Splint as effective as a cast in children with minimally angulated distal radius fractures .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(18):28 CMAJ. 2010 Oct 5;182(14):1507-1296 children with a minimally angulated greenstick or transverse fracture of the wrist were randomized to receive either a wrist splint or a short arm cast for 4 weeks. The children were assessed for physical function at 6 weeks and degree of angulation at 4 weeks. Range of motion, grip strength, and complications were also noted. The two groups were not found to have significant differences for any of the outcome measures.
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)?
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
Randomization
4/4
Outcome Measurements
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Inclusion / Exclusion
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Therapy Description
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Statistics
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?
Minimally angulated (15 degrees or less) distal radius fractures in children do not usually require reduction and are most commonly treated with a short arm cast for 4-6 weeks. Negative features of a cast include poor hygiene, risks from a poor fit, and discomfort. Splinting may be a viable alternative based on studies in adults, though a direct comparison with casting in children is needed before recommendations can be made.
Was war die wichtigste Forschungsfrage?
Is a prefabricated wrist splint as effective as routine casting in the recovery of physical function in children with a minimally angulated distal radius fracture at 6 weeks?
- At 6 weeks, the physical function score was a mean of 92.8 in the splint group compared to a mean of 91.4 in the cast group. The mean difference between the groups was 1.44 (95% CI -1.75-4.62). This was not a significant difference.
- At 1 week, the mean angulation of the splint group was 8.65 degrees compared to 7.92 degrees for the cast group. The mean difference was -2.43 (95% CI -2.43-3.90) and not significant. At 4 weeks the mean angulation had increased to a mean of 9.85 degrees in the splint group and 8.20 in the cast group for a mean difference of -1.65 (95% CI -1.82-5.11), which was not significant.
- The range of motion at 6 weeks was not significantly different between the groups.
- Grip strength at 6 weeks was not significantly different between groups, with a mean of 26.6 pounds in the splint group and 28.8 pounds in the cast group (mean difference of -2.16, 95% CI -7.34-3.02).
- The wrist pain score was not significantly different between groups at any time point.
- In terms of patient preference, 12% of the patients in the splint group would have preferred casting treatment. In contrast, 68% of patients in the cast group reported a preference for splinting. This difference in patient preference was significant (p<0.001). In addition, 5% of parents of children assigned to splinting expressed a preference for casting, whereas 60% of parents of children in the cast group would have preferred a splint (p<0.001).
Was sollte ich mir besonders merken?
The use of a prefabricated splint was shown to have similar effectiveness to a cast in terms of patient function and fracture stability. In addition, the splint was associated with a higher level of patient and parental satisfaction.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Due to what appear to be similar outcomes but different levels of patient convenience and satisfaction, the use of a splint may be a preferred alternative to casting in the treatment of minimally angulated distal radius fractures. The authors note that the sample size may have been too small to detect differences in all outcome measures.
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