Unstable distal radial fractures managed with external fixation require fewer reoperations .
This report has been verified
by one or more authors of the
original publication.
Cette étude a été identifiée comme étant potentiellement à fort impact.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(3):107 J Bone Joint Surg Br. 2008 Sep;90(9):1214-2188 patients with distal radius fracture were selected for surgical fixation. This group was randomized to be managed with either bridging external fixation with supplementary Kirschner-wire (K-Wire) fixation or volar locked plating with screws. The patients treated by volar plating had a significant early improvement in the range of movement of the wrist; this advantage diminished with time, and in absolute terms the difference in range of movement was clinically non-relevant. No clinically significant differences in the reductions was observed on radiographs. Both groups had comparable function at one year. No definitive advantage of either treatment could be established; however, fewer re-operations were required in the external fixation group.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
3/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Distal radius fractures are a common injury, especially in the bones weakened by osteoporosis in post-menopausal women. As with any other fractures the anatomic reduction and immobilization is the key management principle. A wide variety of options are available ranging from conservative management in a cast to closed reduction and pinning, bridging and non-bridging external fixation, and open reduction with plate and screw fixation through a variety of approaches. Each technique has its own sets of merits and demerits.This study aimed to compare the clinical outcomes of bridging external fixation and supplementary Kirschner-wire fixation to volar locked plating.
Quelle était la principale question de recherche ?
Does the bridging external fixation and supplementary Kirschner-wire fixation has better clinical outcomes at 1 year than volar locked plating for unstable fractures of the distal radius?
- No differences in the mean DASH scores at any of the follow-up assessments were observed between the groups and compared to the patients self-reported baseline levels. A trend towards significantly improved DASH scores was, however, found at 6 months, in favour of the external fixation group (p=0.06)
- Patients treated by volar plating had a statistically significant improvement in the range of movement of the wrist at 3 months: pronation (p<0.001), supination (p=0.05), extension (p=0.05) and radial deviation (p=0.002). This improvement diminished at 6 months and 1 year.
- Radiologically, there were no clinically significant differences in the reductions, although more patients with AO/OTA (Orthopaedic Trauma Association) type C fractures were allocated to the external fixation group.
- Radiologically, all the fractures united except one. Complication rate was comparable with 7 patients (18.4%) in the external fixation group having 7 complications compared with 8 (20.5%) in the plate group.
De quoi dois-je me souvenir en priorité ?
The patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist, which diminished with time and was clinically non-relevant. No clinically significant differences in the reductions was observed on radiographs. Both groups had comparable function at one year. No definitive advantage of either treatment could be established; however, fewer re-operations were required in the external fixation group.
Comment cela affectera-t-il les soins prodigués à mes patients ?
Each method has its own sets of merits and demerits, which must be considered for each patient's profile, and appropriate method should be chosen based on thorough assessment. Further research with larger populations is needed.
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