HAND & WRIST
A Comparison of Immediate Postreduction Splinting Constructs for Controlling Initial Displacement of Fractures of the Distal Radius: A Prospective Randomized Study of Long-Arm Versus Short-Arm Splinting
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(5):3 J Hand Surg Am. 2006 May-Jun;31(5):766-70118 patients with displaced distal radius fractures were randomised to undergo either a long-arm sugar tong splinting intervention or a short-arm radial gutter splinting intervention. Radiographic outcomes and disability were observed. Results indicated that comparable outcomes were seen between the long- and short-arm groups. The author's recommend the use of the short-arm splint due to it's improved functionality compared to the long-arm splint.
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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
2/4
Randomization
2/4
Outcome Measurements
3/4
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
There is a lack of agreement in the medical community on the method of treating distal radius fractures. The forearm immobilization intervention is one of the most controversial treatment methods as it has produced conflicting data from studies. This present study examines the outcomes of long-arm and short-arm splinting in treating displaced distal radius fractures.
主な研究課題は何ですか？
What are the radiographic and disability outcomes when patients with displaced distal radius fractures undergo a long-arm sugar tong splinting intervention compared to a short-arm radial gutter splinting intervention at 13 months?
重要な知見は？
- There was a loss of fracture reduction observed at the initial 8-day follow-up in 33 fractures. In the short-arm radial gutter splint group, 16/38 fractures were displaced compared to 17/47 fractures from the long-arm sugar tong splint group. However, this difference was not significant. (p=0.58)
- No significant differences were seen between the splint's ability to maintain fracture reduction in stable and unstable displaced fractures when evaluated for fracture stability. (p=0.78)
- No significant difference was seen in rate of reduction loss between the groups. (p=0.32)
- Better outcomes in the DASH score was seen in the short-arm group (62+-19) compared with those in the long-arm group (70+-15) at one week. (p=0.044)
最も覚えておくべきことは？
Comparable outcomes were seen in the long-arm sugar tong splint group and the short-arm radial gutter splint group in initial reduction maintenance. The authors of this study recommend the short-arm splint for initial immobilization due to its reduced functional limitations compared to the long-arm splint.
それが私の患者ケアにどのように影響するか？
Patients may find the short-arm splint more functionally tolerable compared to the long-arm splint. However, the outcomes in reduction maintenance and disability were comparable with both interventions.
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