Surgical treatment of scaphoid waist fractures associated with high risk of complications .
This report has been verified
by one or more authors of the
original publication.
Diese Studie wurde als potenziell hochrangig eingestuft.
Die KI-gesteuerte High-Impact-Metrik von OE schätzt den Einfluss ein, den eine Arbeit wahrscheinlich haben wird, indem sie Signale sowohl aus der Zeitschrift, in der sie veröffentlicht wurde, als auch aus dem wissenschaftlichen Inhalt des Artikels selbst integriert.
Das mit Hilfe modernster natürlicher Sprachverarbeitung entwickelte OE High Impact-Modell sagt die zukünftige Zitationsleistung einer Studie genauer voraus als der Impact-Faktor einer Zeitschrift allein.
Dies ermöglicht eine frühere Erkennung von klinisch bedeutsamer Forschung und hilft den Lesern, sich auf Artikel zu konzentrieren, die die zukünftige Praxis am ehesten beeinflussen werden.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(17):4 J Hand Surg Am. 2011 Nov;36(11):1759-1768.e1. doi: 10.1016/j.jhsa.2011.08.0336 studies (363 patients) examining outcomes of surgical and nonsurgical treatments of undisplaced or minimally displaced scaphoid waist fractures were evaluated through pairwise meta-analysis. An additional 3 trials were also identified for inclusion in a network meta-analysis. Following assessments of fracture union, complications, range of motion, grip strength, and osteoarthritis between patients who underwent either surgical or non-surgical treatment, there was a non-significant trend to increased union with surgical treatment. However this method of treatment was also associated with a higher risk of complications.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
4/4
Introduction
3/4
Accessing Data
4/4
Analysing Data
3/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
When scaphoid waist fractures occur they should be immobilized in order to allow for anatomical union and to prevent midcarpal arthrosis and carpal malalignment. Treatment can occur either surgically or non-surgically using a cast, but it is still unknown which method is the most effective. Hence, this meta-analysis aimed to compare the odds ratio of fracture union, complications, and other clinical outcomes of surgical and nonsurgical treatment of scaphoid waist fractures.
Was war die wichtigste Forschungsfrage?
Was surgical treatment of scaphoid waist fractures more effective than nonsurgical treatments, in terms of the odds ratio of fracture union?
- In the Pairwise meta-analysis there were 6 studies included (7 publications) that compared non –operative and operative treatment of scaphoid waist fractures. The Network meta-analysis identified another 3 randomized controlled trials that compared 2 non-surgical treatments resulting in a total of 9 trials comparing 5 different treatment methods.
- The Pairwise meta-analysis resulted in an overall pooled odds ratio of fracture union rate that was 2.36 (95% CI: 0.02, 8.9; p=0.210; I-squared: 0%). Although, the pooled odds ratio of fracture union rate was higher in the nonsurgical treatment patients (ratio: 3.10; 95% CI: 0.46, 21.05; p=0.250; I-squared: 0%) than in the surgical patients (ratio: 1.46; 95% CI: 0.11, 20.57; p=0.780; I-squared: 46.1%), this was not significant.
- The Pairwise meta-analysis of complication rate had a pooled odds ratio of 6.96 (95% CI: 2.13, 27.73; p=0.001; I-squared: 0%), which indicated an elevated risk of complication for those undergoing surgical treatment.
- Although the mean overall percentage difference in the range of motion (2.1%; 95% CI: -0.03, 0.08; p=0.430; I-squared: 61.4%) and grip strength (2.6%; 95% CI: -0.013, 0.066; p=0.190; I-squared: 0%) between the surgical and nonsurgical groups in the Pairwise Meta-analysis favoured surgery, these variations were not significant.
- The pooled odds ratios for osteoarthritis of the scaphotrapeziotrapezoid joint (3.25; 95% CI: 0.073, 14.39; p=0.120; I-squared: 65.4%) between the surgical and nonsurgical groups favoured surgery, while the pooled odds ratios for osteoarthritis of the radiocarpal joint (0.75; 95% CI: 0.15, 3.82; p=0.730; I-squared: 67.2%) between the surgical and nonsurgical groups favoured nonsurgery, these differences were not statistically significant.
- The Network meta-analysis assessed the odds ratio of fracture union for all possible pairwise comparisons. The results indicated that long and short thumb spica casts had the highest probability of being the best treatment (0.810). This was influenced by the lower number of non-unions in the solitary trial that compared these treatments.
Was sollte ich mir besonders merken?
Although the pair-wise analysis indicated a higher fraction union rate for the surgical treatment, this difference was not significant. Furthermore, surgical treatment appeared to have a higher risk of developing complications.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Patients should be aware that there is a risk of developing complications by undergoing surgical treatment for scaphoid waist fractures. Although fracture union rates appeared to be higher with surgery in this study, this difference was not significant and there is no clear evidence indicating a significant increased union rates with surgery. Unless new evidence is released, then patients should continue to be treated using nonsurgical treatments.
HAFTUNGSAUSSCHLUSS
Der Inhalt dieser Seite dient nur zu Informationszwecken und ist nicht als Ersatz für professionelle medizinische Beratung, Diagnose oder Behandlung gedacht. Wenn Sie eine medizinische Behandlung benötigen, wenden Sie sich immer an Ihren Arzt oder suchen Sie die nächstgelegene Notaufnahme auf. Die Meinungen, Überzeugungen und Standpunkte, die von den Personen auf dieser Seite geäußert werden, spiegeln nicht die Meinungen, Überzeugungen und Standpunkte von OrthoEvidence wider.
0 von 4 monatliche KOSTENLOSE Artikel freigeschaltet
