Operative treatment of displaced mid-shaft fractures of the clavicle reduces complications .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(12):58 J Bone Joint Surg Am. 2012 Apr 18;94(8):675-84This meta-analysis identified 6 randomized clinical trials that compared operative and non-operative treatment of acute, displaced mid-shaft clavicle fractures. Results from this analysis indicate that there was a reduced complication rate in the operatively treated patients, with a decrease in non-unions and symptomatic malunions. A greater number of patients treated operatively were able to return to moderate activity 16 days following the injury, demonstrating that operative treatment provides superior early outcomes.
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Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
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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)?
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Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
4/4
Introduction
4/4
Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
The non-union rate of acute, displaced mid shaft fractures treated non-operatively has been reported to be as high as 15-20% and has detrimental effects on shoulder muscle strength. Based on these suboptimal outcomes for non-operative management, primary operative care has increased in popularity. The meta-analysis was conducted to evaluate treatment effects, potential harm and patient outcomes of these differing methods.
Qual era la domanda di ricerca principale?
Which treatment, operative or nonoperative, provides the best clinical and functional results, and what are the complications associated with these procedures for patients presenting with displaced mid-shaft fracture of the clavicle?
- Non-union rate was significantly higher in the non-operative patients (29/200), than in the patients treated operatively (3/212) (p=0.001)
- The rate of patients with a symptomatic malunion was signficantly greater in the non-operative group (17/200), compared to the operative group (0/200) (p<0.001)
- The overall complication rate was significantly greater in the non-operative group (84/200), compared to the operative group (62/212) (p=0.0075)
- Three studies reported Constant Shoulder scores at one year weighted operative average was 94.3 compared to the non-operative average of 90.2
- DASH scores appeared to favor the operative group, but only reported numerically in 2 studies and graphically in one
- Early return to moderate activity on the 16th day was possible in 80% of the operatively treated patients, compared to 55% in the non-operative patients
Che cosa devo ricordare di più?
The results from this meta-analysis indicate that operative treatment of acute, displaced mid-shaft fractures of the clavicle provides a reduced rate of complication with fewer patients suffering non-union or symptomatic malunions. A greater number of operatively treated patients also were able to return to function earlier than the conservative treatment.
Come influenzerà l'assistenza ai miei pazienti?
The results from this meta-analysis support the use of primary operative treatment of acute, displaced mid shaft fractures of the clavicle.
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