BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is kn...BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.展开更多
Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)meta...Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)metastatic patterns,(3)treatment strategies,and(4)disease-specific survival(DSS).Materials and Methods:The SEER database was queried to identify patients with histologically confirmed STS of the pelvis or extremity.Univariate and multivariate analysis was performed using the Cox proportional hazards model.Disease-specific survival(DSS)was analyzed using the Kaplan-Meier method.Results:A total of 22,683 patients were retrieved,out of which 2,553(11.3%)had metastasis at diagnosis.Leiomyosarcoma,undifferentiated pleomorphic sarcoma(UPS),liposarcoma,synovial sarcoma,spindle cell sarcoma,and alveolar rhabdomyosarcoma(A-RMS)were the six most common STS presenting with metastasis.Among patients with metastasis,53.7%and 33.2%of patients had primary tumors located in the lower limb and pelvis,respectively.Lung was the most common site of metastasis in all subtypes except A-RMS,in which bone metastases and lymph node(LN)predominated(85.2%and 62.1%,respectively).Chemotherapy and radiotherapy were associated with higher DSS(HR=0.788 and HR=0.755,respectively).Five-year DSS was below 20%in all tumor histologies.Two-year DSS for patients with synchronous lung and liver metastases was 28%.Conclusion:Although the lung was the most common site of metastasis,metastatic patterns are highly variable depending on tumor histology.Metastatic A-RMS is most commonly presented with regional LN and bone involvement.Disease-specific survival remained poor for patients with metastatic disease at presentation regardless of(neo)-adjuvant radiotherapy or chemotherapy.展开更多
文摘BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
文摘Introduction:Patients with soft tissue sarcoma(STS)that present with metastasis at diagnosis have a dire prognosis.Within this patient population,we sought to assess:(1)demographic and clinical characteristics,(2)metastatic patterns,(3)treatment strategies,and(4)disease-specific survival(DSS).Materials and Methods:The SEER database was queried to identify patients with histologically confirmed STS of the pelvis or extremity.Univariate and multivariate analysis was performed using the Cox proportional hazards model.Disease-specific survival(DSS)was analyzed using the Kaplan-Meier method.Results:A total of 22,683 patients were retrieved,out of which 2,553(11.3%)had metastasis at diagnosis.Leiomyosarcoma,undifferentiated pleomorphic sarcoma(UPS),liposarcoma,synovial sarcoma,spindle cell sarcoma,and alveolar rhabdomyosarcoma(A-RMS)were the six most common STS presenting with metastasis.Among patients with metastasis,53.7%and 33.2%of patients had primary tumors located in the lower limb and pelvis,respectively.Lung was the most common site of metastasis in all subtypes except A-RMS,in which bone metastases and lymph node(LN)predominated(85.2%and 62.1%,respectively).Chemotherapy and radiotherapy were associated with higher DSS(HR=0.788 and HR=0.755,respectively).Five-year DSS was below 20%in all tumor histologies.Two-year DSS for patients with synchronous lung and liver metastases was 28%.Conclusion:Although the lung was the most common site of metastasis,metastatic patterns are highly variable depending on tumor histology.Metastatic A-RMS is most commonly presented with regional LN and bone involvement.Disease-specific survival remained poor for patients with metastatic disease at presentation regardless of(neo)-adjuvant radiotherapy or chemotherapy.
