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)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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?
Quels sont les résultats importants ?
- 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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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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