Lucerne cast provides no additional benefit for extra-articular fractures of the phalanges .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):133 J Hand Surg Am. 2012 May;37(5):889-98. Epub 2012 Apr 566 patients with extra-articular fractures of the proximal phalanges were randomized to receive either a forearm cast or a Lucerne cast. Radiographic outcomes demonstrated that there were no significant differences between the two groups, in regards to palmar apex angulation and radial or ulnar angulation. However, once the cast was removed, range of motion was found to be superior in individuals with the Lucerne cast. This significant difference in range of motion was not seen at 12 week follow-up.
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.
2/4
Randomization
2/4
Outcome Measurements
4/4
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
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?
Extra-articular fractures of the proximal phalanges can be treated through a wide variety of conservative methods, which include different types of splints and castings. Currently, many of the treatment options include immobilization of the joints; however, the Lucerne cast allows for free mobilization of the wrist joint. Regardless, the main goal of all strategies should be to restore optimal function. The aim of this randomized controlled trial was to compare the Lucerne cast with the traditional forearm cast in patients with fractures of the proximal phalanges at 12 week follow.
¿Cuál era la pregunta principal de la investigación?
Does the Lucerne cast lead to superior range and motion and restoration of function in comparison to a conventional forearm cast for the treatment of extra-articular fractures of the proximal phalanges in the adult population at 12 week follow-up?
- no significant differences in radial range of motion were observed between the two groups (p>0.05)
- wrist joint motion was significantly greater in the Lucerne group once the cast was removed (p<0.05); however, the difference was not seen at a 12 week follow-up
- no differences between the two groups were seen in radiological outcomes
¿Qué es lo que más debo recordar?
Both clinical and radiological outcomes are similar when the Lucerne cast is compared to the conventional forearm cast at 12 week follow-up.
¿Cómo afectará esto al cuidado de mis pacientes?
Clinicians should still consider using the widely accepting casting methods for extra-articular fractures of the proximal phalanges.
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