Journal of orthopaedic surgery and research
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Review Meta Analysis
Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials.
Perioperative systemic steroid administration for rapid recovery in total knee and hip arthroplasty (TKA/THA) is an important and controversial topic. We conducted this systematic review and meta-analysis to evaluate the overall benefits and harms of perioperative systemic steroid in patients undergoing TKA and THA. ⋯ Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain, high-dose systemic steroid plays a critical role in rapid recovery to TKA and THA. The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control. More large, high-quality studies that investigate the safety and dose-response relationship are necessary.
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Review Meta Analysis Comparative Study
Comparison of local infiltration analgesia and sciatic nerve block for pain control after total knee arthroplasty: a systematic review and meta-analysis.
This meta-analysis aimed to perform a meta-analysis to evaluate the efficiency and safety between local infiltration analgesia (LIA) and sciatic nerve block (SNB) when combined with femoral nerve block (FNB) after total knee arthroplasty (TKA). ⋯ FNB-combined SNB provides superior pain relief and less morphine consumption within the first 24 h compared FNB-combined LIA in total knee arthroplasty. In addition, there were fewer side effects associated with SNB. Because the sample size and the number of included studies were limited, a multicenter RCT is needed to identify the effects of the two kinds of methods and further work must include range of motion analyses and functional test.
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The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons' anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience. ⋯ The guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy.
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Comminuted fractures of the proximal humerus are generally treated with the locking plate system, and clinical results are satisfactory. However, unstable support of the medial column results in varus malunion and screw perforation. We designed a novel medial anatomical locking plate (MLP) to directly support the medial column. Theoretically, the combined application of locking plate and MLP (LPMP) would directly provide strong dual-column stability. We hypothesized that the LPMP could provide greater construct stability than the locking plate alone (LP), locking plate combined with a fibular graft (LPSG), and locking plate combined with a distal radius plate (LPDP). ⋯ From the finite element viewpoint, the LPMP method provided both lateral and medial direct support. The LPMP system was effective in treating proximal humeral fracture with an unstable medial column.
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Trinity Evolution® (TE), a viable cellular bone allograft, previously demonstrated high fusion rates and no safety-related concerns after single-level anterior cervical discectomy and fusion (ACDF) procedures. This prospective multicenter clinical study was performed to assess the radiographic and clinical outcomes of TE in subjects undergoing two-level ACDF procedures. ⋯ Patients undergoing two-level ACDF with TE in combination with a PEEK interbody spacer and supplemental anterior fixation had a high rate of fusion success without any serious adverse events related to the graft material.