In a decidedly upper limb themed series of reviews this edition of Cochrane Corner summarises four new and updated reviews published by the Cochrane Bone, Joint and Muscle Trauma Group over the last few months. The tenacious reviewers at the Cochrane collaboration have turned their beady eyes to conservative treatments for shoulder dislocations and clavicle fractures along with evaluation of femoral nerve blocks in knee replacement and how to best manage entrapment injuries in children.
The first Cochrane Corner of 2014 reports on a bumper number of new and updated reviews from the Cochrane Collaboration. Since November the Cochrane collaboration have turned their beady eye to scrutinise several topical (and sometimes controversial) orthopaedic issues such as pin site care, the use of Continuous Passive Motion (CPM) in the rehabilitation of total knee replacement (TKR) and the efficacy of nerve blocks.
While the Cochrane Collaboration have been busy over the last four months, only a handful of their published reviews have been of any relevance to orthopaedic and trauma surgeons. Those that are provide the reader with an overview of work on imaging modalities, antibiotic therapy, changes to the surgical site dressing and practices surrounding post-operative wound management, including post-op bathing and negative pressure wound therapy for use in the treatment of diabetic foot wounds.
Things have not been quiet in the Cochrane Collaboration in the four months since the last 'Cochrane Corner', with the publication of six new or updated reviews summarised here, all conducted with the bulletproof Collaboration's methodology representing the pinnacle of evidence relevant to orthopaedic surgeons.
Bone is a common site of metastatic disease. Skeletal complications include disabling pain and pathological fractures. Palliative surgery for incurable metastatic bone lesions aims to preserve quality of life and function by providing pain relief and stable mobility with fixation or replacement. Current literature has few treatment studies. We present a 5 year longitudinal cohort study of surgery for metastatic bone disease at our large teaching hospital reviewing our complication and mortality rates. Patients that underwent palliative surgery for metastatic bone lesions were identified from operative records. Demographics, clinical details and outcomes were recorded. Kaplan-Meier analysis was used to calculate survivorship.Aims
Methods
The evolution of locked anatomical clavicular plating in combination with evidence to suggest that fixation of clavicle fractures yields better outcome to conservative treatments has led to an increasing trend towards operative management. There is no evidence however to compare early fixation with delayed reconstruction for symptomatic non- or mal-union. We hypothesize that early intervention yields better functional results to delayed fixation. Between August 2006 and May 2010, 97 patients were managed with operative fixation for their clavicular fracture. Sixty eight with initial fixation and 29 delayed fixation for clavicular non- or mal-union. Patients were prospectively followed up to radiographic union, and outcomes were measured with the Oxford Shoulder Score, QuickDASH, EQ5D and a patient interview. Mean follow-up was to 30 months. All patients were managed with Acumed anatomical clavicular plates.Purpose
Methods
One elderly patient with a fatal intracerebral bleed was found to have justified an early CT scan on the criteria of more than one vomiting episode and a history of unconsiousness.
Our study investigated a consecutive series of 53 cal-caneal fractures treated at Southend General Hospital during a 4 year period. In total 75% were intrarticular and 25% extrarticular. Overall 51.92% of patients underwent operative intervention 66.67% of these being intrarticular. All patients underwent AOFAS scoring. The minimum followup period was 6 months and the average was 18 months. In the non-operative group (Undisplaced intra/extrarticular with Bohler’s angle 20–40 degrees) the <
50 year old group had an average AOFAS score of 86.3 versus 63.64 in the >
50 year old group. In the operative group the AOFAS score was heavily dependent upon restoration of Bohler’s angle. This study shows that if Bohler’s angle is <
20 degrees the average AOFAS score after followup was 51.00 but if the angle has been restored to >
20 degrees the average score is 69.53. This result is reinforced by the fact that 75% of patients returned to work in the >
20 degree Bohler’s angle group wheras only 33.34% returned to work in the <
20 degree group. This study shows that surgical restoration of Bohler’s angle to >
20 degrees gives a better outcome than for conservative treatment.