Citations

Background: Pediatric tibial fractures are common long-bone injuries, yet uncertainty remains in the optimal immobilization strategy. The comparative effectiveness and safety of short leg versus long leg casts in achieving stable healing and functional recovery have not been clearly established. Methods: A literature search was conducted across Medline, CINAHL, Embase, and Cochrane Library, from inception to August 2025, following PRISMA guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO). Statistical analyses were performed using a random-effects model. Results: The initial search yielded 1236 studies; 6 studies with 413 pediatric patients met the inclusion criteria. A total of 163 underwent short leg casting (SLC) and 250 long leg casting (LLC). No differences were observed between SLC and LLC for coronal angulation (MD=0.12 degrees, 95% CI=−0.89 to 1.12, I 2 =58%) or sagittal angulation (MD=0.18 degrees, 95% CI=−0.71 to 1.07, I 2 =56%). Subgroup analyses showed no differences for tibial shaft fractures or Salter-Harris distal tibial fractures. Cast duration was similar between groups (MD=−0.74 wk, 95% CI=−1.49 to 0.01, I 2 =92%). Overall complication rates did not differ (OR=0.76, 95% CI=0.25 to 2.34, I 2 =0%), with no differences in Salter-Harris subgroup analysis (OR=0.67, 95% CI=0.05 to 9.91; I 2 =54%). SLC was associated with shorter time to weight-bearing (MD=−2.29, 95% CI=−4.49 to −0.08, I 2 =68%) and faster time to union (MD=−1.21, 95% CI=−2.16 to −0.25, I 2 =30%). Conclusion: SLCs may be considered as an alternative to LLCs in pediatric tibial shaft and distal tibial physeal fractures based on currently available retrospective comparative evidence. However, the evidence is limited by the retrospective design, clinical heterogeneity, and risk of confounding. Further prospective comparative studies are needed to define optimal indications for SLC use in this population. Level of Evidence: Level III, systematic review and meta-analysis of retrospective comparative studies.

Abstract Introduction The effectiveness of temporary uterine artery ligation (TUAL) in reducing blood loss during laparoscopic myomectomy (LM) is uncertain, despite increased use as an adjunct to improve surgical safety. This study aims to evaluate the safety and efficacy of TUAL in LM for the management of uterine myomas. Material and Methods We conducted a systematic review and meta‐analysis of comparative studies evaluating LM with and without TUAL. Electronic databases were searched up to October 7, 2024. Eligible studies were randomized controlled trials or observational comparative studies published in English that reported at least one primary outcome. The primary outcomes were intraoperative estimated blood loss and perioperative change in hemoglobin. Secondary outcomes included operative time, number and size of myomas removed, length of hospital stay, recurrence, and complication rates. Data extraction and analysis were performed using a random‐effects model. This review was registered prospectively with PROSPERO (CRD42024595684). Results Seven studies met the inclusion criteria, comprising five randomized controlled trials and two retrospective case–control studies, with a total of 857 women (352 undergoing LM with TUAL and 505 undergoing LM alone). TUAL was associated with a reduction in intraoperative estimated blood loss (mean difference [MD]: −84.7 mL; 95% Cl: −89.0; −80.0) and postoperative reduction in hemoglobin level (MD: −0.4 g/dL; 95% Cl: −0.7; −0.2) compared with LM without TUAL. However, TUAL was associated with increased operative time (MD: 16.5 min; 95% Cl: 3.4; 29.6). Conclusions TUAL appears to be a possible adjunct to LM for selected patients in the management of uterine myomas. Our study demonstrated that TUAL with LM could be associated with a reduction in estimated blood loss, despite an increase in operative time. Nonetheless, further studies with a larger sample size and long‐term follow‐up, as well as stratification of outcomes based on ligation technique, are warranted to elucidate the benefits of TUAL.

Importance A greater proportion of older patients (age ≥65 years) are undergoing thyroidectomy amidst an aging population. Given the elusive results in the literature, clarifying whether older patients face different thyroidectomy safety profiles is crucial for optimizing risk assessment and patient counseling. Objective To evaluate the association between older age (age ≥65 years) and thyroidectomy safety by comparing endocrine-related complications, including recurrent laryngeal nerve injury, hypocalcemia, hematoma, and mortality in older compared with younger patients. Data Sources Ovid MEDLINE, CINAHL, Ovid Embase, and the Cochrane Library were systematically searched from inception to May 29, 2025; only English-language studies were included. Study Selection Cohort studies comparing thyroidectomy outcomes between older and younger patients and reporting endocrine-related complications were included. Two independent reviewers screened abstracts and full texts. Of 3192 studies identified, 11 met inclusion criteria. Data Extraction and Synthesis Two independent reviewers extracted data following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias across studies was evaluated using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool. Random-effects models were used to pool data. Main Outcomes and Measures Incidence of recurrent laryngeal nerve injury, hypocalcemia, and hematoma; odds ratios (ORs) with 95% CIs were calculated. Results The analysis included 11 studies with a total of 427 886 patients of whom 104 232 (24.4%) were older adults (≥65 years). Older adults had greater odds of overall recurrent laryngeal nerve injury (2.3% vs 1.0%; OR, 1.58; 95% CI, 1.15-2.16; I 2 = 76%), hematoma (2.4% vs 1.0%; OR, 2.32; 95% CI, 1.70-3.16; I 2 = 0%), and mortality at last follow-up (0.3% vs 0.01%; OR, 11.09; 95% CI, 1.77-69.52; I 2 = 90%) compared with younger patients. However, rates of overall hypocalcemia (OR, 0.80; 95% CI, 0.61-1.05; I 2 = 71%) and wound complications (OR, 1.38; 95% CI, 0.92-2.06; I 2 = 0%) were similar. Conclusions and Relevance This systematic review and meta-analysis found that thyroidectomy is safe in older patients, with only small absolute increases in recurrent laryngeal nerve injury, hematoma, and mortality despite statistical significance. These findings support individualized counseling and perioperative planning while acknowledging the overall safety of thyroidectomy in this population.

ABSTRACT Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta‐analysis aims to evaluate the safety and efficacy of the 755‐nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random‐effects model. Five RCTs ( n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I 2 = 0%). Post‐inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I 2 = 0%) but had no difference with the Q ‐switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I 2 = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long‐term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

Objective To evaluate the safety and efficacy of Grayson's presurgical nasoalveolar molding (PNAM) technique on nasal and alveolar morphology in infants with unilateral cleft lip and palate (UCLP). Design Systematic review and meta-analysis. Setting : Multicenter international literature across clinical and academic institutions. Patients, Participants Infants with UCLP reported in 21 eligible studies (n = 534), of whom 368 received PNAM. Interventions Presurgical nasoalveolar molding (PNAM) according to the Grayson protocol. Main Outcome Measure(s) : Changes in nasal symmetry (nostril width ratio, columellar angle) and alveolar morphology (alveolar gap dimensions, intertuberosity distance). Results PNAM was performed for an average duration of 96 days with 11 adjustments per patient. Pooled analyses demonstrated significant improvements in nasal symmetry: nostril width ratio decreased from 2.4 (95% CI, 1.7–3.1; I² = 98%) to 1.8 (95% CI, 0.9–2.6; I² = 97%), and the columellar angle increased from 52° (95% CI, 42.0–62.8; I² = 100%) to 70° (95% CI, 59.1–80.6; I² = 98%). Alveolar gap narrowed from 10.7 mm (95% CI, 9.5–11.9; I² = 92%) to 3.9 mm (95% CI, 3.1–4.8; I² = 93%). Intertuberosity distance increased slightly, from 31.3 mm (95% CI, 29.3–33.3; I² = 95%) to 31.8 mm (95% CI, 28.9–34.8; I² = 98%). Conclusions Grayson's PNAM appears to improve nasal and alveolar morphology in infants with UCLP prior to definitive surgery. Standardized outcome measures and long-term prospective studies are needed to confirm these findings and refine clinical protocols.

Background: Chronic Achilles tendon ruptures (CATRs) pose a clinical challenge because guidelines on optimal treatment modalities are lacking. This meta-analysis aims to investigate the use of Flexor Hallucis Longus (FHL) tendon transfer as a treatment option. Methods: A literature search was performed across multiple databases from inception until 31 July 2025. The databases searched included Ovid MEDLINE®, EMBASE (Elsevier), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Included studies presented CATR patients of all ages, with no previous surgeries to the ankle, who were managed with an FHL tendon transfer (PROSPERO ID: CRD42023489724). Results: Sixteen studies met the eligibility criteria with 323 patients. For functionality, baseline AOFAS-AH (American Orthopaedic Foot & Ankle Society—Ankle Hindfoot) scores were 56.85 (95% CI: 51.03–62.68, I2 = 96%). At ≥12 months post-operative follow-up, AOFAS-AH scores were 91.46 (95% CI: 88.45, 94.48, I2 = 93%). ATRS (Achilles Tendon Rupture Score) at baseline was reported as 31.04 (95% CI: 5.80, 56.28, I2 = 99%). At ≥12 months post-operative follow-up, ATRS amounted to 90.73 (95% CI: 83.69, 97.77, I2 = 89%). Overall complication rates were 7.5% (CI: 0.04,0.11, I2 = 40%), consisting of superficial infections at 4.2% (95% CI: 0.01, 0.07, I2 = 0%), activity limitations at 4% (95% CI: 0.01, 0.08, I2 = 0%) and disturbed wound healing at 3.8% (95% CI: 0.01, 0.06, I2 = 0%). The minimum clinically important difference (MCID) for ATRS was achieved at 12 months onwards. Conclusions: Surgical management of CATR patients with FHL tendon transfer appears to improve functionality and subjective outcomes, supporting its use amongst the treatment modalities available.

Abstract Columellar strut graft (CSG) and septal extension graft (SEG) are commonly used in septorhinoplasty for nasal tip support. We aimed to systematically review and compare CSG and SEG in achieving a desired nasolabial angle (NLA) and Goode's ratio (GR). Several databases were systematically searched from inception to August 2024. A two-arm meta-analysis of the pooled means was conducted with a random-effects model. This review was registered in PROSPERO (CRD42024574909). Eligible studies included primary septorhinoplasty patients (≥17 years) receiving CSG or SEG. Eight studies met eligibility criteria including 256 CSG and 371 SEG patients. Intergroup comparison of long-term postoperative NLA favored SEG (p < 0.05) while GR showed no differences. However, SEG patients had significant improvement in GR postoperatively (p < 0.05), unlike CSG patients. SEG may provide superior long-term nasal tip rotation and projection stability.

Silver foam dressings have been extensively used in the management of burn injuries; however, its application in children requires elucidation. A literature search was conducted from database inception to October 2023. Eligible studies reported paediatrics patients under 21 years of age receiving silver dressings for burns or scalds. This review was registered prospectively with PROSPERO (CRD42023470239). 18 studies met the inclusion criteria with a total of 701 patients. The pooled mean time to re-epithelisation (TTRE) was 12.9 days (95% CI: 11.2, 14.6, I2 = 94%). The pooled mean duration of hospitalisation was 9.8 days (95% CI: 3.9, 15.7; I2 = 100%). Mean number of total dressing changes per patient was 3.6 (95% CI: 2.2, 4.9; I2 = 99%). There were a total of 98 complications, including 30 (30.6%) infections, 29 (29.6%) surgical requirements, 14 (14.3%) hypertrophic scarring, 17 (17.3%) escalations of care, 5 (5.1%) burn depth progression, and 3 (3.1%) others. Silver foam dressings appear as a safe and effective approach in terms of healing rate and dressing change frequency for selected paediatric patients with burn injuries. Despite the promising results, further comparative studies are required to evaluate the selection criteria and long-term effect of silver foam dressing.

Objective: Hiatal hernia (HH) and symptomatic gastroesophageal reflux disease are common complications after metabolic bariatric surgery. This meta-analysis aims to investigate the safety and efficacy of ligamentum teres augmentation (LTA) for HH repair after metabolic and bariatric surgeries (MBS). Materials and Methods: CENTRAL, Embase, PubMed, and Scopus were searched for articles from their inception to September 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. Results: Five studies met the eligibility criteria, with a total of 165 patients undergoing LTA for HH repair after MBS. The distribution of patients based on surgical procedures included 63% undergoing sleeve gastrectomy, 21% Roux-en-Y gastric bypass, and 16% having one anastomosis gastric bypass. The pooled proportion of reflux symptoms before LTA was 77% (95% CI: 0.580-0.960; I 2 = 89%, n = 106). A pooled proportion of overall postoperative symptoms was 25.6% (95% CI: 0.190-0.321; I 2 = 0%, n = 44), consisting of reflux at 14.5% (95% CI: 0.078-0.212; I 2 = 0%, n = 15). The pooled proportion of unsuccessful LTA outcomes was 12.5% (95% CI: 0.075-0.175; I 2 = 0%, n = 21). Conclusion: Our meta-analysis demonstrated that LTA appears to be a safe and efficacious procedure in the management of HH after MBS.