RESUMEN
PURPOSE: Our primary aim of our study is to evaluate the prevalence of spin among abstracts in orthopaedic randomized controlled trials (RCTs) with nonsignificant primary endpoints. METHODS: This study was conducted in accordance with a previously written protocol publicly available via the Open Science Framework. PubMed (which includes Medline) was searched for RCTs in orthopaedic surgery. The articles that were identified were then uploaded to Rayyan, and the abstracts were screened for inclusion. To be included, a trial had to have randomized the patients for intervention, statistically compare multiple groups, and had a primary endpoint that was not significant. Odds ratios and summary statistics (frequencies and proportions) were then calculated for spin in the abstracts. RESULTS: Of the 780 articles retrieved from our search string, 250 articles met the inclusion criteria. Analysis resulted in 112/250 (44.80%; [95% CI, 38.64-50.96]) RCTs that containing spin within the abstract. Of the 112 RCTs, 52 (46.43%; [95% CI, 37.19-55.66]) had spin in the results, and 89 (79.46%; [95% CI, 71.98-86.95]) had spin in the conclusion of the abstract. The Journal of Bone and Joint Surgery was found to have the highest prevalence of spin (21/37, 56.76% [95% CI, 40.79%-72.72%]) while Arthroscopy: The Journal of Arthroscopic & Related Surgery had the lowest prevalence of spin (5/15, 33.33% [95% CI, 9.48%-57.19%]). No correlation was found between industry funding and increased odds of spin in the abstract (uOR, 1.10; 95% CI, 0.45-2.63). Discrepancies for our primary endpoint, prevalence of spin among abstracts, were analyzed with Gwet's AC1 inter-rater statistic and found to be 81% [95% CI, 0.75-0.87]. CONCLUSION: Spin was found in 44.8% of the abstracts within our sample of orthopaedic RCTs. Nonsignificant primary data were often represented to seem significant, many orthopaedic RCTs did not indicate primary endpoints, and orthopaedic RCTs infrequently reported trial registration.
RESUMEN
In our case report, we describe a 55-year-old male patient with isolated foot drop due to an intraneural synovial ganglion. We successfully treated the lesion with decompression via epineurotomy combined with primary division of the recurrent articular branch of the common peroneal nerve (CPN). Compression neuropathies of the common peroneal nerve arise from a variety of causes. Intrinsic compression due to intraneural ganglion cysts of the CPN is rare. Previous reports of simple decompression of the cystic fluid have resulted in recurrence. The unified articular theory describes a pathway for fluid to fill from the proximal tibiofibular joint into the CPN via a recurrent articular branch. In our case, we divide this articular branch which we feel prevents recurrence.
RESUMEN
PURPOSE: Growth disturbance of the distal femur is the most common complication after distal femoral growth plate fracture. The purpose of our study was to pool data from the literature to determine the incidence of growth disturbance in relation to the Salter-Harris (SH) classification. Additionally, we evaluated the potential influence of fracture displacement and treatment method. METHODS: A structured PubMed search was performed to identify all reports on distal femoral growth plate fractures published in the English language literature, from 1950 to 2007. Reference lists from identified articles and bibliographies from standard pediatric fracture texts were also scrutinized. For a study to be included in this review, it needed to have at least 10 patients with a minimum of 1 year follow-up and be published in the English language. A total of 16 articles met the criteria for inclusion, which accounted for 564 fractures. RESULTS: Of the 564 fractures, 291 (52%) had a growth disturbance. Growth disturbance occurred in 36% of SH 1 fractures, 58% in SH 2, 49% in SH 3, and 64% in SH 4 fractures. In studies with patient-level data, there was growth disturbance in 65% of fractures with displacement and 31% of the fractures with no displacement had growth disturbance. The odds of a displaced fracture having growth arrest was 4 times greater than that of a nondisplaced fracture having a growth arrest. (P = 0.0015) In the studies with patient-level data, 58% (70/121) of fractures treated without fixation developed a growth disturbance, with 37% (45/121) being a clinically significant disturbance. Of the patients treated with fixation, including those who were initially treated without but lost reduction, 63% (19/30) developed a growth disturbance, with 27% (8/30) being clinically significant. Significant growth disturbance was defined as a leg length discrepancy equal to or greater than 1.5 cm and/or 5 degrees of varus or valgus deformity. SH 4 fractures had the greatest incidence of developing a leg length discrepancy greater than 1.5 cm (9/37). Twenty-two percent (112/506) of all distal femoral growth plate fractures developed a leg length discrepancy of greater than 1.5 cm. CONCLUSION AND SIGNIFICANCE: Fifty-two percent of distal femoral growth plate fractures had some form of growth disturbance. Twenty-two percent (112/506) of all distal femoral growth plate fractures developed a leg length discrepancy of greater than 1.5 cm. SH 1 fractures had the lowest incidence of growth disturbance (36%), whereas SH 4 fractures had the highest rate of growth disturbance at 64%. Although there is a greater incidence of growth disturbance in patients who were treated with fixation (58% versus 63%), there was a decreased incidence of significant growth disturbance (37% versus 27%).