Background Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis (OA) of proximal interphalangeal (PIP) joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for PIP joint OA with emphasis on different surgical approaches. Methods The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for PIP joint OA. Data collection included active arc of motion (AOM), extension lag, and complications. We combined the data of various types of surface replacement arthroplasty into one group to compare with silicone arthroplasty. Results A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative AOM and the mean gain in AOM of silicone implant with volar approach were 58° and 17° respectively which was greater than surface replacement implant with dorsal approach as 51° and 8°, respectively. The mean postoperative extension lag of silicone implant with volar approach and surface replacement with dorsal approach was 5° and 14° respectively. The revision rate of silicone implant with volar approach and surface replacement with dorsal approach was 6% and 18% at the mean follow-up period of 41.2 and 51 months, respectively. Conclusions Silicone implant with volar approach showed the best AOM with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
Key Points Question Do rates or types of complications after distal radius fractures depend on treatment type? Findings In this secondary analysis of a randomized clinical trial of 304 adults from 24 health systems, the method of treatment participants received was associated with the rate or type of complications. Compared with participants who received internal fixation, participants who received any other treatments experienced complications at significantly higher rates. Meaning Choice of distal radius fracture treatment method in older patients should be specific to individual goals to minimize complication risks and improve outcomes.
Background: It remains unknown whether treatment trends for distal radius fracture (DRF) have changed in light of value-based care initiatives during recent years. We aimed to characterize modern practice patterns for DRF management. Methods: We used 2009–2015 Truven MarketScan databases to extract data on several variables comprising of demographic characteristics, geographic location, and comorbidities for patients receiving treatment for a DRF. Regression analysis and Joinpoint analysis were used to assess trends over the study period. We analyzed the association of patient factors with type of treatment provided using logistic regression modeling. Results: Among all 499,766 eligible encounters, the rate of internal fixation fluctuated around 13%. Casting/splinting remained the most frequent treatment across all populations. Treatment trends varied by age; children and adolescents were treated almost exclusively with closed treatment (mean: 97%), yet rates of internal fixation increased among adults and elderly patients. Patients age 55 to 64 were most likely to undergo internal fixation (OR: 1.89; 95%CI:1.82–1.96). Higher median household income also significantly increased one’s odds of receiving internal fixation (p<0.001). Despite declining rates of external fixation and percutaneous pinning, regional variations among surgical modalities persist. Conclusion: The increased use of internal fixation for the treatment of distal radius fractures may be slowing. Treatment type continues to differ widely across demographic groups, underscoring the need for standardization. In accordance with value-based care initiatives, treatment decisions should be made to combine patient needs with financial implications on the health system. Comparative effectiveness data to derive optimal management strategies are still warranted.
Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of PFT has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute PFT management. Twenty-eight case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies amongst the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of PFT and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in PFT management.
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