The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2012
Review Meta Analysis Comparative StudyUtility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.
The accuracy of intraoperative periprosthetic frozen section histologic evaluation in predicting a diagnosis of periprosthetic joint infection prior to microbiologic culture results is unknown. ⋯ Intraoperative frozen sections of periprosthetic tissues performed well in predicting a diagnosis of culture-positive periprosthetic joint infection but had moderate accuracy in ruling out this diagnosis. Frozen section histopathology should therefore be considered a valuable part of the diagnostic work-up for patients undergoing revision arthroplasty, especially when the potential for infection remains after a thorough preoperative evaluation. The optimum diagnostic threshold (number of PMNs per high-power field) required to distinguish periprosthetic joint infection from aseptic failure could not be discerned from the included studies. There was no significant difference between the diagnostic accuracy of frozen section histopathology utilizing the most common thresholds of five or ten PMNs per high-power field.
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J Bone Joint Surg Am · Jul 2012
Meta AnalysisEffectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis.
Total knee arthroplasty is associated with substantial blood loss and the risks of transfusion. Conflicting reports have been published regarding the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. We performed a meta-analysis to investigate the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. ⋯ The meta-analysis shows that the use of tranexamic acid for patients undergoing total knee arthroplasty is effective and safe for the reduction of blood loss.
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J Bone Joint Surg Am · Apr 2012
Review Meta Analysis Comparative StudyOperative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials.
Recent studies have suggested benefits following primary operative fixation of substantially displaced midshaft fractures of the clavicle. We reviewed randomized clinical trials of operative versus nonoperative treatment of these fractures, and pooled the functional outcome and complication rates to arrive at summary estimates of these outcomes. ⋯ Operative treatment provided a significantly lower rate of nonunion and symptomatic malunion and an earlier functional return compared with nonoperative treatment. However, there is little evidence at present to show that the long-term functional outcome of operative intervention is significantly superior to nonoperative care.
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J Bone Joint Surg Am · Nov 2011
Review Meta Analysis Comparative StudyPoor citation of prior evidence in hip fracture trials.
Failure to cite prior evidence in the medical literature may result in publication redundancy and inefficient use of research funding. We evaluated trials in which internal fixation was compared with arthroplasty for the treatment of hip fractures in order to determine the extent to which these randomized trials cited all relevant previous trials. ⋯ Our review of studies of hip fracture treatment suggests poor citation of the previous literature. Studies in higher-impact journals with positive results are more likely to be cited in subsequent studies. Therefore, redundancy in publication and unnecessary surgical trials often occur.