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repOrt – Periodico online di SICOOP – 16/08

Sito ufficiale della Società Italiana Chirurghi Ortopedici dell'Ospedalità Privata.

Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis.
Krishnan R(1), MacNeil SD(1), Malvankar – Mehta MS (1).
BMJ Open. 2016 Jan 20;6(1):e009257. doi: 10.1136/bmjopen-2015-009257.

To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients. Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time,
inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life.13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied.
There was no significant difference in infection comparing sutures to staples.there may in fact be no difference in effect between the two skin closure and the methodological limitations of included studies, authors should begin to consider the economic and logistic implications of using staples or sutures for skin closure.

Knee surgery and its evidence base.
Sharma A(1), Hasan K(2), Carter A(3), Zaidi R(1), Cro S(4), Briggs T(1), Goldberg A(1).
Ann R Coll Surg Engl. 2016 Mar;98(3):170-6. doi: 10.1308/rcsann.2016.0075.

from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery  (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the
trend. The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.


Medicine (Baltimore). 2016 Feb;95(5):e2681. doi: 10.1097/MD.0000000000002681.
Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis: Is There a Relationship Between Magnetic Resonance Imaging Abnormalities of the Common Extensor Tendon and the Patient's Clinical Symptom?
Qi L(1), Zhang YD, Yu RB, Shi HB.

The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom.
Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined.MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively
correlate with the patient's clinical symptom.


J Orthop Trauma. 2015 Sep;29(9):e285-92. doi: 10.1097/BOT.0000000000000358.
Implant Removal After Internal Fixation of a Femoral Neck Fracture: Effects on Physical Functioning.
Zielinski SM(1), Heetveld MJ, Bhandari M, Patka P, Van Lieshout EM; FAITH Trial Investigators.

The effect of implant removal after internal fixation of a femoral neck fracture on physical functioning was analyzed. Of 162 patients, 37 (23%) had their implant removed. These patients were younger (median age: 67 vs. 72 years, P = 0.024) and more often independently ambulatory prefracture (100% vs. 84%, P = 0.008) than patients who did not. Implant removal after internal fixation of a femoral neck fracture positively influenced quality of life. Implant removal patients were younger and more often independently ambulatory prefracture, more often had a Pauwels 3 fracture, and an evident implant back-out. Implant removal should be considered liberally for these patients if pain persists or functional recovery is unsatisfactory.