Journal of orthopaedic surgery and research
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Review Meta Analysis Comparative Study
Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphyseal damage: a meta-analysis of randomized controlled trials.
Distal metadiaphyseal tibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and plate internal fixation (PL) are the two mainstay treatments for tibial fractures, but agreement on the best internal fixation for distal tibial fractures is still controversial. This meta-analysis was designed to compare the success of IMN and PL fixations in the treatment of distal metadiaphyseal tibial fractures, in terms of complications and functional recovery. ⋯ Although no significant difference was seen between IMN and PL fixation with regards to the operation time, radiation time, nonunion, deep infection delay union, union time, AOFAS, and Disability Rating Index, significant differences were seen in occurrence of malunion, superficial infection, FFI, and knee pain. Based on this evidence, IMN appears to be a superior choice for functional improvement of the ankle and reduction of postoperative wound superficial infection. PL internal fixation seems to be more advantageous in achieving anatomical reduction and decreasing knee pain.
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Review Meta Analysis
The efficacy of fascia iliaca compartment block for pain control after total hip arthroplasty: a meta-analysis.
Fascia iliaca compartment block (FICB) provides an analgesic option for total hip arthroplasty (THA) patients. The evidence supporting FICB is still not well established. The purpose of this meta-analysis was to assess FICB for pain control in THA patients. ⋯ FICB could be used to effectively reduce pain intensity up to 24 h, total morphine consumption, and length of hospital stay in THA patients. Optimal strategies of FICB need to be studied in the future.
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Randomized Controlled Trial Comparative Study
Comparing two dry needling interventions for plantar heel pain: a protocol for a randomized controlled trial.
Both manual therapy techniques and dry needling have shown to be effective treatment options for the treatment of plantar heel pain; however, in recent years, other techniques based on dry needling (DN), such as percutaneous needle electrolysis (PNE), have also emerged. Currently, PNE is being used in clinical practice to manage myofascial trigger points, despite the lack of studies comparing the effects of this technique over dry needling. Therefore, the aim of this randomized controlled study is to compare the effectiveness of DN versus PNE for improving the level of pain experienced by patients suffering from plantar heel pain provoked by myofascial trigger points. ⋯ The justification for this trial is the need to improve current understanding regarding the effectiveness of treatments targeting the rehabilitation of plantar heel pain. This study will be the first randomized controlled trial to directly compare the effectiveness of DN and PNE combined with a specific stretching program for the treatment of plantar heel pain provoked by myofascial trigger points.
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Restoration of hand function after total brachial plexus root avulsion (tBPRA) is a difficult problem in surgical management. A new modified approach in repairing tBPRA is to use a subcutaneous tunnel across the anterior surface of the chest and neck, and then transfer the contralateral C7 root (cC7) to the lower trunk. However, the anatomical details of this method have not yet been fully described and assessed. The objective of this study was to quantitatively describe the nerve transfer using a cadaveric surgical simulation. ⋯ For surgical management of total tBPRA, transfer of the cC7 nerve to the C8-T1 or lower trunk via a subcutaneous tunnel across the chest and neck will likely be superior to a conventional cC7 root transfer in the clinic. This approach shortens the nerve graft needed and nerve regeneration distance, decreases the number of neurorrhaphy sites, and makes full use of the donor nerves, which may benefit hand flexion restoration.
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The position of Kirschner wires (K-wires) has an influence on the outcome of modified tension-band wiring (MTBW) in fixing patella fractures. However, the instruction for K-wires positioning is not clear enough. This study tried to clarify the effect of K-wires positioning and provide evidence for a more definite instruction. ⋯ The SP of K-wires plays a role in the function of MTBW in the surgical management of transverse patella fracture. At 45° knee flexion, posteriorly placed (close to the articular surface) K-wires enable optimal stability and stress for the fracture, which provides basis for the positioning of K-wires in clinical practice.