| 1. |
- Bajammal, Sohail S., et al.
(author)
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The use of calcium phosphate bone cement in fracture treatment : A meta-analysis of randomized trials
- 2008
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In: Journal of Bone and Joint Surgery. American volume. - 0021-9355 .- 1535-1386. ; 90:6, s. 1186-96
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Journal article (peer-reviewed)abstract
- BACKGROUND: Available options to fill fracture voids include autogenous bone, allograft bone, and synthetic bone materials. The objective of this meta-analysis was to determine whether the use of calcium phosphate bone cement improves clinical and radiographic outcomes and reduces fracture complications as compared with conventional treatment (with or without autogenous bone graft) for the treatment of fractures of the appendicular skeleton in adult patients. METHODS: Multiple databases, online registers of randomized controlled trials, and the proceedings of the meetings of major national orthopaedic associations were searched. Published and unpublished randomized controlled trials were included, and data on methodological quality, population, intervention, and outcomes were abstracted in duplicate. Data were pooled across studies, and relative risks for categorical outcomes and weighted mean differences for continuous outcomes, weighted according to study sample size, were calculated. Heterogeneity across studies was determined, and sensitivity analyses were conducted. RESULTS: We identified eleven published and three unpublished randomized controlled trials. Of the fourteen studies, six involved distal radial fractures, two involved femoral neck fractures, two involved intertrochanteric femoral fractures, two involved tibial plateau fractures, one involved calcaneal fractures, and one involved multiple types of metaphyseal fractures. All of the studies evaluated the use of calcium phosphate cement for the treatment of metaphyseal fractures occurring primarily through trabecular, cancellous bone. Autogenous bone graft was used in the control group in three studies, and no graft material was used in the remaining studies. Patients managed with calcium phosphate had a significantly lower prevalence of loss of fracture reduction in comparison with patients managed with autograft (relative risk reduction, 68%; 95% confidence interval, 29% to 86%) and had less pain at the fracture site in comparison with controls managed with no graft (relative risk reduction, 56%; 95% confidence interval, 14% to 77%). We were unable to compare pain at the bone-graft donor site between the studies because of methodological reasons. Three studies independently demonstrated improved functional outcomes when the use of calcium phosphate was compared with the use of no grafting material. CONCLUSIONS: The use of calcium phosphate bone cement for the treatment of fractures in adult patients is associated with a lower prevalence of pain at the fracture site in comparison with the rate in controls (patients managed with no graft material). Loss of fracture reduction is also decreased in comparison with that in patients managed with autogenous bone graft.
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| 2. |
- Bhandari, Mohit, et al.
(author)
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Resolving controversies in hip fracture care : the need for large collaborative trials in hip fractures
- 2009
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In: Journal of Orthopaedic Trauma. - 0890-5339 .- 1531-2291. ; 23:6, s. 479-484
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Journal article (peer-reviewed)abstract
- Hip fractures are a significant cause of morbidity and mortality worldwide and the burden of disability associated with hip fractures globally vindicate the need for high-quality research to advance the care of patients with hip fractures. Historically, large, multi-centre randomized controlled trials have been rare in the orthopaedic trauma literature. Similar to other medical specialties, orthopaedic research is currently undergoing a paradigm shift from single centre initiatives to larger collaborative groups. This is evident with the establishment of several collaborative groups in Canada, in the United States, and in Europe, which has proven that multi-centre trials can be extremely successful in orthopaedic trauma research.Despite ever increasing literature on the topic of his fractures, the optimal treatment of hip fractures remains unknown and controversial. To resolve this controversy large multi-national collaborative randomized controlled trials are required. In 2005, the International Hip Fracture Research Collaborative was officially established following funding from the Canadian Institute of Health Research International Opportunity Program with the mandate of resolving controversies in hip fracture management. This manuscript will describe the need, the information, the organization, and the accomplishments to date of the International Hip Fracture Research Collaborative.
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| 3. |
- Desai, Neel, et al.
(author)
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Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis.
- 2014
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:5, s. 1009-1023
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Journal article (peer-reviewed)abstract
- To determine whether anatomic double-bundle anterior cruciate ligament (ACL) reconstruction compared to anatomic single-bundle ACL reconstruction more effectively restored antero-posterior (A-P) laxity, rotatory laxity and reduced frequency of graft rupture. Our hypothesis was that anatomic double-bundle ACL reconstruction results in superior rotational knee laxity and fewer graft ruptures due to its double-bundle tension pattern, compared with anatomic single-bundle ACL reconstruction.
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| 4. |
- Hewitt, Dante M., et al.
(author)
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Milliarcsecond localization of the hyperactive repeating FRB 20220912A
- 2024
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In: Monthly Notices of the Royal Astronomical Society. - 0035-8711 .- 1365-2966. ; 529:2, s. 1814-1826
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Journal article (peer-reviewed)abstract
- We present very long-baseline interferometry (VLBI) observations of the hyperactive repeating FRB 20220912A using the European VLBI Network (EVN) outside of regular observing sessions (EVN-Lite). We detected 150 bursts from FRB 20220912A over two observing epochs in 2022 October. Combining the burst data allows us to localize FRB 20220912A to a precision of a few milliarcseconds, corresponding to a transverse scale of less than 10 pc at the distance of the source. This precise localization shows that FRB 20220912A lies closer to the centre of its host galaxy than previously found, although still significantly offset from the host galaxy's nucleus. On arcsecond scales, FRB 20220912A is coincident with a persistent continuum radio source known from archival observations; however, we find no compact persistent emission on milliarcsecond scales. The 5σ upper limit on the presence of such a compact persistent radio source is 120 μJy, corresponding to a luminosity limit of (D/362.4 Mpc)erg s-1 Hz-1. The persistent radio emission is thus likely to be from star formation in the host galaxy. This is in contrast to some other active FRBs, such as FRB 20121102A and FRB 20190520B.
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| 5. |
- Kakar, Sanjeev, et al.
(author)
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Technical considerations in the operative management of femoral neck fractures in elderly patients : a multinational survey.
- 2007
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In: The Journal of trauma, injury, infection, and critical care. - : Ovid Technologies (Wolters Kluwer Health). - 1079-6061 .- 0022-5282. ; 63:3, s. 641-646
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To identify current opinions among orthopedic traumatologists relating to technical aspects of internal fixation and arthroplasty for patients with femoral neck fractures. METHODS: We developed and administered a survey to orthopedic surgeons who were members of the Orthopedic Trauma Association and European clinics affiliated with AO International (Davos, Switzerland). Surgeons reported preferences in specific aspects of the surgical technique for internal fixation as well as arthroplasty. Each surgeon received either a mailed package (7-page survey, a personalized cover letter, and a stamped return envelope) or an email with a link to the same survey on the Internet with an identification code. At 6 weeks, 12 weeks, and 18 weeks after the initial mailing, we remailed the questionnaire to all nonresponders. RESULTS: Of the 442 surgeons who were sent the questionnaire, 298 (68%) responded. The typical respondent was a North American aged more than 40 years, in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center. Among surgeons who treated displaced femoral neck fractures with arthroplasty, significant disparities existed in terms of the type of anesthesia (51% preferring general anesthesia), surgical approach (47% used posterior approach), and placement of unipolar implants (50%). Surgeons tended to agree on the use of cement fixation (69%), repairing the capsule (80%), and not using a drain postoperatively (68%). Surgeons who preferentially treated hip fractures with internal fixation tended to have a lack of consensus in terms of what constituted acceptable surgical delays (43% allowing greater than 48 hours) and which screw configuration to use, with more than half using a triangle with base inferior construct. Surgeons tended to agree on the use of closed fracture reduction techniques (69%), three cannulated screws (73%), and did not routinely perform a capsulotomy (80%) or aspirate the fracture hematoma (90%). Within both treatment groups (internal fixation and arthroplasty), surgeons tended to agree on the use of perioperative antibiotics (>92%), thromboprophylaxis (98%), and postoperative weight bearing status (>87%). CONCLUSIONS: A general lack of consensus exists among orthopedic trauma surgeons in the management of displaced femoral neck fractures. With an ever-growing emphasis upon the practice of evidence-based medicine, we have demonstrated several disparities in the technical aspects of fixation and perioperative care likely caused by a general lack of available evidence. We recommend the need for future research and large collaborative efforts.
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| 6. |
- Karlsson, Jón, 1953, et al.
(author)
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A practical guide to research: design, execution, and publication.
- 2011
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In: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 27:4 Suppl
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Journal article (peer-reviewed)
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| 7. |
- Li, Chuan Silvia, et al.
(author)
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Orthopedic surgeons feel that there is a treatment gap in management of early OA: international survey.
- 2014
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22, s. 363-378
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Journal article (peer-reviewed)abstract
- PURPOSE: To understand orthopedic surgeons' views, preferences, and awareness on "treatment gap" and various conservative and surgical treatments for early to mid-stage knee osteoarthritis (OA). METHODS: A self-administered questionnaire on the treatment of knee OA was developed in collaboration with orthopedic surgeons with extensive research experience and methodological expertise. The survey was distributed electronically to a group of international orthopedic surgeons and surgical trainees. The data were collected, reviewed, and analyzed using descriptive statistics. RESULTS: One hundred and seventy-three surgeons and surgical trainees completed the survey. The respondents reported that about 58% of the patients they treat have early to mid-stage knee OA (Kellgren and Lawrence grade I-III). There were significantly higher usage of medications and lower usage of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) (P<0.05) in developing countries than in developed countries. Four of five surgeons (84%) perceived a need for better treatments for younger (<60years old) physically active OA patients in which UKA or TKA is not indicated. Most respondents (80%) would be willing to adjust age/activity threshold for surgery if a procedure was reversible and recovery was minimal. Two of three surgeons (68.4%) perceived a treatment gap for early knee OA. However, effective treatments for patients within the treatment gap would have substantial positive social, and economic impacts. CONCLUSION: The study suggests an ongoing treatment gap for patients with early knee OA and the need for better evidence to guide practice.
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| 8. |
- Samuelsson, Kristian, 1977, et al.
(author)
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Level of Evidence in Anterior Cruciate Ligament Reconstruction Research: A Systematic Review.
- 2013
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In: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 41:4, s. 924-934
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Research review (peer-reviewed)abstract
- BACKGROUND:There have been numerous studies on anterior cruciate ligament (ACL) reconstruction. Considering the vast number of studies, a quick assessment reveals rather few with a high level of evidence. PURPOSE:The primary aim was to categorize the study type and level of evidence of studies on primary ACL reconstruction by applying the level of evidence rating system proposed by the Oxford Centre for Evidence-Based Medicine. The secondary aims were to correlate the level of evidence with the impact factor of the journal, to evaluate the level of evidence over time, and to evaluate the geographic distribution of the included studies. STUDY DESIGN:Systematic review. METHODS:An electronic search was performed using the databases PubMed, EMBASE, and Cochrane Library. Studies published from January 1995 to August 2011 were included. Therapeutic studies written in English that report on isolated primary ACL reconstruction with clinical outcome measurements related to the reconstruction were included. Categorization and implementation of the level of evidence were performed. Correlation between the level of evidence and the impact factor of the journal was analyzed together with linear regression models to reveal any significant trends over time. RESULTS:A total of 7154 studies were analyzed, of which 1510 were included. Analysis of the study types revealed that case series (n = 494; 32.7%) was the most frequent study type. Randomized controlled trials represented 9.2% (n = 139) of the sample, whereas meta-analyses were rare. Single-bundle studies were the most common studies (n = 1333; 88.3%), followed by double-bundle (n = 98; 6.5%) and single- versus double-bundle (n = 79; 5.2%). The journals Arthroscopy, Knee Surgery Sports Traumatology Arthroscopy (KSSTA), and American Journal of Sports Medicine (AJSM) represented 43.5% (n = 657) of the included studies. Arthroscopy had the highest number of publications in general and in level 4 and 5 studies, whereas AJSM had the lowest number of the 3. AJSM had the highest number of level 1 and 2 studies in general. The mean level of evidence calculated without level 5 studies was 3.15 for Arthroscopy, 3.20 for KSSTA, and 2.9 for AJSM. There was a significant correlation (P < .05) between the impact factor of the journal and mean level of evidence of the journal and the proportion high level of evidence studies (levels 1 and 2). There was a significant (P < .05) trend toward higher mean level of evidence over time. CONCLUSION:Most therapeutic studies on primary ACL reconstruction were of low level of evidence, and there was a positive correlation between the journal's impact factor and the mean level of evidence and the proportion of high level of evidence studies. There was significant trend toward higher mean level of evidence over time.
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| 9. |
- Wennergren, David, et al.
(author)
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High reliability in classification of tibia fractures in the Swedish Fracture Register.
- 2016
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In: Injury. - 1879-0267. ; 47:2, s. 478-82
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Journal article (peer-reviewed)abstract
- The Swedish Fracture Register (SFR) was started in 2011 and registers fractures of all types, treated either surgically or non-surgically. Twenty-six orthopaedic departments in Sweden are affiliated and a total of 84,000 fractures have been registered. The physician who establishes the diagnosis of the fracture registers and classifies it according to the AO/OTA classification. The accuracy of the classification of fractures is important for the reliability of the data in the SFR. This study aimed to evaluate how accurate the classification of tibia fractures in the register is.Three experienced trauma surgeons (raters) were presented with the radiographs of 114 patients with tibia fractures randomly allocated from the SFR. The raters classified the fractures independently and blinded to clinical patient information in two classification sessions with a time interval of one month. The AO/OTA classification coded by the three expert raters (our predefined gold standard) was compared with the classifications in the SFR. Inter- and intra-observer agreement was evaluated. The degree of agreement was reported using the approach of Landis and Koch.The accuracy of the SFR, defined as agreement between the SFR and the gold standard classification, was kappa=0.75 for the AO/OTA type and 0.56 for the AO/OTA group, corresponding to substantial and moderate agreement, respectively. Inter-observer agreement across the three expert raters was kappa=0.74 for the AO/OTA type and 0.53 for the AO/OTA group. Intra-observer agreement was kappa=0.74-0.79 for the AO/OTA type and 0.62-0.64 for the AO/OTA group.This study shows that the accuracy of classification of tibia fractures in the SFR was substantial for the AO/OTA type (kappa=0.75) and moderate for the AO/OTA group (kappa=0.56) as defined by Landis and Koch. This degree of accuracy is similar to that in previous studies. We interpret this as meaning that the results of this study demonstrate the high reliability of the data in the SFR and enable the SFR to be used for further scientific analysis.
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