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.
Este estudo foi identificado como tendo um impacto potencialmente elevado.
A métrica de Alto Impacto da OE, baseada em IA, estima a influência que um artigo poderá ter, integrando sinais da revista em que foi publicado e do conteúdo científico do próprio artigo.
Desenvolvido com recurso ao mais avançado processamento de linguagem natural, o modelo High Impact da OE prevê com maior precisão o desempenho futuro de um estudo em termos de citações do que o fator de impacto da revista por si só.
Isto permite o reconhecimento precoce de investigação clinicamente significativa e ajuda os leitores a concentrarem-se nos artigos com maior probabilidade de moldar a prática futura.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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 que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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