ORIF provides superior clinical outcomes for the treatment of impacted radial fractures .
This report has been verified
by one or more authors of the
original publication.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(10):41 Injury. 2012 Feb;43(2):174-9. Epub 2011 Jun 2575 patients suffering from complex impacted distal radial fractures were randomized to open reduction and internal fixation (ORIF) or to an external fixation (EF) with constant traction to compare clinical and subjective results between these two fixation methods. At 6 month follow-up, the ORIF demonstrated superior clinical outcomes measured by the modified Green and O'Brien rating scale (based on clinical information, scale= 100-0). There were no differences in subjective scores between groups.
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)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
2/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Fixation methods of complex radial fractures have yet to provide completely satisfactory results for patients, often resulting in a loss of radial length and articular issues. The traditional treatment of these fractures is external fixation with constant traction to maintain fixation. ORIF may provide superior results, when compared to EF, but due to the wide range of complex fractures there has yet to be a study comparing these two methods in the treatment of severely impacted fractures.
¿Cuál era la pregunta principal de la investigación?
Does open reduction and internal fixation provide superior clinical, radiological, and subjective outcomes when compared to external fixation with constant traction for the treatment of complex impacted distal radial fractures?
- There were no significant differences in terms of reduction results between the two groups
- 8 patients in each group had a loss of radial length >2 mm EF (20%), ORIF (22%)
- Green and O'Brien's rating were significantly better in the ORIF patients at 6 months (p<0.05) with 53% of patients having good to excellent ratings compared to 23% in the EF group
- Grip strength was greater in the ORIF group at 84% of the ipsilateral side compared to 76% in the EF group (p=0.02)
- A greater number of EF patients had a positive predictive score for Complex Regional Pain Syndrome (CRPS) at 6 week follow-up (p=0.03)
- There were no differences in patient-rated wrist evaluations between the two groups at the 6 month follow-up (p=0.98)
¿Qué es lo que más debo recordar?
ORIF provided superior clinical outcomes, measured using the Green and O'Brien rating system, in-comparison to EF. However, there were no differences in subjective results between the two treatments. ORIF also provided greater grip strength for patient, which may be advantageous for young patients returning to regular and intense physical activity.
¿Cómo afectará esto al cuidado de mis pacientes?
ORIF appears to provide superior clinical outcomes and improved grip strength when compared to EF. This should be considered when treating young active patients who are seeking a quick and safe recovery to regular activity. Further research using large samples should be conducted to confirm these results.
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