bluuebunny/crossref_metadata_2025_split huggingface dataset:
180 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - a Systematic Review and Meta-Analysis
Authors: Lu V , Tennyson M , Zhou A , Fortune M , Thahir A , Krkovic M 
Published: November 2022

Abstract

Aim
Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Method
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.
Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results
312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15,I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusions
TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.
322 Comparative Analysis of Endovascular Intervention and Endarterectomy in Patients with Femoral Artery Disease: A Systematic Review
Authors: Sreejith G , Ravikumar N , Law SHC , Anand P , Varghese N , Kagdi S , Kang N , Salam S , Ongidi I , Nashnoush M 
Published: November 2022

Abstract

Aim
To compare the safety and efficacy of endovascular stenting to endarterectomy in treating femoral artery disease.

Method
We searched databases such as PubMed, Ovid, Embase and Scopus for studies done on endovascular and endarterectomy treatments in the last decade. The inclusion criteria comprised of latest studies within the last 10 years, human studies and restricting to only femoral artery disease. Relevancy of the articles were assessed using PRISMA and the Newcastle-Ottawa quality assessment scale. Thereafter, the data were extracted, and the statistical variables were calculated using MedCalc software. The PRISMA checklist was used to assess risk of bias.

Results
Total of twenty-six retrospective, prospective and sub-analysis studies met the inclusion criteria with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). A division of the outcomes into primary and secondary were assessed based on direct correlation to the parameters evaluated. Our review demonstrated a higher value of technical success for endovascular intervention than endarterectomy with an odds ratio of 4.27 and statistically significant at 95% CI (2.87–6.38). In terms of safety, wound complications, and mortality (short and long-term) were evaluated. For wound infection, endovascular had better odds ratio of 0.65; 95% CI [0.51 to 0.81] and thus preferrable. Delayed wound healing and dehiscence occurred only in 0.15% of endovascular procedures in contrast to 0.99% in endarterectomy. There was no significant difference in both the mortality rates in the two groups appraised.

Conclusions
Endovascular treatment of femoral artery disease is a safe and effective alternative to endarterectomy. It has a lower incidence of wound related and other perioperative complications.
413 Fat Grafting as a Therapeutic Treatment for Frey's Syndrome: A Comprehensive Review of the Literature and Recommendations for Management
Authors: McGregor C , Thomson E , Arvidsson A , Whitaker I 
Published: November 2022

Abstract

Aim
With the reported incidence of Frey's syndrome as high as 59%, the significant morbidity experienced by patients post parotidectomy has resulted in a range of treatment options being proposed with variable outcomes. The lack of consensus has resulted in patients being offered a wide range of treatments with varying success. While fat grafting remains a treatment for contour deformity correction, there is emerging evidence to suggest its effectiveness as a treatment for Frey's syndrome, warranting further investigation. This systematic review aims to evaluate the efficacy of fat grafting as a treatment for Frey's syndrome post parotidectomy.

Method
A systematic review was conducted as per PRISMA guidelines, with all articles from MEDLINE, Embase, Web of Science, Ovid, Scopus, and Cochrane screened by two independent reviewers using discreet inclusion and exclusion criteria followed by in depth full-text reviews.

Results
116 papers were screened with 16 meeting the inclusion criteria (13.8%) totalling 785 patients, with multiple outcome measures for assessing Frey's syndrome. Fat grafting was shown to significantly reduce the incidence of Frey's syndrome in patients having undergone both superficial and total parotidectomies, with 15 studies (93.8%) finding a significant reduction in its incidence post treatment.

Conclusions
With low donor site morbidity, biocompatibility, ease of use, low cost to perform and high patient satisfaction, the systematic review of the evidence supports the use of fat grafting post parotidectomy as an effective treatment for Frey's syndrome. Further research to determine the long-term outcome would inform its suitability as a first line treatment.
493 Hip Arthroscopy for the Primary Management of Femoroacetabular Impingement with Concomitant Chondral Lesions - a Systematic Review and Meta-Analysis
Authors: Lu V , Andronic O , Zhang J , Khanduja V 
Published: November 2022

Abstract

Introduction
Femoroacetabular impingement (FAI) is an important cause of hip pain in the young, active population. Treated by hip arthroscopy (HA), chondral lesions are frequently seen, and there are concerns that patients with chondral defects leading to hip osteoarthritis (OA) will not benefit from HA. This review analyses the use of HA in FAI patients with chondral lesions according to Outerbridge classification.

Method
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science. From twenty-four included studies, patient related outcome measures (PROMs), total hip arthroplasty (THA) conversion rate, radiological outcomes were collected. Clinical studies of HA used for primary FAI management, classifying chondral lesions according to Outerbridge classification were included. Patients treated with open procedure, osteonecrosis, Legg-Calve-Perthes disease, previous ipsilateral hip fractures were excluded. Risk of bias was assessed using ROBINS-I.

Results
Improved post-operative PROMs included mHHS (n=18; mean difference:-2.42; 95%CI:-2.99 to -1.85; p&lt;0.0001), NAHS (n=8; mean difference:-1.73; 95%CI: -2.23 to -1.23; p&lt;0.0001), VAS (n=7; mean difference:2.03; 95%CI:0.93–3.13; p&lt;0.0001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%).
Patients had worse PROMs if they underwent HA with labral debridement (p=0.0149), have Outerbridge 3 and 4 lesions (p=0.0116), kissing lesions (p=0.0292). Reconstructive cartilage techniques were superior to microfracture (p=0.0416). Even in “kissing” lesions, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.0267).

Conclusions
This meta-analysis suggests that acceptable post-operative outcomes following HA in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved.
553 Does Patella Implant Design Affect Outcomes? Patella Resurfacing in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Yap NJ , Simpson C , Ng N , Ndou S , Wright E , Scott C , Clement N 
Published: November 2022

Abstract

Aim
To investigate whether implant design affect (1)incidence of anterior knee pain, (2)patient reported outcomes and (3)reintervention rates in a resurfaced vs non-resurfaced Total Knee Arthroplasty (TKA).

Method
MEDline, pubmed and google scholar studies were evaluated using SIGN assessment tool and data analysis was conducted using Review Manager 5.2 on only randomised controlled trials. Search terms: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, patellar retaining.

Results
33 randomised controlled studies were identified. A total of 11 used the modern “patella-friendly” implants and 22 used the older “patella non-friendly” implants.
There was no significant difference in anterior knee pain rates for either surgical option. When using patella-friendly implant, patella resurfacing results in a statistically higher clinical (P 0.007, MD -0.77) and functional (P &lt; 0.0001, MD -1.87) KSS than the non-resurfaced counterparts, but scores were not clinically significant. When the patella was not resurfaced, there was a significant increased risk of reoperation with “non-patella friendly” implant (p=0.04, OR 1.42, CI 1.01, 2.00), whilst there was no significant difference between reoperation rates for the “patella friendly” implants (OR 1.17, CI 0.59,2.30).

Conclusions
Patella implant design has been shown to significantly improve KSS scores but with no clinical significance. Risk of further procedures was significantly higher in non-resurfaced patella TKAs with “non-friendly” implants, likely due to increased rates of anterior knee pain in these older generation implants leading to secondary resurfacing. However, when utilising “patella-friendly” implants, resurfacing does not lower reintervention rates. This meta-analysis finds no clinical indication to resurface the patellar whilst performing a TKA.
562 Midline Versus Off Midline Extraction Site in Laparoscopic Left Sided Colorectal Resections for Colorectal Malignancy: A Systematic Review and Meta-Analysis
Authors: Bhattacharya P , Hussain MI , Mohamedahmed AYY , Faiz N , Peravali R 
Published: November 2022

Abstract

Method
To evaluate comparative outcomes of off-midline and midline extraction sites in laparoscopic left sided colorectal resections.

Method
A systematic search of electronic databases and bibliographic reference lists was conducted, and a combination of free text and controlled vocabulary search was adapted to thesaurus headings, search operators and limits in electronic databases were applied. Studies comparing the outcomes of Off Midline and Midline incisions for specimen extraction in laparoscopic left sided colorectal resections were included. Incisional hernias, surgical site infections, operative time, estimated blood loss, anastomotic leak and length of hospital stay were the evaluated outcome parameters.

Results
We identified 5 comparative studies reporting a total of 1187 patients comparing outcomes of off-midline (n=486) and midline (n=701) incisions for specimen extraction in laparoscopic left colorectal resections. The off-midline approach was associated with lower post operative surgical site infection (OR 0.71, P=0.68), anastomotic leak (OR 0.76,P=0.66), and incisional hernia (MD: 0.65,P=0.64) compared to midline approach, however it was not statistically significant. There was no significant difference in operative time (MD: 0.10, P=0.99), intra-operative blood loss (MD 2.31, P=0.91), and post-operative hospital stay (MD : 0.78, P=0.18) between the two groups.

Conclusions
Off-midline extraction site for left sided colorectal resections have no significant difference in rates of post operative surgical site infection and incisional hernias when compared to midline extraction site. No significant difference was found in operative time, intra-operative blood loss, anastomotic leak and post operative hospital stay in this study. Future higher-level research is required to further evaluate the clinical outcomes.
653 The Impact of Preoperative Screening for Venous Pathology on Lower Limb Free Flap Reconstruction
Authors: Adeboye T , Hagiga A , Dheansa B 
Published: November 2022

Abstract

Aim
Lower limb reconstruction free flap failure rate is 8.5% and is contributed to by venous thrombosis and congestion. Mapping of free flaps and the recipient site to identify venous pathology is not standard and often pathology is only found intraoperatively leading to changes in reconstructive plans. There are no guidelines on preoperative venous assessment. We aimed to review available evidence to delineate the impact preoperative venous imaging has on flap outcomes

Method
A systematic review of MEDLINE, Scopus, Web of Science, Cochrane Library and Embase were searched in August 2021. The reference lists of retrieved publications were checked manually and backward searched using Web of Science and Google Scholar. Data was reviewed by two researchers independently and compared.

Results
Eleven articles were eligible for inclusion encompassing 99 patients and 107 flaps with lower limb pathology at either the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using USS duplex scanning or CT angiography. Interventions included using another vein, intraoperative thrombectomy, and preoperative anticoagulation. 3 out of 69 (4.34%) of these free flaps resulted in failure.
38 veins diagnosed with venous pathology intraoperatively were managed by using an alternative vein, venotomy, thrombectomy, embolectomy or heparinising the vein. 5 out of 38 flaps failed (13.15%).

Conclusions
Preoperative screening for venous pathology showed higher flap survival rate. A standardised approach for identifying venous issues in lower limb free flap reconstruction is needed. Future studies should focus on the prognostic validity of preoperative screening tools and management of identified venous pathology.
665 A Systematic Review of Breast Site Associated Complications Following Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction
Authors: Darling A , McLaughlin D , McGarry K 
Published: November 2022

Abstract

Aim
Breast reconstruction with autologous tissue provides durable reconstruction with native tissue. However, perioperative complications impact negatively on patient perception of success and increase the psychological trauma of mastectomy. The Deep Inferior Epigastric Perforator (DIEP) flap has a recognised low rate of donor site complications. This paper provides the first systematic review focussing on breast site associated complications.

Method
PRISMA guidelines informed a systematic search of Medline, Embase and Web of Science. Studies were screened against set inclusion and exclusion criteria; data was collated regarding demographics, flap characteristics and flap complications.

Results
Twenty-nine studies representing 21,680 flaps were included with the rate of major breast-associated complications ranging between 0 and 55.1% of flaps and 0 to 10.3% of patients; the rate of minor complications ranged between 0 and 48.2% of flaps and 0 to 16.3% of patients. All papers reported major complications including total flap loss (1–17.2% flaps, 0–7.4% patients), partial flap loss (0–44.8% flaps, 0–5% patients) and venous congestion or arterial compromise (1.5–55.1% flaps, 4.3–10.3% patients). Twenty-eight papers reported minor complications and included fat necrosis (1.8–48.2% flaps, 3–16.3% patients); wound problems (1–15.6% flaps, 3.7% patients); skin necrosis (9.2–17.8% flaps, 0.3–7.4% patients; seroma (0–4.9% flaps, 0–5.1% patients); haematoma (0.36–9.3% flaps, 0–8.4% patients) and infection (0.2–20% flaps, 0–6.3% patients).

Conclusions
This systematic review concludes that the DIEP flap has an acceptable level of breast site associated complications and should continue to be considered as gold standard in breast reconstruction. This review can be used in preoperative counselling and to inform consent.
782 Mohs Micrographic Surgery and Patient Satisfaction in Skin Cancer; a Systematic Review
Authors: Said Noor M , Chawla M 
Published: November 2022

Abstract

Aim
Mohs micrographic surgery (MMS) has revolutionised the treatment of skin cancer. It is commonly considered as gold standard, with good cosmesis effect for patients. Patient perception plays an important outcome in skin cancers. This systematic review aims to explore evidence of post-operative patient reported satisfaction after MMS.

Method
We conducted a systematic search using 10 databases including OVID Medline(R), Pubmed, Cochrane (CENTRAL) of all study types between 2000–2021. Studies were appraised for bias and data was tabulated with a narrative synthesis.

Results
The literature search generated 1068 studies. After removing duplicates, 728 were screened and 37 underwent full-text review. Thirteen relevant studies comprising 3046 patients undergoing MMS were included. Patients undergoing MMS expressed higher anxiety pre-operatively compared to conventional excision surgery but post-operatively Mohs was associated with a significantly higher skin cancer index (SCI) score. This was both in the short- and long-term follow up. Patients showed overall very high satisfaction with the technical quality, irrespective of reconstructive complexity or the surgeon's expertise. Patients’ main concerns post-operatively included scar skin thickness, colour, and irregularity. Higher satisfaction was observed in those with better pre-operative quality of life (QOL) including skin quality, co-morbidities, mental health, and age.

Conclusion
Overall patient satisfaction after MMS is high and supports transition to this surgical technique within skin cancer surgery. Higher satisfaction rates are observed in patients with better pre-operative QOL. Post-operatively patients are most concerned of scar thickness, colour, and irregularity. These factors should guide surgeons’ decision-making when aiming to maximise patient satisfaction.
910 Is There a Clinically Significant Advantage to Minimally Invasive Over Standard Surgical Approaches in Total Hip Arthroplasty? a Systematic Review
Authors: Moosavi H , Dandachli W 
Published: November 2022

Abstract

Aim
Conventional surgical approaches in Total Hip Arthroplasty (THA) utilise one long incision to access to the hip joint. Nowadays minimally invasive (MIS) approaches, involving one or more incisions of less than 10cm in length, are being increasingly utilised. This systematic review aims to investigate whether or not there is a statistically significant benefit for the MIS approaches over the conventional ones, and if so, whether a particular approach is superior to the others.

Method
This study was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following an initial scoping search, six databases were selected in order to search for relevant studies, those being Embase, Medline, PubMed, Science Direct, Scopus and the Cochrane Library for Systematic Reviews, based pre-determined inclusion criteria formulated using the PICO (population, intervention, control, and outcome) format.

Results
10 studies were included for qualitative analysis including 7 randomised control trials, 2 cohort studies and 1 systematic review. There was no agreement in the results, with some studies favouring conventional approaches and other MIS.

Conclusions
Minimally invasive surgery is an evolving concept in THA. Based on this study, there is still not enough data in the literature to warrant adopting MIS over conventional approaches as standard practice. The SuperPATH approach appears to be the most promising MIS technique. More research comparing MIS to conventional approaches in the longer term is needed.
517 Composite Surgical Site Infections in Patients Undergoing Kidney Transplantation in a Tertiary Renal Centre
Authors: Chowdhury AM , Khurram MA , Mohamed IH 
Published: November 2022

Abstract

Aim
Surgical Site Infections (SSI) contribute to morbidity and mortality in patients undergoing surgery, especially in high-risk group patients, such as kidney failure patients. Conventional classification and reporting can be inadequate for this group of patients. We developed a composite SSI definition extending the conventional Centres for Disease Control and Prevention criteria to include seromas, lymphoceles, collections, and haematomas specific to kidney transplantation requiring intervention occurring within 21 days. Primary outcomes are incidence; secondary outcomes are length of stay and readmission within 30 days.

Method
A retrospective, single-centre, cohort study was performed of adults who underwent kidney transplantation (01/04/2017–31/03/2018). Pre-, peri- and post-operative data were collected from electronic health records.

Results
130 patients were identified. SSIs occurred in 26% (34/130) of patients (31 organ/retroperitoneal space, 2 superficial and 1 deep). There was no statistically significant difference in age, sex, body mass index, primary pathology, diabetes status, organ donor type, cold ischaemia time, graft function and induction agent in patients with or without SSI. Longer dialysis time was the only factor associated with developing an SSI (7.1 vs 4.0 years; p=0.007). Patients with SSIs were significantly more likely to have &gt;1 week index admission (41% vs 21%, p=0.0249, OR2.660) and readmission within 30 days post-discharge (35% vs 15%, p=0.0118, OR 3.306).

Conclusions
SSI in kidney transplant patients is common and associated with prolonged index admission and higher readmission rates. Strategies to mitigate this such as negative pressure wound therapy should be explored.
531 Less Is More: Extensive Cardiac Investigations Add Little Value in Waitlisting Patients for Kidney Transplantation
Authors: Chow BJ , Khurram MA , Capuano E , Pugliese F , Yaqoob MM , Mohamed IH 
Published: November 2022

Abstract

Aim
Extensive cardiac investigations have long been considered necessary to aid decision-making in waitlisting for kidney transplantation. However, the utility and reliability of such comprehensive tests are not well established. This study assessed the prognostic power of coronary artery calcium scoring (CACS) using computed tomography coronary angiogram (CTCA) and myocardial perfusion scintigraphy (MPS) in predicting major adverse cardiac events (MACE).

Method
We conducted a retrospective study of all ESRD patients considered for kidney transplantation and referred for MPS and/or CTCA for CACS between October 2012 to March 2014 and assessed MACE occurrences (heart failure, cardiac arrest, myocardial infarction, angina, CVA, PVD, and transient ischaemic attack) within a 9-year follow-up period.

Results
Among 131 patients in our study, 91.6% had a MPS (76.7% Negative MPS result, 23.3% Positive MPS result) and 92.4% had a CTCA (75.2% CACS &lt;400 (Low Score), 24.8% CACS&gt;400 (High Score)). Sensitivity, specificity, positive and negative predictive values were poor for CTCA (38.8%, 84.7% 63.3%, 67.0%) and MPS (34.8%, 82.4%, 55.2%, 67.0%). There was no statistical significance in MACE when stratified by CACS and MPS in transplanted patients (log-rank p= 0.155). No statistical difference in MACE was observed when stratified by MPS status (p=0.749) or CACS status (p=0.706) in non-transplanted patients.

Discussion
This challenges the value of extensive cardiac assessments (MPS, CTCA) in predicting MACE. Candidates conventionally considered low-risk by these methods had similar risk of MACE when transplanted against higher-risk groups. Thus, such tests are best used for risk stratification and counselling for shared decision-making.