Level II-meta-analysis of non-homogenous controlled trials.

III.

rhBMP-2 is associated with a higher rate of general complications as well as retrograde ejaculation, HO, and cervical tissue swelling in spine fusion. There is a slightly increased risk of new onset of tumors, however, without statistical significance.

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The use of platelet concentrates in spine fusion shows significantly decreased union rates compared with the control group. However, complication and revision rates were not significantly increased. The current data do not recommend the use of platelet concentrate in spine fusion.

Radial head fractures, particularly Mason I and II, are considered "harmless" injuries, and their severity is underestimated. In recent years, associated injuries to ligaments, cartilage, and adjacent bones have been studied in more detail. This meta-analysis collects the data on their incidence from the current literature. A systematic review of the online databases PubMed, EMBASE, CINAHL and Cochrane Library was performed to identify clinical studies on associated injuries in radial head fracture. Their incidence was assessed as weighted means and broken down into Mason types. The clinical relevance of these injuries was not primarily assessed, but all available data were collected. Data on 1323 patients (48 % female) were extracted from 11 studies. 66 % had a Mason I, 21 % a Mason II, and 13 % a Mason III injury. In 33 % of all patients, associated injuries were found. The most common injury was damage to the lateral collateral ligaments (51 %), the second most common to the capitellum (22 %). 82 % of the Mason III fractures had associated injuries, compared to 36 % in Mason II, and 15 % in Mason I. Data on the clinical relevance of these injuries showed a rate of 11 % of persisting complaints requiring further treatment. Associated injuries with radial head fractures are more frequent, and need treatment more frequently, than commonly assumed. Even in "harmless" Mason I fractures, severe associated injuries requiring surgical treatment are frequent. For clinical practice, persisting pain, even in a "simple" Mason I injury, should lead to a timely, specialised assessment and treatment.

Study Design Systematic review and meta-analysis. Objective The objective of this meta-analysis was to evaluate the current best evidence to assess effectiveness and safety of recombinant human bone morphogenetic protein-7 (rhBMP-7) as a biological stimulant in spine fusion. Methods Studies were included if they reported on outcomes after spine fusion with rhBMP-7. The data was synthesized using Mantel-Haenszel pooled risk ratios (RRs) with 95% confidence intervals (CIs). Main end points were union rate, overall complications, postoperative back and leg pain, revision rates, and new-onset cancer. Results Our search produced 796 studies, 6 of which were eligible for inclusion. These studies report on a total of 442 patients (328 experimental, 114 controls) with a mean age of 59 ± 11 years. Our analysis showed no statistically significant differences in union rates (RR 0.97, 95% CI 0.84 to 1.11, p = 0.247), overall complications (RR 0.92, 95% CI 0.71 to 1.20, p = 0.545), postoperative back and leg pain (RR 1.03, 95% CI 0.48 to 2.19, p = 0.941), or revision rate (RR 0.81, 95% CI 0.47 to 1.40, p = 0.449). There was a mathematical indicator of increased tumor rates, but with only one case, the clinical meaningfulness of this finding is questionable. Conclusion We were not able to find data in support of the use of rhBMP-7 for spine fusion. We found no evidence for increased complication or revision rates with rhBMP-7. On the other hand, we also found no evidence in support of improved union rates.

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