ORIF of distal radial fractures leads to better immediate postoperative function .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):48 J Bone Joint Surg Am. 2009 Aug;91(8):1837-46.45 patients with displaced unstable fracture of the distal radius were randomized to receive open reduction and internal fixation or closed reduction and pin fixation. This study assessed if ORIF provided better early clinical outcomes compared to closed reduction with pin fixation. The results from this study indicated that ORIF provided better early postoperative outcomes in terms of ROM, strength, and DASH scores. At one year follow-up, both methods resulted in similar functional outcomes.
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
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
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?
Distal radius fractures are the most common fracture of the upper extremity. Anatomic reduction with stable fixation has long been the treatment of choice for displaced, unstable fractures. Closed reduction with percutaneous pin fixation and/or external fixation has historically been the most common treatment for unstable injuries. However, open reduction and internal fixation has gained popularity, with emergence of volar locking plate technology. Internal fixation may allow immediate range of motion of the wrist. Few randomized trials exist to determine if this method is superior, with emphasis on early functional recovery.
¿Cuál era la pregunta principal de la investigación?
In patients undergoing reduction for a distal radial fracture, will open reduction and internal fixation with a volar plate lead to better outcomes when evaluated against closed reduction with percutaneous pin fixation, upto one year?
- Patients in the open reduction and internal fixation group had greater ROM and strength in all parameters compared to patients in the control group at the early postoperative time points (significance was achieved in all measurements, except digital motion to palm, at 6 weeks)
- Mean flexion-extension arc was significantly greater for the open reduction and internal fixation group over time (P<0.01)
- At six weeks postoperatively, average DASH score was 27 in the open reduction and internal fixation group and 53 in the closed reduction and percutaneous pin fixation group (p<0.01). At one year, scores became similar in both groups (4 compared with 9; P=0.18).
¿Qué es lo que más debo recordar?
Both open reduction and internal fixation with a volar plate and closed reduction with percutaneous pin fixation to treat distal radial fractures resulted in good clinical and radiographical outcomes. Patients managed with a volar plate had better ROM, grip strength, and lower DASH scores in the early postoperative period.
¿Cómo afectará esto al cuidado de mis pacientes?
This study suggests open reduction and internal fixation with a volar plate, as compared to closed reduction with percutaneous pin fixation, is a superior treatment modality in patients with distal radius fractures. Future methodologically sound studies are required with larger sample sizes to validate such conclusions.
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