Background: Osteoarthritis of the thumb base is the second most prevalent arthritis of the hand. Management is primarily conservative, consisting of analgesia, splinting, physiotherapy, and steroid injections. Surgery is considered when conservative measures fail. Methods: The primary objective was to assess the safety and efficacy of the surgical interventions and therein, evaluate whether any superiority exists among the available interventions. Efficacy was evaluated by examining four parameters: pain, function, range of movement and strength of the joint postoperatively. Safety was determined by comparing the rate and severity of postoperative complications. A systematic search of MEDLINE (2014–2019), EMBASE (2014–2019), CINAHL (2014–2019) and CENTRAL (2014–2019) databases was carried out. Abstracts were screened for relevant studies. Randomised controlled trials were only considered. Results: Eight studies were included in the quantitative synthesis. The procedures evaluated are: Trapeziectomy (T), trapeziectomy with ligament reconstruction (T + LR), trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI), trapeziectomy with allograft suspension (T + ALS) and joint arthrodesis (A). Low-moderate quality evidence suggests that T + LRTI yields better range of movement (palmar abduction) when compared with (T) alone; (SMD 0.61, 95% CI 0.22 to 1.00, random-effects, p = 0.002). Comparing adverse events showed that arthrodesis carries a greater risk of adverse events when compared with T + LRTI; (RR 0.33, 95% CI 0.17 to 0.61, random-effects, p = 0.0005). In addition, T + LRTI is preferred over arthrodesis by patients (OR 0.29 95% CI 0.09 to 0.95; p = 0.04). This difference was no seen in the other comparison groups. Conclusions: It is difficult to declare with any degree of certainty which procedure offers the best functional outcome and safety profile. Results suggest T + LRTI yields good postoperative range of movement. Arthrodesis demonstrated an unacceptably high rate of moderate-severe complications and should be considered with careful consideration.
Originally described as “wringer injuries” by MacCollum in 1938, 1 traumatic multiplanar degloving injuries that occur as the result of the hand, forearm or arm being drawn between the rollers of a machine are functionally devastating and present a significant reconstructive challenge. Revascularization and comprehensive excision of devitalized bone and soft tissue, followed by appropriate skeletal fixation and vascularized soft tissue cover are the mainstays of management. To date, published case series have described local flaps and free tissue transfer for coverage of wounds that involve exposed vital structures such as nerves, vessels, and tendons. 2 NovoSorb biodegradable temporizing matrix (BTM; PolyNovo Biomaterials Pty Ltd, Melbourne, Australia) is a bilayer bioabsorbable synthetic polymer dermal substitute, which has the ability to integrate into large wound beds and is resistant to infection. 3 BTM comprises a bioabsorbable, polyurethane matrix that allows for cellular infiltration and a temporary nonbiodegradable, nonporous polyurethane layer, which limits moisture loss and provides a barrier to bacteria. Here we describe the successful use of BTM in the staged reconstruction of a high-energy industrial roller injury in an adolescent patient.
Background Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized. Methods A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software. Results Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p = < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups. Conclusions With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify. Level of evidence: Not ratable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.