The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jan 2011
Review Meta AnalysisEarly effects of resident work-hour restrictions on patient safety: a systematic review and plea for improved studies.
since the inception of the eighty-hour work week, work hour restrictions have incited considerable debate. Work hour policies were designed to prevent medical errors and to reduce patient morbidity and mortality. It is unclear whether work hour restrictions have been helpful in medicine in general and in orthopaedic surgery specifically. This systematic review of the literature was designed to determine the success of these restrictions in terms of patient mortality, medical errors, and complications. ⋯ therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jun 2010
Review Meta Analysis Comparative StudySurgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials.
There is a current trend in orthopaedic practice to treat nondisplaced or minimally displaced fractures with early open reduction and internal fixation instead of cast immobilization. This trend is not evidence-based. In this systematic review and meta-analysis, we pool data from trials comparing surgical and conservative treatment for acute nondisplaced and minimally displaced scaphoid fractures, thus aiming to summarize the best available evidence. ⋯ Based on primary studies with limited methodological quality, this study suggests that surgical treatment is favorable for acute nondisplaced and minimally displaced scaphoid fractures with regard to functional outcome and time off work; however, surgical treatment engenders more complications. Thus, the long-term risks and short-term benefits of surgery should be carefully weighed in clinical decision-making.
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J Bone Joint Surg Am · Feb 2010
Meta AnalysisThe prevalence of and specific risk factors for venous thromboembolic disease following elective spine surgery.
Venous thromboembolic disease, including deep venous thrombosis and pulmonary embolism, is a serious and potentially life-threatening complication following orthopaedic surgical procedures. We sought to investigate the prevalence of thromboembolism as well as the efficacy and complications of various prophylactic measures in a population of patients who had undergone elective spine surgery. ⋯ The risk of deep venous thrombosis and pulmonary embolism is relatively low following elective spine surgery, particularly for patients who receive pharmacologic prophylaxis. Unfortunately, pharmacologic prophylaxis exposes patients to a greater risk of epidural hematoma. More evidence is needed prior to establishing a protocol for prophylaxis against venous thromboembolic disease in patients undergoing elective spine surgery. Future prospective studies should seek to define the safety of various prophylactic modalities and to identify specific subpopulations of patients who are at greater risk for venous thromboembolism.
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J Bone Joint Surg Am · Nov 2008
Review Meta AnalysisThe use of antifibrinolytic agents in spine surgery. A meta-analysis.
Antifibrinolytic agents have been shown to decrease the blood loss associated with major orthopaedic surgical procedures. Spine surgery, particularly procedures performed for deformity correction and procedures involving long arthrodesis constructs, can be associated with a large amount of blood loss requiring blood transfusions. The purpose of the present study was to determine if antifibrinolytic agents reduced blood transfusions in patients managed with spine surgery and to see if one agent had a greater effect than another. ⋯ Aprotinin, tranexamic acid, and epsilon-aminocaproic acid are effective for reducing blood loss and transfusions in patients managed with spine surgery. With the exception of aprotinin, the side-effect profiles of these agents have not been shown to cause any substantial morbidity or to increase the rate of thromboembolic events. Epsilon-aminocaproic acid had a greater effect on reducing blood transfusions as the complexity of surgery increased. The surgeon and/or the anesthesiologist should consider the use of antifibrinolytic agents for patients undergoing spinal procedures in which a large amount of blood loss can be expected; however, at the present time, this is not a United States Food and Drug Administration-approved indication for these agents.
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J Bone Joint Surg Am · Nov 2008
Randomized Controlled Trial Meta AnalysisElectrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials.
Bone stimulation represents a $500 million market in the United States. The use of electromagnetic stimulation in the treatment of fractures is common; however, the efficacy of this modality remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of electromagnetic stimulation on long-bone fracture-healing. ⋯ While our pooled analysis does not show a significant impact of electromagnetic stimulation on delayed unions or ununited long-bone fractures, methodological limitations and high between-study heterogeneity leave the impact of electromagnetic stimulation on fracture-healing uncertain.