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)?
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.
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
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 ?
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.
Quelle était la principale question de recherche ?
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
De quoi dois-je me souvenir en priorité ?
Both clinical and radiological outcomes are similar when the Lucerne cast is compared to the conventional forearm cast at 12 week follow-up.
Comment cela affectera-t-il les soins prodigués à mes patients ?
Clinicians should still consider using the widely accepting casting methods for extra-articular fractures of the proximal phalanges.
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