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Mudawi A, Alzobi O, Derbas JN, Ahmed G, Abousamhadaneh M. Optimizing percutaneous reduction and fixation with guidewire modification in pelvic and acetabular fractures: surgical technique and case series. Eur J Orthop Surg Traumatol 2024; 34:2107-2112. [PMID: 38548873 PMCID: PMC11101512 DOI: 10.1007/s00590-024-03905-x] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Minimally invasive percutaneous screw fixation for pelvic ring and acetabular fractures has become increasingly popular due to its numerous benefits. However, the precise placement of the screw remains a critical challenge, necessitating a modification of the current techniques. This paper introduces a refined technique employing a modified guidewire to enhance the precision and efficiency of percutaneous fixation in pelvic and acetabular fractures. METHODS This study details the surgical techniques implemented for correcting guidewire misdirection in percutaneous screw fixation and includes a retrospective analysis of patients treated with this modified approach over a three-year period. RESULTS In this study, 25 patients with pelvic ring and acetabular fractures underwent percutaneous screw fixation. The cohort, predominantly male (23 out of 25), had an average age of 38 years. The majority of injuries were due to traffic accidents (18 out of 25). Types of injuries included pelvic ring (6 cases), acetabular fractures (8 cases), and combined injuries (11 cases). Various screw types, including antegrade and retrograde anterior column screws, retrograde posterior column screws, and lateral compression screws, were used, tailored to each case. Over an average follow-up of 18 months, there were no additional procedures or complications, such as neurovascular injury or hardware failure, indicating successful outcomes in all cases. CONCLUSIONS This study introduces a simple yet effective method to address guidewire misdirection during percutaneous fixation for pelvic and acetabular fractures, offering enhanced precision and potentially better patient outcomes. Further research with a larger patient cohort is required for a more comprehensive understanding of its efficacy compared to traditional methods. LEVEL OF EVIDENCE IV. Therapeutic Study (Surgical technique and Cases-series).
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Affiliation(s)
- Aiman Mudawi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Jawad Nouraldeen Derbas
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Maamoun Abousamhadaneh
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 2024; 34:1333-1343. [PMID: 38133653 PMCID: PMC10980635 DOI: 10.1007/s00590-023-03798-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. METHODS We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR - 0.82; 95% CI, - 1.027 to - 0.58, p value < 0.00001) and mechanical restoration (OR - 0.95; 95% CI, - 1.49 to - 0.41, p value < 0.0006). While knee range of motion (OR - 2.23; 95% CI - 4.89-0.43, p value 0.1) and femoral prosthesis position (OR - 0.98; 95% CI, - 2.03-0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. CONCLUSION This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | | | | | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Shujauddin M, Hantouly AT, Moghamis I, Alzobi O, Mazhar FV, Mekhaimar MM. Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report. Heliyon 2024; 10:e26217. [PMID: 38439871 PMCID: PMC10909629 DOI: 10.1016/j.heliyon.2024.e26217] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Gluteal compartment syndrome (GCS) is a rare diagnosis that results mostly from a non-traumatic etiology. We describe a case of a gluteal compartment syndrome, complicated with sciatic nerve palsy. Case presentation This paper reported a case of gluteal compartment syndrome caused by prolonged immobilization due to carbon monoxide poisoning. The case was complicated with sciatic nerve palsy and a sequala of leukoencephalopathy. Discussion and conclusion This case report highlighted the importance of having a high suspicion for gluteal compartment syndrome in patients with history of lying down with prolonged immobilization. The diagnosis can be made solely on clinical examination and a fasciotomy must be performed with no delay.
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Affiliation(s)
- Mohammad Shujauddin
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isam Moghamis
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fuad Vayalil Mazhar
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Maged Mekhaimar
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Hantouly AT, AlBarazanji A, Al-Juboori M, Alebbini M, Toubasi AA, Mohammed A, Alzobi O, Ahmed G. Epidemiology of proximal femur fractures in the young population of Qatar. Eur J Orthop Surg Traumatol 2024; 34:21-29. [PMID: 37548762 PMCID: PMC10771613 DOI: 10.1007/s00590-023-03664-1] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To review the epidemiological characteristics of proximal femur fractures in the young population (< 60 years) of Qatar between 2017 and 2019. METHODS All patient treated for proximal femur fractures at Hamad General Hospital (HGH), a level one trauma center, were retrospectively reviewed between Jan 2017 and Dec 2019. All adults (18-60 years) with proximal femur fracture (femur head, femur neck, intertrochanteric and subtrochanteric fractures) were included with no restriction to the AO/OTA classification or fractures subtypes. Excluded cases were pathological fractures, cases with insufficient documentation or no radiographs. RESULTS A total of 203 patients with a mean age of 40.07 ± 11.76 years were included, of who 89.9% were males. The incidence of proximal femur fracture was 3.12/100,000/year. Fall from height (48.1%) followed by road traffic accidents (26.9%) were common cause of injury. The most common fracture type was intertrochanteric fracture (36.1%) followed by femur neck fractures (33.7%). CONCLUSION This study provides the initial insights into the proximal femur fractures in the young population of Qatar. This is the first study to investigate of the epidemiology of such fractures in this particular patient group. Contrary to the existing literature on older age groups, the majority of the injuries were observed in males. Falls from height followed by road traffic accidents were the primary mechanisms leading to these fractures. Improved understanding of the profile of these injuries can aid in their prevention by implementing more effective safety measures.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Asim AlBarazanji
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Juboori
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohanad Alebbini
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Asma Mohammed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Elmhiregh A, Abuodeh Y, Alzobi O, Zikria B, Alkhayarin M, Morrey BF. All-polyethylene versus metal-backed tibial components in total knee arthroplasty: a meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 2023; 33:3611-3622. [PMID: 37249643 PMCID: PMC10651551 DOI: 10.1007/s00590-023-03594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The design of tibial trays for total knee arthroplasty (TKA) has been a topic of research for several decades. Although all-polyethylene trays were developed to address issues such as osteolysis and to enhance the longevity of the prosthesis, as well as knee range of motion, metal-backed designs have remained the most commonly used type of prosthesis. This meta-analysis aimed to compare the clinical, radiological, and survival outcomes of both designs. METHODS Five databases were searched from inception until October 1, 2020, for randomized controlled trials (RCTs) that compared the outcomes of all-polyethylene and metal-backed tibial components in TKA. The outcomes of interest included range of motion, knee society score, stairs climbing scores, radiostereographic analysis, survivorship and complication. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Newcastle-Ottawa tool. RESULTS A total of 14 RCTs with 1367 TKA were included with a mean age of - years and - years for all-polyethylene and metal-backed tibial components groups, respectively. All-polyethylene group demonstrated statistically significant differences in five-year survivorship (OR 0.27; 95% CI 0.10-0.75; p value 0.01) and stairs climbing score (OR - 2.07; 95% CI - 3.27-0.87; p value 0.0007) when compared to the metal-backed group. The metal-backed design was significantly more radiographically stable in anterior-posterior, varus-valgus, and internal-external rotations at the 2-year follow-up compared to all-polyethylene tibias (OR - 0.09; 95% CI - 0.16 to - 0.02; p value 0.02) as per the pooled radiostereographic analysis. However, ten-year survivorship (OR 0.92; 95% CI 0.53-1.60; p value 0.78), range of motion (OR - 0.57; 95% CI - 2.00-0.85, p value 0.43), knee society scores (OR 1.38; 95% CI - 0.47-3.23, p value 0.14), and complications (OR 0.83; 95% CI 0.5-1.39, p value 0.48) were comparable between both groups. CONCLUSIONS While this meta-analysis suggests that all-polyethylene tibial components in total knee arthroplasty may offer advantages over metal-backed components in terms of five-year survivorship, and stairs climbing score, this finding should be considered in the context of potential confounding factors. Nonetheless, based on the results, the all-polyethylene implant should be considered a viable choice for primary knee replacement. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Yousef Abuodeh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mohd Alkhayarin
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Alzobi O, Aminake G, Mohammed A, Hantouly A, Marín T, Zikria B. Outcomes of arthroscopic elbow synovectomy and neurolysis of the ulnar nerve for tenosynovial giant cell tumor in a young athlete: a case report and literature review. JSES Int 2023; 7:2542-2546. [PMID: 37969494 PMCID: PMC10638581 DOI: 10.1016/j.jseint.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Affiliation(s)
- Osama Alzobi
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayyoub Mohammed
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Hantouly AT, Alzobi O, Toubasi AA, Zikria B, Al Dosari MAA, Ahmed G. Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:3672-3683. [PMID: 36244018 PMCID: PMC10435641 DOI: 10.1007/s00167-022-07196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI). METHODS PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis. RESULTS The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91-97%), 89% (95% CI 82-95%), and 138.5 (95% CI 49.1-390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99-15.6) and 0.1 (95% CI 0.0-0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61-79%), 94% (95% CI 88-98%), and 28.0 (95% CI 12.6-62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0-19.5) and 0.1 (95% CI 0.0-0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5-49.6) and 0.3 (95% CI 0.2-0.4). CONCLUSIONS NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Bouri F, Hantouly AT, Alzobi O, Toubasi AA, Kayali H, Fuad M, Muneer M, Hagert E, Ibrahim A. Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis. J Hand Surg Glob Online 2023; 5:435-444. [PMID: 37521555 PMCID: PMC10382890 DOI: 10.1016/j.jhsg.2023.03.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/29/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.
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Affiliation(s)
- Fadi Bouri
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Hammam Kayali
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mazhar Fuad
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Muneer
- Department of Plastic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden
| | - Ayman Ibrahim
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
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Hantouly AT, Salameh M, Toubasi AA, Salman LA, Alzobi O, Ahmed AF, Ahmed G. The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: a meta-analysis of comparative studies. Eur J Orthop Surg Traumatol 2022; 33:739-749. [PMID: 35377073 PMCID: PMC10125946 DOI: 10.1007/s00590-022-03240-z] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Subtrochanteric and reverse oblique intertrochanteric fractures are challenging and often difficult to reduce. While intramedullary nailing (IMN) is considered the standard treatment, achieving anatomic reduction prior to fixation is essential. This study aimed to assess the impact of cerclage wiring with IMN on the outcomes and complication rate in treating subtrochanteric and reverse oblique intertrochanteric fractures. METHODS This meta-analysis was conducted in line with PRISMA guidelines. The primary outcome was the time to union. The secondary outcomes were operative time, blood loss, quality of reduction, reduction alignment (if in varus), complications and reoperations. PubMed, Cochrane, Web of Science and Google Scholar were searched till July 2021. Articles that compared intramedullary nailing (IMN) versus intramedullary nailing and cerclage wiring (IMN-C) in the treatment of subtrochanteric and reverse oblique intertrochanteric fractures were included. The risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS This meta-analysis included 415 patients with subtrochanteric and reverse oblique intertrochanteric fracture from six comparative studies. Our findings showed that IMN-C was significantly associated with higher mean duration of surgery and blood loss. However, IMN-C had significantly lower mean time to union compared to IMN alone. In addition, IMN-C had lower pooled prevalence of varus reduction and overall complications. CONCLUSION This study showed that the use of cerclage wiring is associated with lower time to union, lower prevalence of varus reduction and overall complications. Therefore, cerclage wiring augmentation is a safe technique with low complication rate and may be advised whenever open reduction is needed in the management of subtrochanteric and reverse oblique intertrochanteric fractures.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Orthopedic Surgery Department, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Loay A Salman
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ghalib Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
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Hantouly AT, Ahmed AF, Alzobi O, Toubasi A, Salameh M, Elmhiregh A, Hameed S, Ahmed GO, Alvand A, Al Dosari MAA. Mobile-bearing versus fixed-bearing total knee arthroplasty: a meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 2021; 32:481-495. [PMID: 34021791 PMCID: PMC8924090 DOI: 10.1007/s00590-021-02999-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
Objective The purpose of this study was to perform a meta-analysis comparing mobile-bearing with fixed-bearing total knee arthroplasty (TKA) in terms of all-cause revision rates, aspetic loosening, knee functional scores, range of motion and radiographic lucent lines and osteolysis. Methods PubMed, Cochrane Library, Google Scholar and Web of Science were searched up to January 2020. Randomized controlled trials that compared primary mobile-bearing with fixed-bearing TKA, reporting at least one of the outcomes of interest, at a minimum follow-up of 12 months were included. All outcomes of interest were pooled at short-term (< 5 years), mid-term (5 to 9 years) and long-term (> = 10 years) follow-up intervals. Results A total of 70 eligible articles were included in the qualitative and statistical analyses. There was no difference between mobile-bearing or fixed-bearing TKA at short-term, mid-term and long-term follow-ups in all outcome measures including all-cause revision rate, aseptic loosening, oxford knee score, knee society score, Hospital for Special Surgery score, maximum knee flexion, radiographic lucent lines and radiographic osteolysis. Conclusion The current level of evidence demonstrated that both mobile-bearing and fixed-bearing designs achieved excellent outcomes, yet it does not prove the theoretical advantages of the mobile-bearing insert over its fixed-bearing counterpart. The use of either design could therefore be supported based on the outcomes assessed in this study. Level of Evidence: Level II, Therapeutic Supplementary information The online version contains supplementary material available at (10.1007/s00590-021-02999-x).
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Osama Alzobi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Motasem Salameh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Aissam Elmhiregh
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Shamsi Hameed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Ghalib O Ahmed
- Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ahmed AF, Hantouly A, Toubasi A, Alzobi O, Mahmoud S, Qaimkhani S, Ahmed GO, Al Dosari MAA. The safety of outpatient total shoulder arthroplasty: a systematic review and meta-analysis. Int Orthop 2021; 45:697-710. [PMID: 33486581 PMCID: PMC7892728 DOI: 10.1007/s00264-021-04940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022]
Abstract
Purpose To meet the increasing demands of total shoulder arthroplasty (TSA) while reducing its financial burden, there has been a shift toward outpatient surgery. This systematic review and meta-analysis aimed to evaluate the safety of outpatient TSA. Methods The primary objective was to compare re-admission rates and postoperative complications in outpatient versus inpatient TSA. The secondary objectives were functional outcomes and costs. PubMed, Google Scholar, and Web of Science were searched until March 28, 2020. The inclusion criteria were studies reporting at least complications or readmission rates within a period of 30 days or more. Results Ten level III retrospective studies were included with 7637 (3.8%) and 192,025 (96.2%) patients underwent outpatient and inpatient TSA, respectively. Outpatient TSA had relatively younger and healthier patients. There were no differences between outpatient and inpatient arthroplasty for 30- and 90-day readmissions. Furthermore, unadjusted comparisons demonstrated significantly less total and major surgical complications, less total, major, and minor medical complications in favour of outpatient TSA. However, subgroup analyses demonstrated that there were no significant differences in all complication if the studies had matched controls and regardless of data source (database or nondatabase studies). The revision rates were similar between both groups at a 12–24 months follow-up. Two studies reported a significant reduction in costs in favour of outpatient TSA. Conclusion This study highlights that outpatient TSA could be a safe and effective alternative to inpatient TSA in appropriately selected patients. It was evident that outpatient TSA does not lead to increased readmissions, complications, or revision rates. A potential additional benefit of outpatient TSA was cost reduction. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-04940-7.
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Affiliation(s)
- Abdulaziz F Ahmed
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar.
| | - Ashraf Hantouly
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ammar Toubasi
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Osama Alzobi
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Shady Mahmoud
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saeed Qaimkhani
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ghalib O Ahmed
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Mohammed Al Ateeq Al Dosari
- Section of Orthopedics, Department of Surgery, Orthopaedic Surgery Resident, Hamad General Hospital, PO Box 3050, Doha, Qatar
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