Abstract: Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review
Notice bibliographique
Résumé
BACKGROUND: Camptodactyly is a common condition estimated to affect 1% of the population. The treatment for camptodactyly remains controversial, with a diverse range of surgical and conservative management approaches proposed. The ambiguity in the literature regarding the definition of camptodactyly, high variability in both conservative and surgical treatments, and lack of consistency in outcomes evaluation lead to significant challenges when guiding patients and their families through selecting management strategies. PURPOSE: The aim of this systematic review is to improve patient care and decision making in camptodactyly management, through clarifying the definition of camptodactyly and indications for treatment, summarizing treatment outcomes for camptodactyly patients, and defining risks of treatment including complications, pain and burden of care. METHODS: A systematic review was conducted, which included randomized control trials, prospective and retrospective cohort studies, case-control studies, case series and case reports on outcomes following the surgical and/or conservative management of idiopathic camptodactyly in children aged 0 to 18 years. The literature was searched using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database (EMBASE), Allied and Complementary Medicine (AMED) and Cumulative Index of Nursing and Allied Health Literature (CINAHL). The primary outcome evaluated was post-treatment flexion contracture, and the secondary outcomes were indications for surgery, post-treatment complications, functional limitations and patient satisfaction. RESULTS: Database searching generated 947 records, with 805 screened after duplicates removed, and 57 full-text articles reviewed. A total of 16 articles describing the conservative and/or surgical treatment of camptodactyly were included in the final review, with seven case series and nine retrospective cohort studies, and no prospective studies or randomized controlled trials. There was lack of consistency on the definition of camptodactyly as it related to the etiology of the flexion deformity. All 16 studies received a “Weak” global rating and demonstrated low quality evidence that showed a reduction in flexion contracture in most patients after treatment (from pre-treatment averages of 20° to 85° to post-treatment averages of 5° to 37°). Only one study performed statistical analysis of the change in flexion contracture of the proximal interphalangeal joint (PIPJ) after treatment and found the improvement after passive stretch exercises to be statistically significant. There was general agreement that surgery should be considered for severe flexion contracture of more than 30°, or failure to respond to conservative management. Surgical treatment generally led to more complications compared to conservative management. Only one study reported on functional limitations and one study reported on patient-reported outcomes. CONCLUSION: The current literature on camptodactyly management is weak, and the evidence on the effectiveness of surgical and conservative treatment is inconclusive. Given the complexity of treatment options available, future research may consider the development of decision aids to guide patients and families through selecting management strategies, and promote shared decision making.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,004 | 0,003 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».