TRAUMA
Operative versus non-operative treatment for clavicle fracture: a meta-analysis
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(16):49 Int Orthop. 2013 Aug;37(8):1495-5005 randomized clinical trials and 3 controlled clinical trials (663 patients) were examined in this meta-analysis to determine if operative treatment provides better results than nonoperative treatment of clavicle fractures. The results from this meta-analysis suggest that operative care was associated with a reduced risk of non-union, malunion, and fewer neurological complications compared to nonoperative care. Statistical analysis of functional outcomes and long term adverse effects could not be completed due to incomplete reporting. However, qualitative assessment indicated that Constant Shoulder Scores and DASH scores were superior in the operative group.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
3/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Clavicle fractures are an exceedingly common injury in adults. Until recently these injuries tended to be treated through nonoperative means. However, recent research has indicated that operative care may potentially result in fewer nonunions, malunions, delayed unions and neurological complications, while providing superior functional outcomes. This meta-analysis and systematic review aims to provide an update to current assessments in the literature.
主な研究課題は何ですか？
Does operative treatment of a fractured clavicle provide better clinical and functional outcomes compared to nonoperative treatment involving a sling or bandage?
重要な知見は？
- 8 studies (I^2 = 0%) involving 566 patients indicated a reduced risk of nonunion for operative treatment compared to nonoperative (RR 0.12, 95 % CI 0.05-0.29) (p<0.0001).
- 6 homogeneous (I^2 = 0%) studies with 453 patients indicated a decreased risk of malunion in the operative treatment (RR 0.11, 95 % CI 0.04-0.29) (p<0.0001).
- 5 studies (I^2 = 29%) (337 patients) found no significant difference in the delayed union rates (RR 0.78, 95 % CI 0.31-1.95) (p=0.59).
- 7 studies (I^2 = 28%) (468 patients) showed fewer neurological complications associated with operative treatment (RR 0.45, 95 % CI 0.25-0.80) (p=0.008).
- A meta-analysis could not be competed on the CS and DASH scores due to incomplete reporting of standard deviation. A qualitative assessment of CS scores from 5 studies and DASH scores from 4 studies indicated superior results for operative treatment of clavicle fractures.
最も覚えておくべきことは？
This meta-analysis supports operative measures for the treatment of a fractured clavicle based on reduced rates of nonunion, malunion and neurological complications. However, it should be noted that the functional outcomes examined (CS and DASH scores) were not included in the meta-analysis. Qualitative assessment of these outcomes indicated that operative treatment may provide superior function.
それが私の患者ケアにどのように影響するか？
Operative care of clavicle fractures effectively reduced the risks of non-union, malunion and neurological complications compared to non-operative treatment. Further research still needs to be conducted to identify specifically which types of clavicle fractures benefit the most from surgical fixation. Finally, treatment should be left to the discretion of the treating physician and patient preference.
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