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)?
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
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
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?
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.
Qual era a principal questão de investigação?
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)
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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