Dataset Information

The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis.

ABSTRACT:

Background

Management of traumatic lower extremity injuries requires a skill set of orthopedic surgery and plastic surgery to optimize the return of form and function. A systematic review and meta-analysis was performed comparing demographics, injuries, and surgical outcomes of patients sustaining lower extremity traumatic injuries receiving either orthoplastic management or nonorthoplastic management.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and GRADE certainty evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were systematically and independently searched. Nine studies published from 2013 through 2019 compared 1663 orthoplastic managed patients to 692 nonorthoplastic managed patients with traumatic lower extremity injuries.

Results

Orthoplastic management, compared to nonorthoplastic management likely decreases time to bone fixation [standard mean differences: -0.35, 95% confidence interval (CI): -0.46 to -0.25, P < 0.0001; participants = 1777; studies = 3; I² = 0%; moderate certainty evidence], use of negative pressure wound therapy [risk ratios (RR): 0.03, 95% CI: 0.00-0.24, P = 0.0007; participants = 189; studies = 2; I² = 0%; moderate certainty evidence] with reliance on healing by secondary intention (RR: 0.02, 95% CI: 0.00-0.10, P < 0.0001; participants = 189; studies = 2; I² = 0%; moderate certainty evidence), and risk of wound/osteomyelitis infections (RR: 0.37, 95% CI: 0.23-0.61, P < 0.0001; participants = 224; studies = 3; I² = 0%; moderate certainty evidence). Orthoplastic management likely results in more free flaps compared to nonorthoplastic management (RR: 3.46, 95% CI: 1.28-9.33, P = 0.01; participants = 592; studies = 5; I² = 75%; moderate certainty evidence).

Conclusion

Orthoplastic management of traumatic lower extremity injuries provides a synergistic model to optimize and expedite definitive skeletal fixation and free flap-based soft-tissue coverage for return of extremity form and function.

SUBMITTER: Klifto KM

PROVIDER: S-EPMC8099387 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundLower limb trauma requiring immobilization is a significant contributor to overall venous thromboembolism (VTE) burden. The clinical effectiveness of thromboprophylaxis for this indication and the optimal agent strategy are still a matter of debate. Our main objective was to assess the efficacy of pharmacological thromboprophylaxis to prevent VTE in patients with isolated temporary lower limb immobilization after trauma. We aimed to estimate and compare the clinical efficacy and the safety of the different thromboprophylactic treatments to determine the best strategy.Methods and findingsWe conducted a systematic review and a Bayesian network meta-analysis (NMA) including all available randomized trials comparing a pharmacological thromboprophylactic treatment to placebo or to no treatment in patients with leg immobilization after trauma. We searched Medline, Embase, and Web of Science until July 2021. Only RCT or observational studies with analysis of confounding factors including adult patients requiring temporary immobilization for an isolated lower limb injury treated conservatively or surgically and assessing pharmacological thromboprophylactic agents or placebo or no treatment were eligible for inclusion. The primary endpoint was the incidence of major VTE (proximal deep vein thrombosis, symptomatic VTE, and pulmonary embolism-related death). We extracted data according to Preferred Reporting Items for Systematic Reviews and Meta-analyses for NMA and appraised selected trials with the Cochrane review handbook. Fourteen studies were included (8,198 patients). Compared to the control group, rivaroxaban, fondaparinux, and low molecular weight heparins were associated with a significant risk reduction of major VTE with an odds ratio of 0.02 (95% credible interval (CrI) 0.00 to 0.19), 0.22 (95% CrI 0.06 to 0.65), and 0.32 (95% CrI 0.15 to 0.56), respectively. No increase of the major bleeding risk was observed with either treatment. Rivaroxaban has the highest likelihood of being ranked top in terms of efficacy and net clinical benefit. The main limitation is that the network had as many indirect comparisons as direct comparisons.ConclusionsThis NMA confirms the favorable benefit/risk ratio of thromboprophylaxis for patients with leg immobilization after trauma with the highest level of evidence for rivaroxaban.Trial registrationPROSPERO CRD42021257669.

Project description:BACKGROUND:The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i's) and lower extremity amputation is unclear. PURPOSE:To systematically review randomized control trials (RCTs) and observational studies quantifying risk of lower extremity amputations associated with SGLT2i use. DATA SOURCES AND STUDY SELECTION:We searched PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials from January 2011 to February 2020 for RCTs and observational studies including lower extremity amputation outcomes for individuals with type 2 diabetes mellitus treated with SGLT2i's vs. alternative treatments or placebo. DATA EXTRACTION AND SYNTHESIS:Two reviewers independently extracted data. MAIN OUTCOMES AND MEASURES:Our primary outcome was risk of lower limb amputation. Secondary outcomes included peripheral arterial disease, peripheral vascular disease, venous ulcerations, and diabetic foot infections. We also evaluated the risk of bias. We conducted random and fixed effects relative risk meta-analysis of RCTs. RESULTS:After screening 2,006 studies, 12 RCTs and 18 observational studies were included, of which 7 RCTs and 18 observational studies had at least one event. The random effects meta-analysis of 7 RCTs suggested the absence of a statistically significant association between SGLT2i exposure with evidence of substantial statistical heterogeneity (n = 424/23,716 vs n = 267/18,737 in controls; RR 1.28, CI's 0.93-1.76; I2 = 62.0%; p = 0.12) whereas fixed effects analysis showed an increased risk with statistical heterogeneity (RR 1.27, 1.09-1.48; I2 = 62%; p = 0.003). Subgroup analysis of canagliflozin vs placebo showed a statistically significantly increased risk in a fixed effects meta-analysis (n = 2 RCTs, RR 1.59, 1.26-2.01; I2 = 88%; p = 0.0001) whereas the meta-analysis of dapagliflozin or empagliflozin (n = 2 RCTs each) and a single RCT for ertugliflozin did not show a significantly increased risk. The findings from observational studies were too heterogeneous to be pooled in a meta-analysis and draw meaningful conclusions. Both randomized and observational studies were of generally good methodological quality. CONCLUSIONS:Overall, there was no consistent evidence of SGLT2i exposure and increased risk of amputation. The increased risk of amputation seen in the large, long-term Canagliflozin Cardiovascular Assessment Study (CANVAS) trial for canagliflozin, and select observational studies, merits continued exploration.

Project description:BackgroundCurrently, work-related musculoskeletal disorders are a significant public health concern and are a leading cause of disability-adjusted life years and reduced quality of life worldwide. In developing countries, including Ethiopia, as a result of poor occupational health and safety practices and underreporting of the problems, work-related musculoskeletal disorders have been increased, remaining less prioritized, and there is no adequate evidence on the prevalence of musculoskeletal disorders. Thus, the current study aimed to determine and provide the overall prevalence of occupational-related upper and lower extremity musculoskeletal pain among the working population of Ethiopia.MethodsThe current study considered full-text articles conducted in Ethiopia, written in English, and published from 2017 to 2020. Ten electronic databases: PubMed/MEDLINE, Web of Science, SCOPUS, Google Scholar, MedNar, Embase, CINAHL, Cochrane Library, African Index Medicus, and African Journals Online database were used to search the articles using a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings, and main keywords. The quality assessment of the articles was performed using the Joanna Briggs Institute Critical Appraisal tools to determine the relevance of the article to the current study.ResultsOf the 1377 articles identified from the included electronic databases, 12 studies were included in the systematic review and meta-analysis. The study found that the pooled prevalence of occupational-related elbow pain, wrist/hand pain, knee/leg pain, foot/ankle pain, and hip/thigh pain in the previous one year was 19.7% (95% CI: 12.3, 30.1), 24.2% (95% CI: 17.4, 32.7), 25.0% (95% CI: 18.5, 32.8), 20.2% (95% CI: 12.8, 30.4), and 15.5% (95% CI: 9.9, 23.4), respectively. Based on a subgroup analysis, the last year's pooled prevalence of occupational-related elbow, wrist/hand, knee/leg, foot/ankle, and hip/thigh pain was increased to 33.7% [95% CI: 31.9, 35.5], 29.7% [95% CI: 28.2, 31.2], 31.5% [95% CI: 29.9, 33.2], 30.6% [95% CI: 29.0, 32.4], and 27.3% [95% CI: 25.5, 29.2], respectively.ConclusionOccupational-related musculoskeletal disorders continue to have a potential impact on workers' health and productivity. The current study found that the overall pooled prevalence of occupational-related upper and lower extremity musculoskeletal disorders in the last year ranged from 15.5 to 33.7%. Implementing occupational health and safety measures play an important role in preventing work-related musculoskeletal disorders and other occupational hazards.

Project description:BackgroundInertial measurement units (IMUs) are useful in monitoring running and alerting running-related injuries in various sports settings. However, the quantitative summaries of the validity and reliability of the measurements from IMUs during running are still lacking. The purpose of this review was to investigate the concurrent validity and test-retest reliability of IMUs for measuring gait spatiotemporal outcomes and lower extremity kinematics of health adults during running.MethodsPubMed, CINAHL, Embase, Scopus and Web of Science electronic databases were searched from inception until September 2021. The inclusion criteria were as follows: (1) evaluated the validity or reliability of measurements from IMUs, (2) measured specific kinematic outcomes, (3) compared measurements using IMUs with those obtained using reference systems, (4) collected data during running, (5) assessed human beings and (6) were published in English. Eligible articles were reviewed using a modified quality assessment. A meta-analysis was performed to assess the pooled correlation coefficients of validity and reliability.ResultsTwenty-five articles were included in the systematic review, and data from 12 were pooled for meta-analysis. The methodological quality of studies ranged from low to moderate. Concurrent validity is excellent for stride length (intraclass correlation coefficient (ICC) (95% confidence interval (CI)) = 0.937 (0.859, 0.972), p < 0.001), step frequency (ICC (95% CI) = 0.926 (0.896, 0.948), r (95% CI) = 0.989 (0.957, 0.997), p < 0.001) and ankle angle in the sagittal plane (r (95% CI) = 0.939 (0.544, 0.993), p = 0.002), moderate to excellent for stance time (ICC (95% CI) = 0.664 (0.354, 0.845), r (95% CI) = 0.811 (0.701, 0.881), p < 0.001) and good for running speed (ICC (95% CI) = 0.848 (0.523, 0.958), p = 0.0003). The summary Fisher's Z value of flight time was not statistically significant (p = 0.13). Similarly, the stance time showed excellent test-retest reliability (ICC (95% CI) = 0.954 (0.903, 0.978), p < 0.001) and step frequency showed good test-retest reliability (ICC (95% CI) = 0.896 (0.837, 0.933), p < 0.001).ConclusionsFindings in the current review support IMUs measurement of running gait spatiotemporal parameters, but IMUs measurement of running kinematics on lower extremity joints needs to be reported with caution in healthy adults.Trial registrationPROSPERO Registration Number: CRD42021279395.