Evidence map›Paper›PMID 39090587›Full record

SynthesisBMC musculoskeletal disorders2024

Arthroscopic assisted versus open non-vascularized bone grafting in delayed union and nonunion of the scaphoid: a systematic review and meta-analysis.

Atefeh Noori, Jonathan Persitz, Shawn Khan, Andrea Chan, Ryan Paul

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC musculoskeletal disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Atefeh NooriHand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada.
Jonathan PersitzHand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada.
Shawn KhanHand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada.
Andrea ChanHand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada. andrea.chan@sickkids.ca.
Ryan PaulHand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, Affiliated with University of Toronto, East Wing, 2nd Floor, Rm. 400, Toronto, Canada. ryan.paul2@uhn.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDelayed union and nonunion of the scaphoid is a common complication often requiring surgical reconstruction and bone grafting. Our goal was to systematically assess the healing time and clinical outcomes following arthroscopic-assisted versus open non-vascularized bone grafting of the scaphoid.

methodsA comprehensive search of the MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central databases was completed from inception to September 2023. We included randomized trials and observational studies that reported outcomes following scaphoid delayed union/nonunion comparing arthroscopic-assisted vs. open non-vascularized bone grafting. Two reviewers independently extracted data and assessed the risk of bias. One investigator assessed certainty of evidence and a senior investigator confirmed the assessment. We pooled effects using random-effects models, when possible, for all outcomes reported by more than 1 study.

resultsOverall, 26 studies and 822 patients were included in the study. Very low certainty evidence demonstrated that arthroscopic-assisted surgery may decrease healing time compared to open surgery (weighted mean difference [WMD] -7.8 weeks; 95%CI -12.8 to -2.8). Arthroscopic bone grafting did not result in an improvement in union rate (relative risk 1.01; 95%CI 0.9 to 1.09). The pooled data in arthroscopic graft group showed mean time to union of 11.4 weeks (95%CI: 10.4 to 12.5) with union rate of 95% (95%CI 91-98%). A single comparative study reported very low certainty evidence that arthroscopy-assisted vs. open surgery may not have an effect on pain relief (MD 0 cm, 95%CI -0.4 to 0.5 on VAS 10 cm for pain) or improving function (MD -1.2, 95% CI -4.8 to 2.3 on 100 points DASH). CONCLUSION AND FUTURE DIRECTIONS: Our results suggest that arthroscopic-assisted non-vascularized bone grafting may be associated with improved average weeks to heal in comparison with open surgery for scaphoid delayed union/nonunion reconstruction with overall comparable union rates. There is insufficient evidence to assess the effects of arthroscopic-assisted reconstruction on union rate, time to union, and patient-reported outcomes in patients with other important nonunion characteristics such as established humpback deformity.

Indexed as

ArthroscopyBone TransplantationFracture HealingFractures, UnunitedScaphoid BoneHumansTreatment OutcomeArthroscopic-assistedMeta-analysisNonunionNon-vascularized bone graftingScaphoid delayed unionSystematic review

Identifiers

PMID39090587
PMCPMC11293166

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.