JBJS ReviewsPub Date : 2024-07-05eCollection Date: 2024-07-01DOI: 10.2106/JBJS.RVW.24.00048
Ashley B Anderson, Jason M Souza, Lisa Prasso, Shannon Ford, Julio A Rivera, Louise Hassinger, Tawnee Sparling, Jonathan A Forsberg, Benjamin K Potter
{"title":"Team Approach: Osseointegration Amputation Surgery.","authors":"Ashley B Anderson, Jason M Souza, Lisa Prasso, Shannon Ford, Julio A Rivera, Louise Hassinger, Tawnee Sparling, Jonathan A Forsberg, Benjamin K Potter","doi":"10.2106/JBJS.RVW.24.00048","DOIUrl":"10.2106/JBJS.RVW.24.00048","url":null,"abstract":"<p><p>» The purpose of this article was to review the multidisciplinary, team-based approach necessary for the optimal management of patients with limb loss undergoing osseointegration surgery.» In this study, we describe the interdisciplinary process of screening, counseling, and surgical and rehabilitation considerations with an emphasis on principles rather than specific implants or techniques.» Integrated perioperative management and long-term surveillance are crucial to ensure the best possible outcomes.» We hope this model will service as an implant-agnostic guide to others seeking to development an osseointegration center of excellence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-07-05eCollection Date: 2024-07-01DOI: 10.2106/JBJS.RVW.24.00022
Ali Lari, Ali Esmaeil, Yousef AlSalem, Fahad Alabbad, Maged Shahin, Ahmed Aoude
{"title":"Comparative Outcomes and Failure Rates of Total Femur Replacement in Oncologic and Nononcologic Indications: A Systematic Review and Meta-analysis.","authors":"Ali Lari, Ali Esmaeil, Yousef AlSalem, Fahad Alabbad, Maged Shahin, Ahmed Aoude","doi":"10.2106/JBJS.RVW.24.00022","DOIUrl":"10.2106/JBJS.RVW.24.00022","url":null,"abstract":"<p><strong>Background: </strong>Total femur replacement (TFR) has become increasingly significant as a salvage procedure for both oncologic reconstruction and complex nononcologic conditions such as revision arthroplasty. Despite its effectiveness in limb salvage, TFR is associated with high complication and failure rates, which vary depending on the underlying indication.</p><p><strong>Methods: </strong>This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of MEDLINE, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, focusing on studies that reported outcomes of TFR in oncologic and nononcologic cases. Primary outcomes included failure mode and rates according to the Henderson classification, functional outcomes scores, and mobility status. Data were analyzed using random-effects models and generalized linear mixed models.</p><p><strong>Results: </strong>A total of 35 studies involving 1,002 patients were included. The majority of TFRs were performed for oncologic reasons (63.7%). The mean Musculoskeletal Tumor Society (MSTS) score was 66%, with a limb salvage rate of 89%. The meta-analysis revealed a combined failure rate of 34%. For type 4 failures (infection), nononcologic patients exhibited a significantly higher rate at 18% (95% confidence interval [CI], 12%-26%, I2 = 46%, p < 0.01) compared with 8% in oncologic patients (95% CI, 6%-12%, I2 = 0%). Regarding combined types 1 to 4 failures, oncologic patients had a rate of 20% (95% CI, 25%-52%, I2 = 60%), whereas nononcologic patients faced a higher rate of 37% (95% CI, 12%-26%, I2 = 63%) (p < 0.05), indicating a significant difference. There were no significant differences in the MSTS score. In addition, there were no notable differences when comparing failure modes 1, 2, and 3 independently. Mobility analysis showed that approximately 70% of patients required walking aids after surgery.</p><p><strong>Conclusion: </strong>TFR offers a valuable limb salvage option in both oncologic and nononcologic scenarios, despite its high failure rates. Although functional outcomes were similar between groups, the higher failure rate in nononcologic cases and the poor overall quality of evidence warrant further comprehensive assessments into predictors of outcomes to optimize results.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-06-24eCollection Date: 2024-06-01DOI: 10.2106/JBJS.RVW.24.00036
Olivia K Blaber, Mikalyn T DeFoor, Zachary A Aman, Emily R McDermott, Nicholas N DePhillipo, Jonathan F Dickens, Travis J Dekker
{"title":"Lack of Consensus on the Management of Medial Collateral Ligament Tears in the Setting of Concomitant Anterior Cruciate Ligament Injury: A Critical Analysis.","authors":"Olivia K Blaber, Mikalyn T DeFoor, Zachary A Aman, Emily R McDermott, Nicholas N DePhillipo, Jonathan F Dickens, Travis J Dekker","doi":"10.2106/JBJS.RVW.24.00036","DOIUrl":"10.2106/JBJS.RVW.24.00036","url":null,"abstract":"<p><p>» There is no clear agreement on the optimal timing or superior type of fixation for medial collateral ligament (MCL) tears in the setting of anterior cruciate ligament (ACL) injury.» Anatomic healing of medial knee structures is critical to maintain native knee kinematics, supported by biomechanical studies that demonstrate increased graft laxity and residual valgus rotational instability after ACL reconstruction (ACLR) alone in the setting of concomitant ACL/MCL injury.» Historically, most surgeons have favored treating acute combined ACL/MCL tears conservatively with MCL rehabilitation, followed by stress radiographs at 6 weeks after injury to assess for persistent valgus laxity before performing delayed ACLR to allow for full knee range of motion, and reduce the risk of postoperative stiffness and arthrofibrosis.» However, with the advancement of early mobilization and aggressive physical therapy protocols, acute surgical management of MCL tears in the setting of ACL injury can have benefits of avoiding residual laxity and further intra-articular damage, as well as earlier return to sport.» Residual valgus laxity from incomplete MCL healing at the time of ACLR should be addressed surgically, as this can lead to an increased risk of ACLR graft failure.» The treatment of combined ACL/MCL injuries requires an individualized approach, including athlete-specific factors such as level and position of play, timing of injury related to in-season play, contact vs. noncontact sport, and anticipated longevity, as well as consideration of the tear pattern, acuity of injury, tissue quality, and surgeon familiarity with the available techniques.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-06-18eCollection Date: 2024-06-01DOI: 10.2106/JBJS.RVW.24.00035
Dev Laungani, Joshua R Porto, Lucas Haase, Kira Smith, Raymond Chen, Robert Gillespie
{"title":"Tranexamic Acid in Total Shoulder Arthroplasty: A Scoping Review of Current Practices and Future Directions.","authors":"Dev Laungani, Joshua R Porto, Lucas Haase, Kira Smith, Raymond Chen, Robert Gillespie","doi":"10.2106/JBJS.RVW.24.00035","DOIUrl":"10.2106/JBJS.RVW.24.00035","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of tranexamic acid (TXA) as an antifibrinolytic agent in total shoulder arthroplasty (TSA) is well documented; however, there remains considerable practice variability concerning the optimal route of administration and dosing protocols concerning the medication's use. Our aim was to conduct a scoping review of the literature regarding the efficacy of various methods of TXA administration in TSA and to identify knowledge gaps that may be addressed.</p><p><strong>Methods: </strong>A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The PubMed and MEDLINE electronic databases were searched to identify all articles published before March 2023 investigating the administration of TXA in TSA. Randomized controlled trials and cohort studies were included, and data were extracted to capture information regarding intervention details and related outcomes such as blood loss, transfusion needs, and complication rates.</p><p><strong>Results: </strong>A total of 15 studies were included in this review. All selected studies used either intravenous (IV) or topical TXA, with 1 study also including a combined approach of both topical and IV TXA. Of the studies that used an IV approach, the most commonly reported favorable outcomes were a reduction in blood volume loss, reduction in hemoglobin or hematocrit change, and decreased drain output. Dosing varied significantly between all identified studies because some used a standard dosing amount in grams or milligrams for all treatment group participants, whereas others used weight-based dosing amounts. All studies that used a weight-based dosing regimen as well as studies using a standard dosing amount between 1,000 and 5,000 mg reported favorable outcomes for postoperative blood loss.</p><p><strong>Conclusion: </strong>Both IV and topical TXA clearly demonstrate favorable perioperative hematologic profiles in TSA. Although both approaches have demonstrated a successful association with decreased blood loss and transfusion requirements, there is no definitive benefit to choosing one over the other. Furthermore, the use of oral TXA either in combination or isolation warrants further study in TSA because of its comparable efficacy profiles and significantly lower associated costs of application.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-06-18eCollection Date: 2024-06-01DOI: 10.2106/JBJS.RVW.24.00061
Michel A Arcand, Dominique Poulin, Edward J Testa, Nicholas J Lemme
{"title":"Testosterone: A Review for Orthopaedic Surgeons.","authors":"Michel A Arcand, Dominique Poulin, Edward J Testa, Nicholas J Lemme","doi":"10.2106/JBJS.RVW.24.00061","DOIUrl":"10.2106/JBJS.RVW.24.00061","url":null,"abstract":"<p><p>» Testosterone replacement treatment (TRT) and anabolic androgenic steroid (AAS) use is common and possibly increasing.» Diagnosing and treating hypogonadism in men is controversial.» Hypogonadism and the use of AASs seem to have a detrimental effect on the musculoskeletal system. The current literature on TRT and the musculoskeletal system shows an increased risk of tendon injury.» There may be a role for testosterone supplementation in the postoperative period.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-06-14eCollection Date: 2024-06-01DOI: 10.2106/JBJS.RVW.24.00019
Mark Edward Puhaindran, Aymeric Yu Tang Lim
{"title":"Tumors of the Brachial Plexus: A Critical Analysis Review.","authors":"Mark Edward Puhaindran, Aymeric Yu Tang Lim","doi":"10.2106/JBJS.RVW.24.00019","DOIUrl":"10.2106/JBJS.RVW.24.00019","url":null,"abstract":"<p><p>» Tumors of the brachial plexus are uncommon and can present as a mass, with or without neurological symptoms. At times, asymptomatic tumors are also picked up incidentally when imaging is performed for other reasons.» Magnetic resonance imaging is the main imaging modality used to evaluate tumors of the brachial plexus. Other imaging modalities can be used as required.» Benign tumors that are asymptomatic should be observed. Excision can be considered for those that are found to be growing over time.» Biopsies of tumors of the brachial plexus are associated with the risk of nerve injury. Despite this, they should be performed for tumors that are suspected to be malignant before starting definitive treatment.» For malignant tumors, treatment decisions should be discussed at multidisciplinary tumor boards, and include both the oncology and peripheral nerve surgical team, musculoskeletal radiology, neuroradiology, and general radiology.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 6","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11175764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-05-28eCollection Date: 2024-05-01DOI: 10.2106/JBJS.RVW.24.00043
Sarah Hunter, Haemish Crawford, Braden Te Ao, Cameron Grant
{"title":"Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection: A Systematic Review.","authors":"Sarah Hunter, Haemish Crawford, Braden Te Ao, Cameron Grant","doi":"10.2106/JBJS.RVW.24.00043","DOIUrl":"10.2106/JBJS.RVW.24.00043","url":null,"abstract":"<p><strong>Background: </strong>Childhood bone and joint infection (BJI) is a potentially severe disease with consequences for growth and development. Critically unwell children may require prolonged hospitalization and multiple surgeries. Acknowledging rising healthcare costs and the financial impact of illness on caregivers, increased efforts are required to optimize treatment. This systematic review aims to characterize existing costs of hospital care and summarize strategies, which reduce treatment expense.</p><p><strong>Methods: </strong>A systematic review of the literature was performed from January 1, 1980, to January 31, 2024. Data were extracted on hospitalization costs for pediatric BJI by decade and global region. Results have been converted to cost per day in US dollars with purchase parity for 2023. Studies reporting innovations in clinical care to reduce length of stay (LOS) and simplify treatment were identified. Studies trialing shorter antibiotic treatment were only included if they specifically reported changes in LOS.</p><p><strong>Results: </strong>Twenty-three studies met inclusion criteria; of these, a daily hospitalization cost could be derived from 7 publications. Overall hospitalization cost and inpatient charges rose steeply from the 1990s to the 2020s. By contrast, average LOS seems to have decreased. Cost per day was higher in the United States than in Europe and higher for cases with confirmed methicillin-resistant Staphylococcus aureus. Sixteen studies report innovations to optimize care. For studies where reduced LOS was achieved, early magnetic resonance imaging with immediate transfer to theater when necessary and discharge on oral antibiotics were consistent features.</p><p><strong>Conclusion: </strong>Rising costs of hospital care and economic consequences for families can be mitigated by simplifying treatment for childhood BJI. Hospitals that adopt protocols for early advanced imaging and oral antibiotic switch may provide satisfactory clinical outcomes at lower cost.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-05-20eCollection Date: 2024-05-01DOI: 10.2106/JBJS.RVW.24.00008
Marcos R Gonzalez, Joseph O Werenski, Santiago A Lozano-Calderon
{"title":"Postoperative Outcomes of Total Humerus Replacement for Oncologic Reconstruction of the Upper Limb: A Systematic Review of the Literature.","authors":"Marcos R Gonzalez, Joseph O Werenski, Santiago A Lozano-Calderon","doi":"10.2106/JBJS.RVW.24.00008","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00008","url":null,"abstract":"<p><strong>Background: </strong>Total humerus replacement (THR) is a reconstruction procedure performed after resection of massive humeral tumors. However, there is limited literature on the rates of failure and functional outcomes of this implant. Our study aimed to determine the main failure modes, implant survival, and postoperative functional outcomes of THR.</p><p><strong>Methods: </strong>A comprehensive search of the PubMed and Embase databases was conducted. We registered our study on PROSPERO (448684) and used the Strengthening the Reporting of Observational Studies in Epidemiology checklist for quality assessment. The Henderson classification was used to assess endoprosthesis failure and the Musculoskeletal Tumor Society (MSTS) score for functional outcomes. Weighted means and standard deviations were calculated.</p><p><strong>Results: </strong>Ten studies comprising 171 patients undergoing THR were finally included. The overall failure rate was 32.2%. Tumor progression (12.6%) and prosthetic infections (9.4%) were the most common failure modes, followed by soft-tissue failures (5.9%), aseptic loosening (3.5%), and structural failure (1.8%). Two-year, 5-year, and 10-year implant survival rates for the entire cohort were 86%, 81%, and 69.3%. Ten-year implant survival for primary THRs was 78.3%, compared with 38.6% for revision THRs (p = 0.049). The mean MSTS score at the last follow-up was 77%. Patients whose implants did not fail had a higher MSTS score (79.3%) than those with failed implants (71.4%) (p = 0.02).</p><p><strong>Conclusion: </strong>One-third of THR will fail, mostly due to tumor progression and prosthetic infection. Overall functional scores were acceptable, with MSTS scores displaying great hand and elbow function but limited shoulder function.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 5","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-05-15eCollection Date: 2024-05-01DOI: 10.2106/JBJS.RVW.24.00030
Anthony Modica, Adam D Bitterman
{"title":"The Impact of Patient Education on Inpatient Fall Risk: A Review.","authors":"Anthony Modica, Adam D Bitterman","doi":"10.2106/JBJS.RVW.24.00030","DOIUrl":"10.2106/JBJS.RVW.24.00030","url":null,"abstract":"<p><p>» Patient falls in the hospital are one of the leading sentinel events identified by the Joint Commission.» Hospital falls affect orthopaedic patients of older age at higher rates, and up to 34% of falls lead to injury such as fractures.» Patients often misperceive their fall risk, and modalities aimed at educating patients to address the incongruence between perceived and actual fall risk significantly reduce fall rate and injurious fall rate.» Adequate communication with patients and their families with the goal of educating them may diminish the physical, psychological, and emotional detriment to orthopaedic patients.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-05-06eCollection Date: 2024-05-01DOI: 10.2106/JBJS.RVW.24.00031
Jiayong Liu, Shiva Senthilkumar, Thomas Cho, Chris G Sanford
{"title":"Acute Ankle Diastasis Injuries Treated with Dynamic, Static Fixation or Anatomic Repair: A Meta-Analysis and Systematic Review of Comparison Studies.","authors":"Jiayong Liu, Shiva Senthilkumar, Thomas Cho, Chris G Sanford","doi":"10.2106/JBJS.RVW.24.00031","DOIUrl":"10.2106/JBJS.RVW.24.00031","url":null,"abstract":"<p><strong>Background: </strong>Acute ankle diastasis injuries are complex and debilitating. These injuries occur when the syndesmotic complex becomes compromised. Treatments of acute syndesmotic injuries include static fixation with screws, dynamic fixation with an elastic device, or anatomic repair of the damaged ligament. However, there is disagreement over which method is most effective. The primary purpose of this study was to compare the 3 treatment methods for acute syndesmotic injuries.</p><p><strong>Methods: </strong>A systematic literature search was conducted on Embase and PubMed. Studies that compared at least 2 groups with relevant American Orthopaedic Foot & Ankle Society (AOFAS), Visual Analog Scale (VAS), reoperation rate, and complication (implant failure, implant irritation, and infection) data were analyzed. Statistical analysis for this study was performed using Review Manager 5.4, with a standard p-value of ≤0.05 for statistical significance.</p><p><strong>Results: </strong>Twenty-one studies including a total of 1,059 patients (452 dynamic, 529 static, and 78 anatomic) were included for analysis. Dynamic fixation had significantly higher mean AOFAS scores at 3 months postoperation by 5.12 points (95% confidence interval [CI], 0.29-9.96, p = 0.04) as well as at 1 year postoperation by 4.64 points (95% CI, 1.74-7.55, p = 0.002) than static fixation. Anatomic repair had significantly higher AOFAS scores at 6 months postoperation by 3.20 points (95% CI, 1.06-5.34, p = 0.003) and 1 year postoperation by 1.86 points (95% CI, 0.59-3.14, p = 0.004) than static fixation. Dynamic fixation had significantly higher AOFAS scores at 6 months postoperation by 2.81 points (95% CI, 0.76-4.86, p = 0.007), 12 months postoperation by 3.17 points (95% CI, 0.76-5.58, p = 0.01), and at 2 years postoperation by 5.56 points (95% CI, 3.80-7.32, p < 0.001) than anatomic repair. Dynamic fixation also had a lower VAS score average (favorable), only significant at 12 months postoperation, than static fixation by 0.7 points (95% CI -0.99 to -0.40, p < 0.001). Anatomic repair did not have significant difference in VAS scores compared with static fixation. Anatomic repair had significantly lower VAS scores at 12 months postoperation by 0.32 points (95% CI -0.59 to -0.05, p = 0.02) than dynamic fixation. Dynamic fixation had significantly less implant failures (odds ratio [OR], 0.13, 95% CI, 0.05-0.32, p < 0.001) than static fixation. Anatomic repair was not significantly different from static fixation in the complication metrics. Dynamic fixation and anatomic repair were not significantly different in the complication metrics either. Dynamic fixation had a significantly lower reoperation rate than static fixation (OR, 0.23, 95% CI, 0.09-0.54, p < 0.001). Anatomic repair did not have a significantly different reoperation rate compared with static fixation. However, dynamic fixation had a significantly lower reoperation rate than anatomic repair (OR, 4.65, 95","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}