HAND & WRIST
External or internal fixation in the treatment of non-reducible distal radial fractures?
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):151 Acta Orthop. 2011 Oct;82(5):610-3. Epub 2011 Sep 650 patients with unstable, irreducible, or comminuted distal radial fractures were randomized to either receive open reduction with internal fixation (ORIF) or closed reduction with bridging external fixation. The purpose of this trial was to compare grip strength and range of motion over a medium-term follow-up. The 1 year results indicated that there was a significant difference in grip strength and ROM between groups favoring ORIF. However, this difference was not maintained at 5 years with both groups approaching the normal grip strength and ROM values of the uninjured side.
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.
1/4
Randomization
2/4
Outcome Measurements
1/4
Inclusion / Exclusion
2/4
Therapy Description
2/4
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?
Surgical treatment is typically recommended for patients with unstable, non-reducible distal radial fractures. The standard method of fixation is external fixation however, ORIF has increased in popularity due to introduction of the volar locking plate technique. A previous randomized study demonstrated superior grip strength and forearm rotation at year with ORIF compared to closed reduction and external fixation. This present study provided an evaluation of the same patients at a 3-7 year follow-up (mean 5). This study was needed to determine if the short term results found in the 1 year study persist over time.
¿Cuál era la pregunta principal de la investigación?
Does ORIF result in improved grip strength and forearm rotation compared to external fixation in the treatment of unstable distal radial fractures, measured at a mean follow up of 5 years?
¿Cuáles fueron los hallazgos importantes?
- All 50 patients that were randomized completed the QuickDASH questionnaire, and 45 patients participated in the clinical and radiographic assessment.
- The mean grip strength (reported as a percentage of the uninjured side) was 95% (SD 12) in patients that underwent internal fixation, compared to 90% (SD 21) in the external fixation group (p=0.3, 95% CI:-4 to 16 percent units).
- QuickDASH scores, range of motion, general health and radiographic outcomes were similar between both groups.
¿Qué es lo que más debo recordar?
At the 1 year follow up of the study, there were statistically significant differences between groups regarding grip strength and pronation-supination that favoured ORIF. However, this previously reported difference was lost at the 5 year follow-up, as both groups approached the normal grip strength and ROM values of the uninjured side.
¿Cómo afectará esto al cuidado de mis pacientes?
ORIF and external fixation appear to provide similar long-term strength and ROM outcomes for non-reducible distal radial fractures when compared to the uninjured arm. However, the short term outcomes should be considered when determining the best treatment option as ORIF may provided better strength and ROM outcomes over the first post-operative year.
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