Joystick reduction benefits operative efficiency in pediatric supracondylar humeral Fx .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(9):9 J Orthop Sci. 2016 Sep;21(5):609-1368 pediatric patients with displaced supracondylar humeral fractures were randomized to one of two methods of closed reduction. In one group, if closed manipulation did not yield acceptable reduction, the joystick technique was used to facilitate reduction. In the other group, only manual traction was used for reduction. Once reduction was achieved, all patients received fracture fixation with percutaneous pinning. Results demonstrated a significantly shorter operative time, shorter fluoroscopy time, and higher reduction success rate in the joystick group compared to the manual traction group. The time to union, final radiographic outcome, and the clinical outcome did not significantly differ 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.
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Randomization
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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
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?
Supracondylar humeral fractures are a relatively common childhood injury, usually resulting from a fall. Many of these fractures require fixation, most commonly using percutaneous pinning. Obtaining an adequate closed reduction of the fracture can be challenging with many cases converted to open reduction following failed attempts at closed reduction. The joystick technique, using either a Kirschner wire or a Shanz pin, has been reported to aid reduction, though whether there is any significant advantage of this technique over manual traction in obtaining reduction has yet to be tested in a randomized controlled trial.
¿Cuál era la pregunta principal de la investigación?
In the closed reduction of pediatric supracondylar humeral fractures, is there a significant difference in operative outcomes, including operative time, fluoroscopy time, reduction success, and postoperative radiographic outcome between reduction by joystick technique versus traditional manual traction?
- Operative time was significantly shorter in the joystick group (30.5+/-9.0min) compared to the manual traction group (48.2+/-16.4min) (p=0.000).
- Fluoroscopy time was significantly shorter in the joystick group (25.4+/-10.5s) compared to the manual traction group (55.0+/-21.2s) (p=0.000).
- The rate of failed intraoperative reduction was significantly lower in the joystick group (0/34) compared to the manual traction group (9/25) (p=0.004).
- No significant difference in the length of hospital stay was observed between the joystick group (3.0+/-1.5 days) and the manual traction group (3.2+/-1.3 days). (p=0.595).
- Time to union did not significantly differ between the joystick group (5.8+/-1.5 weeks) and the manual traction group (5.6+/-1.6 weeks) (p=0.625). Malunion occurred in four patients from each group. Nonunion was not observed in any patient in either group.
- Pin-tract infection occurred in three patients in the joystick group and two patients in the manual traction group. No other complications occurred.
- No significant difference in Flynn elbow score at final follow-up was observed between groups (p=0.664).
¿Qué es lo que más debo recordar?
In the closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures, closed reduction via the joystick technique significantly reduced operative time, fluoroscopy time, and improved the success rate when compared to reduction via manual traction. No significant differences in postoperative radiographic or clinical outcome were noted.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study suggest that closed reduction with the joystick technique in percutaneous pinning of pediatric supracondylar humeral fractures may improve operative efficiency when compared to only attempting with standard manual traction. Additionally, the joystick technique for fracture reduction did not have a negative impact on the postoperative radiographic and clinical outcome when evaluated over a 2-year follow-up. Nevertheless, the current results are limited in strength by the small sample size, with large multi-center trials needed to verify these findings and further evaluate potential complications or the joystick technique.
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