Journal de traumatisme et de traitement

Objective: To statistically summarize all available results presented in the literature; to compute an inherently meaningful best estimate of the mean expectable treatment effect; to provide statistical evidence that advanced age and large chondral lesions adversely effect the outcome after microfracture.
Methods: We searched four electronic databases for prospective and retrospective studies that included sufficient statistical information. In order to convert all score values to the most frequently used Lysholm Score a regression analysis had to be performed at first, using data of 26 own patients. Subsequently, meta-, subgroup and regression analyses were performed.
Results: 16 studies representing 777 patients aged from 13 to 72 years with chondral lesions from 0.2 cm² to 20 cm² of size, evaluated after a follow-up period of six to 17 years referred to our eligibility criteria. We calculated an overall best estimate of 26.76 Lysholm points for the mean treatment effect. With values of 22.38 Lysholm points for group 1 (patients younger than 38 years on average) and 31.11 Lysholm points for group 2 (patients with a mean age greater-than-or-equal to 38 years) our subgroup analysis revealed a barely significant difference between the two means (p=0.499). Due to the fact that the mean preoperative score value in group 2 was considerably lower than in group 1 these findings might be caused by the uneven increase of the Lysholm Score and not by age-related facts. However, neither a subgroup analysis referring to the defect size, nor a linear regression with mean age as the predicting variable could reveal significant results.
Conclusion: Our meta-analysis enables patients to take a realistic view on their improvement in quality of life after knee microfracture, but it does not facilitate surgeon’s decision whether microfracture is the appropriate technique to treat a given full-thickness cartilage lesion of the knee.

The majority of patients with blunt chest trauma are treated conservatively or using minor thoracic surgical procedures, and video-assisted thoracoscopic surgery. However, in a small but significant number of patients an urgent exploration of the chest via, thoracotomy is unavoidable. In those cases thoracotomy means not only a surgical incision, but the most invasive (aggressive) method used in the complex treatment of blunt chest trauma. The objectives of this study were the following: (2) to specify the indications for urgent thoracotomy, regarding the possibilities of video-assisted thoracoscopic surgery; [2] to reveal the main factors influencing outcomes following urgent thoracotomy. A retrospective review of 1,826 patients (age 40.3 ± 12.4, range 18 – 79 years) with blunt chest trauma over the period of 10 years (2002-2011) was performed. A detailed analysis was completed involving 102 (5.6%) patients who
underwent urgent thoracotomy. We recorded patients’ age and gender, the mechanism of injury, clinical condition, NISS, injuries of the chest, intrapleural hemorrhage (hemothorax) and air leakage (aeropathic syndrome), methods of treatment, mortality and morbidity occurring within 30 days following urgent thoracotomy. Student’s t and chisquared tests were used for the comparison of the data. The level of  statistical significance was set at p<0.05. Comparing to the previous period (1987-2000), video-assisted  horacoscopic surgery has reduced twice (to 5.6%) the incidence rate of urgent thoracotomy.  he overall postoperative morbidity and mortality rate was 65.7% and 8.8%, respectively. Video-assisted   horacoscopic approach is the method of choice for clinically stable patients. However, when surgical  intervention is unavoidable for clinically unstable patients, it should be started with urgent thoracotomy.  Multiple fractures of ribs and/or sternum that caused flail chest, injuries of lungs, and intensive  intrapleural hemorrhage, resulting in patient’s clinically unstable condition were the main factors  influencing morbidity and mortality following urgent thoracotomy due to blunt chest trauma.

Hook plates are used to treat acromio-clavicular joint dislocations and lateral clavicle fractures. Our study looked at patient outcome following treatment with a Synthes clavicular hook plate.
Method: Medical notes review and telephone interview of patients treated with a clavicular hook plate between 2003 and 2009 at Airedale General Hospital. Modified constant score calculated looking at pain, range of movement, power and functional level, and general comments recorded.
Results: Total of fifteen patients treated with hook plates, unable to contact two patients, three notes unavailable. Of remaining ten patients (M:F; 7:3), six were for lateral clavicle fractures, three for ACJ dislocation and one not recorded. One plate was still in situ. Follow up after plate removal ranged from 0-79 months, mean 22 months. Only complication was a fatigue fracture next to the plate prior to removal. Modified constant score, out of 80, had a mean of 78 (range 25-80). Patients reported problems with pain and reduced range of movement whilst the hook plate was in situ, with some pain remaining after removal, particularly affecting their sleep.
Conclusion: It is previously documented that hook plates are an effective way of treating ACJ dislocations and lateral clavicle fractures, however patients should be appropriately counselled of the likely  is comfort whilst in situ which occasionally persists after removal.