimates of Dupuytren flexion contractures, particularly when conducted by trainees. Joint angle measurements taken for the purposes of research should be done with a goniometer at minimum.

Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta-analysis

Our aim was to determine whether the thoracodorsal (Td) vessels have comparable clinical outcomes to the internal mammary (IM) vessels as recipients for autologous free tissue transfer for breast reconstruction.