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Younis MH, Hanstein R, Javed K, Fornari ED, Gomez JA, Sharkey MS, Schulz JF. Does Combining Drilling and Curettage to Percutaneous Trans-epiphyseal Screws Improve Correction of Limb Length Discrepancy? A Comparative Study. Indian J Orthop 2024; 58:190-198. [PMID: 38312896 PMCID: PMC10831026 DOI: 10.1007/s43465-023-01070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/21/2023] [Indexed: 02/06/2024]
Abstract
Objectives Physeal drilling and curettage (PDC) and percutaneous epiphysiodesis using transphyseal screws (PETS) are among the most widely used techniques to treat leg-length discrepancy (LLD). This study compared the efficacy and outcomes between PETS alone and PETS combined with PDC (PETS + PDC). Methods Retrospective study of children who underwent epiphysiodesis of the proximal tibia or distal femur with either PETS or PETS + PDC between 2008 and 2018 at a single institution. Radiographic parameters and complications were reviewed at completion of treatment and most recent follow-up. Results A total of 23 epiphysiodeses in 15 patients, average age 13.1 years, with either PETS (13 femur/tibias) or PETS + PDC (10 femur/tibias) were included. PETS patients were treated for a longer time (median: 24 months vs 11 months, p = 0.004), however, follow-up time was similar between groups (p = 0.577), on average 2.7 years. In the PETS group, LLD decreased from 2.55 to 0.84 cm at most recent follow-up (p = 0.010), and in the PETS + PDC group from 3.01 to 1.2 cm (p = 0.005), achieving a correction of 1.71 cm for PETS and 1.83 cm for PETS + PDC (p = 0.871). A correction of LLD to ≤ 2 cm was achieved in 8 PETS (89%) and 4 PETS + PDC cases (67%) (p = 0.525). Two PETS patients (22%) and 1 PETS + PDC (17%) patient returned to the OR for further correction due to persistent LLD (p = 1.000). No differences existed in total number of complications, angular deformity or return to physical activity between groups (p ≥ 0.05 for each comparison). Conclusions This study showed equal efficiency in resolving LLD between the PETS and PETS + PDC procedures with minimal operative complications.Level of Evidence III.
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Affiliation(s)
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | | | - Eric D. Fornari
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jaime A. Gomez
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Melinda S. Sharkey
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jacob F. Schulz
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
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Younis MH, Hanstein R, Javed K, Fornari ED, Gomez JA, Sharkey MS, Schulz JF. Percutaneous epiphysiodesis using transphyseal screws (PETS) versus tension-band plating (TBP): comparative study of outcomes for correcting limb length discrepancy. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03304-0. [PMID: 35723838 DOI: 10.1007/s00590-022-03304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The best effective treatment strategy for limb length discrepancy (LLD) is still being debated. The goal of this study was to compare the efficacy and results of tension-band plating (TBP) and percutaneous epiphysiodesis using transphyseal screws (PETS) for LLD correction. METHODS From June 2008 to January 2019, children who had lower extremity epiphysiodesis with either TBP or PETS were reviewed retrospectively. At the conclusion of treatment, LLD, angular deformity, and complications were reviewed. The t-test or Wilcoxon rank sum test was used to compare continuous variables. Categorical variables were evaluated using Fisher's exact test or χ2 test. RESULTS A total of 32 epiphysiodeses with TBP (14 patients, 24 femur/tibias) or PETS (13 patients, 23 femur/tibias) were compared. TBPs were conducted while the patients were younger (11.0 vs. 13.1 years, p = 0.005). The treatment durations were similar in both groups (TBP: 23.5 months vs. PETS: 24 months, p = 0.132). PETS had significantly shorter operative time (p = 0.047), length of hospital stay (p = 0.014), and time to return to full activity (p = 0.043). LLD in the TBP group reduced from 2.64 to 1.38 cm (p = 0.005), while in the PETS group it decreased from 2.76 to 1.08 cm (p = 0.001). During treatment, the rate of LLD correction was 0.49 ± 0.9 cm/year for limbs treated with TBP and 1.0 ± 1.1 cm/year for limbs treated with PETS (p = 0.185). At the end of treatment, 8 TBP cases (47%) and 9 PETS cases (60%) had achieved LLD ≤ 2 cm (p = 0.502), and at the most recent follow-up, this had grown to 11 (65%) in the TBP group and 12 (80%) in the PETS group. There were no significant differences in the total number of complications between groups (p > 0.05). Revision surgery was required in 11 TBP and 3 PETS limbs due to persistent LLD or angular deformity (AD) (p = 0.016). Logistic regression did not reveal any significant association between TBP and the rate of complication or revision surgery. CONCLUSION PETS and TBP are both effective methods for limb length equalization. PETS, on the other hand, was linked to a shorter operative time, a shorter hospital stay, a faster recovery to pre-operative function, and a lower complication rate. The rate of revision surgery due to persistent LLD or AD was higher in TBP. We advise surgeons against utilizing TBP to correct LLD. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manaf H Younis
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA.
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | | | - Eric D Fornari
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Jaime A Gomez
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Melinda S Sharkey
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Jacob F Schulz
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
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Younis MH, Fuentes-Rivera L, Summers S, Pretell-Mazzini J. Survival in patients with carcinomas presenting with bone metastasis at diagnosis: a SEER population-based cohort study. Arch Orthop Trauma Surg 2021; 141:367-373. [PMID: 32236712 DOI: 10.1007/s00402-020-03417-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Carcinoma metastasis to bone is a common reason for consultation to orthopedic surgeons. The presence of bone metastases (BM) is usually associated with poor prognosis which is worsened in the presence of synchronous metastases. The purpose of this study was to: (1) identify the most common carcinomas presenting with BM at diagnosis, to (2) analyze their survival, and (3) compare this against the survival of patients with additional synchronous metastasis based on a large population analysis. MATERIALS AND METHODS Patients diagnosed with carcinoma between January 2010 and December 2015 were identified from the Surveillance, Epidemiology and End Results (SEER) database. The most common carcinomas presenting with BM at diagnosis were identified. Survival based on the presence of BM and synchronous metastases (lung, brain, liver, lymph nodes) was evaluated with Kaplan-Meier analysis. Five-year survival (%) stratified by carcinoma type was calculated. Hazard ratio (HR) for mortality comparing isolated BM to other synchronous metastases was performed. RESULTS A total of 4.85% of patients (98,606/2,035,204) with carcinoma presented with BM at diagnosis, most commonly from a lung primary. Five-year survival with isolated BM was lowest in patients with pancreatic carcinoma (5.8%, 95% CI 3.0-9.9%), and highest in patients with breast carcinoma (41.1%, 95% CI 38.6-43.5%). Synchronous metastases increased significantly the risk of mortality within the majority of carcinomas. CONCLUSION BM at diagnosis has a poor prognosis which is worsened if synchronous metastases are present; a fact to consider when planning orthopedic interventions. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Manaf H Younis
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA
| | - Lorena Fuentes-Rivera
- Escuela de Medicina, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, 15102, Peru
| | - Spencer Summers
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Division, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA. .,Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Avenue, Fourth floor, Room 4036, Miami, FL, 33136, USA.
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Younis MH, Summers S, Pretell-Mazzini J. Bone metastasis in extremity soft tissue sarcomas: risk factors and survival analysis using the SEER registry. Musculoskelet Surg 2020; 106:59-68. [PMID: 32638225 DOI: 10.1007/s12306-020-00673-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION While lung is the most common site of metastasis, bone metastasis of soft tissue sarcoma is a part of the natural history affecting the prognosis of these patients. To date, no studies have analyzed the histologic subtypes more likely to metastasize to bone, the risk factors for bone metastasis at initial presentation, or the effect that bone metastasis has on the survival of these patients. MATERIAL/METHODS Patients were identified from the Surveillance, Epidemiology and End Results database with primary extremity STS between 2010 and 2015. Risk factors for early bone metastasis, survival based on different sites of metastasis, and prognostic factors of survival were analyzed. RESULTS Among 8,234 STS, 2.2% (n = 180) presented with skeletal metastasis. Bone metastasis was more likely when regional lymph nodes were involved (OR = 4.48, p = 0.008). Deep and moderate or high-grade sarcomas had 5-12-fold tendency to present with bone and lung metastasis (p = 0.046, 0.006, 0.030, respectively). The 5-year survival rate was 41.2% (26.9-54.9%) for isolated bone metastasis and 32.9% (21.2-45.1%) for patients with bone and lung metastasis. Resection of the primary sarcoma was the only significant predictor of survival (HR = 0.44, p = 0.021) for patients with bone metastasis. CONCLUSION High tumor grade, deep location to fascia and regional lymph node metastasis are significant risk factors for skeletal metastasis at diagnosis of an extremity STS. While neither systemic chemotherapy nor radiotherapy of the primary sarcoma has a significant influence on survival in the presence of bone metastasis, radical resection of the primary STS is associated with increased survival.
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Affiliation(s)
- M H Younis
- Musculoskeletal Oncology Division, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth Floor, Room 4036, Miami, FL, 33136, USA
| | - S Summers
- Musculoskeletal Oncology Division, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth Floor, Room 4036, Miami, FL, 33136, USA
| | - J Pretell-Mazzini
- Musculoskeletal Oncology Division, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Fourth Floor, Room 4036, Miami, FL, 33136, USA.
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Abstract
* Bones are a common site for metastases; however, muscle metastases recently have been more commonly reported, not only as a result of the multidisciplinary approach in the treatment of these patients but also because of more sensitive imaging modalities such as positron emission tomography-computed tomography (PET-CT) that identify these lesions in early stages.* The most common carcinoma is lung carcinoma, with a hematogenous route of spread mainly to the axial region of the body (the psoas muscle, the gluteal muscles, and the paravertebral muscles).
* Clinically, skeletal muscle metastases from carcinomas frequently present as painful palpable masses with or without swelling and are commonly found before diagnosis of the primary carcinoma.* Multiple imaging modalities, including radiographs, CT, magnetic resonance imaging (MRI), and PET-CT, have been used for diagnosis and staging, but tissue sampling is needed for a final diagnosis. The most important differential diagnosis of skeletal muscle metastases is with soft-tissue sarcomas.* Treatment is mainly based on chemotherapy and/or radiation; surgery is performed in cases of symptomatic lesions that fail to respond to nonoperative treatment.
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Affiliation(s)
- Juan Pretell-Mazzini
- University of Miami Hospital-Jackson Memorial Hospital, Miller School of Medicine, Miami, Florida
| | - Manaf H Younis
- University of Miami Hospital-Jackson Memorial Hospital, Miller School of Medicine, Miami, Florida
| | - Ty Subhawong
- University of Miami Hospital-Jackson Memorial Hospital, Miller School of Medicine, Miami, Florida
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Younis MH, Abu-Hijleh HA, Aldahamsheh OO, Abualruz A, Thalib L. Meta-Analysis of the Diagnostic Accuracy of Primary Bone and Soft Tissue Sarcomas by 18F-FDG-PET. Med Princ Pract 2020; 29:465-472. [PMID: 31887730 PMCID: PMC7511687 DOI: 10.1159/000505651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/30/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The goal of this meta-analysis was to assess the use of FDG-PET in the diagnosis of primary bone and soft tissue sarcomas. SUBJECTS AND METHODS Several databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched. In addition to sensitivity and specificity, the diagnostic accuracy region for detecting and grading sarcomas were pooled using bivariate and hierarchical summary receiver-operating characteristic (HSROC) models. Subgroup analysis included pooling soft tissue and bone sarcomas separately, and sensitivity analysis included high-quality studies. The quality of eligible studies was assessed using QUADAS-2. RESULTS Of the 1,258 papers screened, 21 studies satisfied the inclusion criteria. The pooled sensitivity and specificity of FDG-PET combined with CT for the detection of sarcomas were 89.2 and 76.3%, respectively. These diagnostic accuracy measures were higher when combined with CT than those of PDG-PET alone. Diagnostic accuracy for bone and soft tissue lesions were comparable but slightly better for soft tissue tumors. Pooling only the high-quality studies with low risk of bias yielded a sensitivity of 88.5% and specificity reduced to 65.6%. There was no evidence for publication bias, but significant heterogeneity among the studies was apparent. This study also showed that FDG-PET can efficiently differentiate between benign and malignant tumors, with a mean standard uptake value of maximally 2.52 units in benign and 6.81 units in malignant tumors (89.2% sensitivity and 75.1% specificity). CONCLUSION Our findings indicate FDG-PET can efficiently differentiate between benign and malignant bone and soft tissue tumors. We also found that FDG-PET improves accuracy in diagnosing soft tissue sarcomas when combined with CT.
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Affiliation(s)
- Manaf H Younis
- Department of Orthopedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | | | | | - Abdulrahman Abualruz
- Department of Radiology, Wake Forest Baptist Hospital, Winston- Salem, North Carolina, USA
| | - Lukman Thalib
- Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar,
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Al-Absi ES, Al-Sadeq DW, Younis MH, Yassine HM, Abdalla OM, Mesleh AG, Hadwan TA, Amimo JO, Thalib L, Nasrallah GK. Corrigendum: Performance evaluation of five commercial assays in assessing seroprevalence of HEV antibodies among blood donors. J Med Microbiol 2018; 68:115. [PMID: 30431419 DOI: 10.1099/jmm.0.000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Enas S Al-Absi
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar.,2Biomedical Research Center, Qatar University, Doha, Qatar
| | - Duaa W Al-Sadeq
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Manaf H Younis
- 3Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- 2Biomedical Research Center, Qatar University, Doha, Qatar
| | - Omnya M Abdalla
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Areej G Mesleh
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Tameem A Hadwan
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Joshua O Amimo
- 4Department of Animal Production, Faculty of Veterinary Medicine University of Nairobi, Nairobi, Kenya.,5Biosciences of Eastern and Central Africa-International Livestock Research Institute (BecA-ILRI), Nairobi, Kenya
| | - Lukman Thalib
- 3Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar.,2Biomedical Research Center, Qatar University, Doha, Qatar
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Al-Absi ES, Al- Sadeq DW, Younis MH, Yassine HM, Abdalla OM, Mesleh AG, Hadwan TA, Amimo JO, Thalib L, Nasrallah GK. Performance evaluation of five commercial assays in assessing seroprevalence of HEV antibodies among blood donors. J Med Microbiol 2018; 67:1302-1309. [DOI: 10.1099/jmm.0.000807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Enas S. Al-Absi
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- 2Biomedical Research Center, Qatar University, Doha, Qatar
| | - Duaa W. Al- Sadeq
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Manaf H. Younis
- 3Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar
| | | | - Omnya M. Abdalla
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Areej G. Mesleh
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Tameem A. Hadwan
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Joshua O. Amimo
- 4Department of Animal Production, Faculty of Veterinary Medicine University of Nairobi, Nairobi, Kenya
- 5Bioscieces of Eastern and Central Africa-International Livestock Research Institute (BecA-ILRI), Nairobi, Kenya
| | - Lukman Thalib
- 5Bioscieces of Eastern and Central Africa-International Livestock Research Institute (BecA-ILRI), Nairobi, Kenya
| | - Gheyath K. Nasrallah
- 1Department of Biomedical Science, College of Health Sciences, Qatar University, Doha, Qatar
- 2Biomedical Research Center, Qatar University, Doha, Qatar
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AlKhatib N, Younis MH, Hegazy A, Ibrahim T. Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis. Int Orthop 2018; 43:677-685. [PMID: 29869695 DOI: 10.1007/s00264-018-3998-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Femoral neck fractures in children represent less than 1% of all paediatric fractures. Osteonecrosis of the femoral head is one of the devastating complications of this fracture. Time to treatment is one of the most important predictors of this outcome with no clear consensus in the literature. The aim of this study was to determine whether early treatment (< 24 hours) of pediatric femoral neck fractures is associated with a lower rate of osteonecrosis of the femoral head compared to late treatment (> 24 hours). METHODS We searched several databases (PubMed, Embase, and Cochrane library), from January 1966 to November 2017 for any comparative studies that evaluated early (< 24 hours) versus late (> 24 hours) treatment of paediatric femoral neck fractures. We pooled the effect sizes using fixed effects model that compared the rate of osteonecrosis of the femoral head between children undergoing early versus late treatment, open versus closed reduction, displaced versus non-displaced and different Delbet type femoral neck fractures. Descriptive and qualitative data was also extracted. RESULTS Of the 391 articles identified, six studies (prospective and retrospective cohort studies) were eligible for the meta-analysis, with a total of 231 paediatric femoral neck fractures. The pooled odds ratio (OR) for osteonecrosis of the femoral head did not show any statistically significant difference between early (< 24 hours) versus late (> 24 hours) treatment (OR = 1.19, 95% CI 0.56, 2.51, I2 = 23.6%), nor between open versus closed reduction of paediatric femoral neck fractures (OR = 1.62, 95% CI 0.82, 3.22, I2 = 19.57%). Displaced and Delbet type I/II femoral neck fractures were 3.8 (OR = 3.81, 95% CI 1.49, 9.78, I2 = 0.00%) and 2.4 (OR = 2.43, 95% CI 1.28, 4.61, I2 = 0.57%) times more associated with osteonecrosis of the femoral head compared to non-displaced and Delbet type III/IV fractures respectively. CONCLUSIONS The cumulative evidence at present does not indicate an association between the time to treatment or method of reduction of femoral neck fractures in children and the risk of osteonecrosis of the femoral head. However, initial expedient treatment of femoral neck fractures in children should always remain the rule especially for displaced and Delbet type I/II femoral neck fractures. LEVEL OF EVIDENCE II/III.
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Affiliation(s)
- Nedal AlKhatib
- Department of Surgery, Section of Orthopedics, Hamad General Hospital, Doha, Qatar
| | - Manaf H Younis
- Department of Surgery, Section of Orthopedics, Hamad General Hospital, Doha, Qatar
| | - Abdelsalam Hegazy
- Department of Surgery, Section of Orthopedic Surgery, Sidra Medical & Research Center, PO Box 26999, Doha, Qatar
| | - Talal Ibrahim
- Department of Surgery, Section of Orthopedics, Hamad General Hospital, Doha, Qatar.
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Alkhatib NJ, Younis MH, Alobaidi AS, Shaath NM. An unusual osteomyelitis caused by Moraxella osloensis: A case report. Int J Surg Case Rep 2017; 41:146-149. [PMID: 29078156 PMCID: PMC5742016 DOI: 10.1016/j.ijscr.2017.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 11/18/2022] Open
Abstract
Moraxella osloensis is a gram-negative coccobacillus, which part of normal flora in human skin and mucus. Moraxella osloensis rarely causes infections in human, especially in immunocompromised. Proper microbiologic investigation is important to diagnose Moraxella osloensis. Accurate diagnosis and proper treatment are crucial for the resolution of infections caused by Moraxella osloensis.
Introduction Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. Presentation of case We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. Discussion M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Conclusion Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics.
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Affiliation(s)
- Nidal J Alkhatib
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - Manaf H Younis
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar; Department of Public Health, College of Health Sciences, Qatar University, Doha, Qatar.
| | - Ahmad S Alobaidi
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
| | - Nebal M Shaath
- Orthopedic Surgery Department, Hamad Medical Corporation, Doha, Qatar
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