SPORTS MEDICINE
Reduction of acute anterior dislocations: A prospective randomized study comparing a new technique with the Hippocratic and Kocher methods
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):188 J Bone Joint Surg Am. 2009 Dec;91(12):2775-82.154 patients with acute anterior dislocation of the glenohumeral joint were randomized to receive either FARES (fast, reliable, safe) reduction, Hippocratic method reduction, or Kocher method reduction. This trial evaluated the efficacy of the FARES reduction method and compared it to the two common methods currently in use. The results from this trial indicated that the FARES method of glenohumeral joint reduction was significantly more efficacious, faster, and associated with less pain when compared to the Kocher and Hippocratic methods.
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.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
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?
Anterior dislocations of the glenohumeral joint are common. Although several methods of reduction of anterior dislocations of the shoulder exist, few studies have compared efficacy, safety, and reliability of the different techniques. In this study, a new method of reduction of acute anterior shoulder dislocations was compared to the Hippocratic and Kocher methods.
¿Cuál era la pregunta principal de la investigación?
In patients with acute anterior dislocation of the glenohumeral joint, are FARES, Hippocratic, and Kocher reduction methods comparable in terms of efficacy and pain?
¿Cuáles fueron los hallazgos importantes?
- Reduction was achieved for 88.7% (47) patients in the FARES group; 72.5% (37) patients in the Hippocratic method and for 68% (34) in Kocher group. Efficacy significantly favored the FARES technique (p=0.033)
- Reduction was significantly faster with the FARES method, as compared to the other two methods (FARES, time in minutes, 2.36 ± 1.24; Hippocratic, 5.55 ± 1.58; Kocher, 4.32 ± 2.12) (p<0.001)
- Pain was significantly milder when reduction was performed using the FARES technique (VAS scores: FARES, scale 0-9, 1.57 ± 1.43; Hippocratic, 4.88 ± 2.17; Kocher, 5.44 ± 1.92) (p<0.001)
¿Qué es lo que más debo recordar?
The FARES method was found to be significantly more effective, faster, and less painful when compared to the Hippocratic and Kocher methods of reduction for anterior glenohumeral dislocation. Moreover, the technique was performed by only one physician and was applicable to anterior shoulder and simple fracture-dislocations.
¿Cómo afectará esto al cuidado de mis pacientes?
FARES method appears to be the optimal technique to reduce anterior dislocations of the glenohumeral joint in terms of efficiency and pain. Further trials should be conducted with larger sample sizes, which are accompanied with longer follow-ups to fully evaluate FARES method of reduction.
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