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Article ; Online: Acetabular fractures in the elderly. what is the current evidence for optimal treatment?

Papakostidis, Costas / Giannoudis, P V

2024 Volume 55, Issue 3, Page(s) 111364

MeSH term(s)	Humans ; Aged ; Hip Fractures/surgery ; Fractures, Bone/surgery ; Spinal Fractures ; Acetabulum/surgery ; Acetabulum/injuries ; Fracture Fixation, Internal ; Retrospective Studies ; Treatment Outcome ; Arthroplasty, Replacement, Hip
Language	English
Publishing date	2024-02-19
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2024.111364
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Reconstruction of infected long bone defects: Issues and Challenges.

Papakostidis, Costas / Giannoudis, Peter V

Injury

2023 Volume 54, Issue 3, Page(s) 807–810

MeSH term(s)	Humans ; Plastic Surgery Procedures ; Follow-Up Studies ; Bone Transplantation ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2023-02-24
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.01.052
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Systematic reviews and meta-analyses: What are the common pitfalls?

Papakostidis, Costas / Giannoudis, P V

Injury

2022 Volume 53, Issue 4, Page(s) 1301–1304

Language	English
Publishing date	2022-01-31
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2022.01.042
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Meta-analysis. What have we learned?

Papakostidis, Costas / Giannoudis, Peter V

Injury

2022 Volume 54 Suppl 3, Page(s) S30–S34

Abstract: Meta-analyses constitute fundamental tools of the Evidence-Based Medicine (EBM) aiming at synthesizing outcome data from individual trials in order to produce pooled effect estimates for various outcomes of interest. Combining summary data from several ... ...

Abstract	Meta-analyses constitute fundamental tools of the Evidence-Based Medicine (EBM) aiming at synthesizing outcome data from individual trials in order to produce pooled effect estimates for various outcomes of interest. Combining summary data from several studies increases the sample size, improves the statistical power of the findings as well as the precision of the obtained effect estimates. For all these reasons, meta-analyses are thought of providing the best evidence to support clinical practice guidelines. However, the strength of the provided evidence is closely dependent on the quality of included studies as well as the rigour of the meta-analytic process. In addition, over the course of the evolution of the current meta-analytic methodology, some concerns have been expressed on the ultimate usefulness of such a complex and time consuming procedure on establishing timely, valid evidence on various specified topics in the field of Orthopaedics and Trauma Surgery. This article provides an overview of the appropriate methodology, benefits and potential drawbacks of the meta-analytic procedure.
MeSH term(s)	Humans ; Evidence-Based Medicine/methods ; Meta-Analysis as Topic
Language	English
Publishing date	2022-06-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2022.06.012
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Distraction osteogenesis versus induced membrane technique for infected tibial non-unions with segmental bone loss: a systematic review of the literature and meta-analysis of available studies.

Wakefield, Sophia M / Papakostidis, Costas / Giannoudis, Vasileios P / Mandía-Martínez, Alfonso / Giannoudis, Peter V

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2023

Abstract: Introduction: Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using ... ...

Abstract	Introduction: Infected tibial non-unions with associated bone loss can be challenging to manage. At present, the two main methods utilized in the management of these fractures include the Ilizarov technique of Distraction Osteogenesis (DO) using external fixator devices, or alternatively, the Induced Membrane Technique (IMT), devised by Masquelet. As there is a paucity of data directly comparing the outcomes of these techniques, there is no universal agreement on which strategy a surgeon should choose to use. Aims: This systematic review and meta-analysis aimed to summarize the outcomes of both DO and IMT, in terms of primary outcomes (bone union and infection elimination), and secondary outcomes (complication rates and functional outcomes). Methods: A PRISMA strategy was used. Medline, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated using OCEBM and GRADE systems. Results: Thirty-two studies with 1136 subjects met the inclusion criteria. With respect to the primary outcomes of interest, union was observed in 94.6% (DO method) and 88.0% (IMT method); this difference, however, was not significant between the two techniques (p = 0.45). In addition, infection elimination rates were also higher in the Ilizarov DO group when compared to Masquelet (Mq) IMT (93.0% vs 80.4% respectively). Again, no significant difference was observed (p = 0.06). For all secondary outcomes assessed (unplanned re-operations, re-fracture rates amputation rate), no statistically significant differences were documented between the treatment options. Conclusion: This study demonstrated that there is no clinical difference in outcomes for patients treated with Ilizarov DO versus Mq IMT techniques. The evidence base at present is relatively sparse and, therefore, we would recommend for further Level I studies to be conducted, to make more meaningful conclusions.
Language	English
Publishing date	2023-11-03
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-023-02375-w
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis.

Papakostidis, Costas / Giannoudis, Peter V / Watson, J Tracy / Zura, Robert / Steen, R Grant

Journal of orthopaedic surgery and research

2021 Volume 16, Issue 1, Page(s) 236

Abstract: Background: Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether ... ...

Abstract	Background: Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods: To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia. Results: Of 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4-7.2%, I Conclusions: TKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.
MeSH term(s)	Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Knee/methods ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Coma/epidemiology ; Coma/etiology ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/methods ; Female ; Humans ; Male ; Patient Readmission/statistics & numerical data ; Pneumonia/epidemiology ; Pneumonia/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Renal Insufficiency/epidemiology ; Renal Insufficiency/etiology ; Sepsis/epidemiology ; Sepsis/etiology ; Severity of Illness Index ; Stroke/epidemiology ; Stroke/etiology ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology
Language	English
Publishing date	2021-03-31
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ISSN	1749-799X
ISSN (online)	1749-799X
DOI	10.1186/s13018-021-02358-w
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Article ; Online: Mixed results with the Masquelet technique: A fact or a myth?

Mi, Meng / Papakostidis, Costas / Wu, Xinbao / Giannoudis, Peter V

Injury

2019 Volume 51, Issue 2, Page(s) 132–135

MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Cements/therapeutic use ; Bone Morphogenetic Proteins/therapeutic use ; Bone Transplantation/adverse effects ; Bone Transplantation/methods ; Debridement ; External Fixators ; Female ; Fracture Healing ; Fractures, Ununited/drug therapy ; Fractures, Ununited/surgery ; Graft Survival ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Surgical Wound Infection/etiology ; Treatment Outcome ; Young Adult
Chemical Substances	Bone Cements ; Bone Morphogenetic Proteins
Language	English
Publishing date	2019-12-19
Publishing country	Netherlands
Document type	Editorial ; Review
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2019.12.032
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Incidence of deep infection, union and malunion for open diaphyseal femoral shaft fractures treated with IM nailing: A systematic review.

Saleeb, Hany / Tosounidis, Theodoros / Papakostidis, Costas / Giannoudis, Peter V

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2018 Volume 17, Issue 5, Page(s) 257–269

Abstract: Background: and purpose: We have undertaken a systematic review to evaluate the clinical results of intramedullary nailing (IMN) for open diaphyseal femoral fractures on the rates of union, delayed union, malunion, superficial and deep infection and ... ...

Abstract	Background: and purpose: We have undertaken a systematic review to evaluate the clinical results of intramedullary nailing (IMN) for open diaphyseal femoral fractures on the rates of union, delayed union, malunion, superficial and deep infection and bone grafting. Methods: We searched the electronic databases of EMBASE, MEDLINE, from their inception until December 1st, 2017 with no language restrictions. The reference lists of all included articles and relevant reviews were also examined for potentially eligible studies. Hand search using electronic database of recent major orthopaedic journals was also carried. Two reviewers working independently extracted study characteristics and data to estimate the diagnostic odds ratio and 95% confidence interval for each result. Results: Seventeen studies were eligible. Pooled estimate of effect size for union rate was 97% (95% CI: 94-99%). Deep infection rate was 6% (95% CI: 3-9.3%) and more prominent in Gustilo type III injuries; superficial infection was 5.6% (95% CI: 3-9.3%). Delayed union rate 3% (95% CI: 1-5.6%) while, malunion rate was 8.4% (95% CI: 5.7-11.6%). The need for bone grafting ranged from 0 to 9%. Conclusions: IMN remains the treatment of choice for open femoral diaphyseal fractures with very good union rates. Gustilo grade III injuries demonstrate a distinct higher deep infection rate and strict adherence to established surgical debridement and fixation protocols is advocated. The need for bone grafting can be as high as 9% and patients should be made aware of the possibility of requiring this additional procedure.
MeSH term(s)	Bone Transplantation ; Debridement ; Diaphyses/injuries ; Diaphyses/surgery ; Femoral Fractures/complications ; Femoral Fractures/surgery ; Fracture Fixation, Intramedullary/adverse effects ; Fracture Healing ; Fractures, Malunited/epidemiology ; Fractures, Malunited/etiology ; Fractures, Open/complications ; Fractures, Open/surgery ; Fractures, Ununited/epidemiology ; Fractures, Ununited/etiology ; Humans ; Incidence ; Infections/epidemiology ; Infections/etiology
Language	English
Publishing date	2018-08-27
Publishing country	Scotland
Document type	Journal Article ; Systematic Review
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2018.08.003
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Article: Physical Health and Psychological Outcomes in Adult Patients with Long-bone Fracture Non-unions: Evidence Today.

Johnson, Louise / Igoe, Emily / Kleftouris, George / Papachristos, Ioannis V / Papakostidis, Costas / Giannoudis, Peter V

Journal of clinical medicine

2019 Volume 8, Issue 11

Abstract: Background: Research has suggested that bone fractures can hinder the health status of patients' life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of ... ...

Abstract	Background: Research has suggested that bone fractures can hinder the health status of patients' life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes. Methods: Electronic databases 'PubMed', 'Cochrane', 'PsycInfo', 'Medline', 'Embase', 'Web of Science', and 'CINAHL' were used. Search terms used were nonunion OR non-union OR "non union" OR "long bone" OR "delayed union" AND "quality of life" OR qol OR depression OR anxiety OR psycholog* OR PTSD OR "post-traumatic stress disorder". Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The "non-union" group to a normative, matched population and (2) the "non-union group" to the same group after union was achieved. However, studies that did not use comparison groups were also included. Results: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery. Conclusions: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.
Language	English
Publishing date	2019-11-15
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm8111998
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Article ; Online: Duration of Administration of Antibiotic Agents for Open Fractures: Meta-Analysis of the Existing Evidence.

Messner, Juergen / Papakostidis, Costas / Giannoudis, Peter V / Kanakaris, Nikolaos K

Surgical infections

2017 Volume 18, Issue 8, Page(s) 854–867

Abstract: Background: Surgical site infection remains a significant concern in treating patients with open fractures. In prevention of such, current guidelines support the immediate administration of antibiotic agents. The duration of antibiotic treatment is ... ...

Abstract	Background: Surgical site infection remains a significant concern in treating patients with open fractures. In prevention of such, current guidelines support the immediate administration of antibiotic agents. The duration of antibiotic treatment is still controversial. A maximum of 72 hours, even in the absence of definitive soft tissue coverage, is recommended in a number of recent guidelines and consensus reports. The aim of this meta-analysis was to review and analyze all published literature evidence with regard to antibiotic duration in open fracture treatment. Methods: We conducted a comprehensive review of the available literature from the 1970s until the present, including five comparative (1284 open fractures) and 27 observational (5408 open fractures) studies. A subgroup analysis was further performed, based on the Gustilo type of open injury and the anatomic location of the fracture. In addition, we investigated the effect of antibiotic regimes shorter than 72 hours on infection rates. Results: In the comparative studies, the summarized estimate of infection rate favored less than a 72-hour duration of antibiotic treatment, because prolongation of antibiotic treatment more than 72 hours did not seem to offer any protective effect against septic complications of open fractures (odds ratio: 0.85, 95% confidence interval [CI]: 0.60-1.21). The same trend was also documented in the observational studies, where the overall pooled estimate of infection rate was 10% (95% CI: 6.8%-14%) when antibiotic treatment did not exceed 72 hours and 9.2% (95% CI: 6.6%-12.2%) for more than 72 hours of antibiotic treatment (p = 0.53). In Gustilo I and II open fractures, the calculated pooled estimate of infection rate did not differ significantly when antibiotic treatment exceeded 72 hours (6%, 95% CI: 3.3%-9%) compared with shorter (up to 72 h) antibiotic protocols (4%, 95% CI: 1.8%-7%) (p = 0.52). In Gustilo III open fractures also, the calculated pooled estimate of infection rate (21.3%, 95% CI: 13%-31%) when duration of antibiotic treatment was more than 72 hours did not differ significantly compared with a shorter (less than 72 h) antibiotic treatment (17.7%, 95% CI: 12.5%-23.5%) (p = 0.39). A further subgroup analysis indicated that even shorter antibiotic regimes (24-48 h) were also equivalent to prolonged regimes of more than 72 hours in terms of infection rates. Conclusions: The results of the present systematic review and meta-analysis could not substantiate any benefit against septic complications of a prolonged duration of antibiotic treatment of open fractures, irrespective of their severity.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2017.108
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