RESUMEN

BACKGROUND: Acromioclavicular joint (ACJ) disruptions are corrected by surgery either with an endobutton or a hook plate. The results in the long term were found to be similar in many randomized controlled trials. This study aims to conduct a meta-analysis to evaluate the functional outcome and complications of double endo button versus clavicular hook plate (CHP) for ACJ disruption (Rockwood types III-VI). MATERIALS AND METHODS: Two authors independently searched related articles from electronic databases (PubMed, Google Scholar, MEDLINE, SCOPUS, and Web of Science) till January 26, 2022. The data were extracted from the related articles and analyzed by Stata software. For bias calculation of each study, the Newcastle-Ottawa scale and the RevMan 5.4 software were used. RESULTS: 14 cohort studies, 2 randomized control trial studies, and 1 case-control study including patients were selected in this meta-analysis. The results of our study showed a significantly higher Constant-Murley Score (WMD 5.79, 95% confidence interval [CI] 2.23-9.36), Visual Analog Scale (WMD- 0.63, 95% CI [-0.79, -0.46]) and University of California at Los Angeles shoulder score (UCLA) scale (WMD 3.32, 95% CI [2.87, 3.77]) for double endobutton group. At the same time, some complications like implant failure were more common in the double endobutton group. CONCLUSION: This meta-analysis shows better functional and clinical outcomes of shoulder joint for the treatment of acromioclavicular joint (ACJ) disruption cases (Rockwood types III-VI) with no need for secondary operation, unlike the CHP. Complications like subacromial erosion, ACJ arthrodesis, and infection rate are higher in the CHP group, whereas the chance of implant failure is higher in the double endobutton group.

---

RésuméLes perturbations de l'articulation acromio-claviculaire (ACJ) sont corrigées par chirurgie soit avec un endobouton, soit avec une plaque à crochets. Les résultats à long terme se sont révélés similaires dans de nombreux essais contrôlés randomisés. Cette étude vise à mener une méta-analyse pour évaluer les résultats fonctionnels et les complications du double endobouton par rapport à la plaque à crochet claviculaire (CHP) pour la perturbation de l'ACJ (Rockwood types III ­ VI).Matériels et méthodes:Deux auteurs ont recherché indépendamment des articles connexes dans des bases de données électroniques (PubMed, Google Scholar, MEDLINE, SCOPUS et Web of Science) jusqu'au 26 janvier 2022. Les données ont été extraites des articles connexes et analysées par le logiciel Stata. Pour le calcul du biais de chaque étude, l'échelle de Newcastle-Ottawa et le logiciel RevMan 5.4 ont été utilisés.Résultats:14 études de cohorte, 2 études d'essais contrôlés randomisés et 1 étude cas-témoins incluant des patients ont été sélectionnées dans cette méta-analyse. Les résultats de notre étude ont montré un score de Constant-Murley significativement plus élevé (WMD 5,79, intervalle de confiance [IC] à 95 % 2,23­9,36), une échelle visuelle analogique (WMD− 0,63, IC à 95 % [−0,79, −0,46]) et un score universitaire. de Californie sur l'échelle de score d'épaule de Los Angeles (UCLA) (WMD 3,32, IC à 95 % [2,87, 3,77]) pour le groupe à double endobouton. Dans le même temps, certaines complications comme l'échec de l'implant étaient plus fréquentes dans le groupe à double endobouton.Conclusion:Cette méta-analyse montre de meilleurs résultats fonctionnels et cliniques de l'articulation de l'épaule pour le traitement des cas de rupture de l'articulation acromio-claviculaire (ACJ) (types Rockwood III à VI) sans nécessité d'opération secondaire, contrairement à la CHP. Les complications telles que l'érosion sous-acromiale, l'arthrodèse de l'ACJ et le taux d'infection sont plus élevées dans le groupe CHP, alors que le risque d'échec de l'implant est plus élevé dans le groupe à double endobouton.

Asunto(s)

Articulación Acromioclavicular , Placas Óseas , Articulación Acromioclavicular/cirugía , Humanos , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Clavícula/cirugía , Rango del Movimiento Articular , Complicaciones Posoperatorias/epidemiología , Masculino , Femenino

RESUMEN

Background Periarthritis or frozen shoulder, also called adhesive capsulitis, is characterized by stiffness and pain along with gradual loss of active and passive movement in the glenohumeral joint. More than 2-5% of the population suffers from periarthritis with a higher incidence in the age group of 40-60 years. The various treatment modalities used for its management include simple physiotherapy, short-wave therapy, ultrasonic therapy, transcutaneous electrical nerve stimulation, hydrotherapy, analgesics, intra-articular injections, manipulation under general anesthesia (MUA), and surgical management. The application of intra-articular steroid injection has been a common and efficacious option in rapidly diminishing shoulder pain and disability. Some recent studies reported a better outcome using platelet-rich plasma (PRP) injections in frozen shoulder cases. Hence, this randomized controlled trial was conducted to compare the efficacy of intra-articular injections of PRP and triamcinolone in patients of shoulder periarthritis in a population from the eastern region of India Methodology A total of 60 patients with periarthritis shoulder were allocated into two groups after randomization. Group A received 2 mL autologous PRP, and Group B received 2 mL of triamcinolone (40 mg/mL) intra-articular injection. Patients were followed up on the 4th week, 12th week, and 24th week. The assessment of pain and function using the visual analog scale (VAS) score and the Disabilities of Arm, Shoulder, and Hand (DASH) score, respectively, was done at each follow-up. The primary analyses of both primary and secondary outcomes were conducted in the intention-to-treat (ITT) population. SPSS version 24 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results The mean VAS score in the PRP and triamcinolone groups was 14.33 ± 3.79 and 31.63 ± 7.62, respectively (p = 0.0001) after 24 weeks. The mean DASH score in the PRP and triamcinolone groups was 18.08 ± 8.08 and 31.76 ± 3.63, respectively (p = 0.0001), which shows significant improvement in both pain and disability scores in the PRP group after 24 weeks. Conclusions The triamcinolone group showed better short-term outcomes whereas PRP showed better long-term outcomes in reducing pain and disability scores in terms of VAS and DASH scores.

RESUMEN

A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.