Operative treatment results in better short-term outcomes & recovery in scaphoid fractures .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(14):6 PLoS One. 2015 May 5;10(5):e01252476 randomized controlled trials (340 fractures) were pooled in this meta-analysis to analyze the efficacy of operative treatment compared to non-operative treatment in the management of minimally-displaced and acute undisplaced scaphoid fractures. Results demonstrated that operative treatment had better functional outcomes in the short-term, however these results were not sustained for more than a year post-treatment. Operative treatment was also associated with a more rapid rate of return to work, and earlier time to union of fractures.
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?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Acute, undisplaced, stable scaphoid fractures are often effectively treated by short- or long-arm casts. However, prolonged immobilization can cause complications that may delay rehabilitation, resulting in weaker outcomes after immobilization. Internal fixation, in theory, has benefits of early return of wrist movement, a higher rate of union and an earlier return to regular life, with the avoidance of cast immobilization. Reports have shown that operative treatment is safe and effective, yet outcomes from current studies comparing these methods are not conclusive. Recently, a number of randomized controlled trials have been published analyzing operative and non-operative treatment for these fractures and, thus, an updated analysis of current literature was prudent.
Was war die wichtigste Forschungsfrage?
How do operative and non-operative treatment compare for the treatment of minimally-displaced and acute undisplaced scaphoid fractures?
- Analysis of functional scores showed significant differences favoring operative treatment at 2 and 3 months (p<0.05, 2 studies), yet at 6, 12, and greater than 12 months the difference was non-significant (P>0.05, 2 studies)
- Analysis of ROM demonstrated no significant differences between groups at 2, 3, 6, 12 months (p>0.05, 2 studies), or greater than 12 months (p>0.05, 3 studies) and pinch strength data at more than 12 months showed that both treatments were similar (P=0.88, 2 studies)
- Pooled data at 2, 3, 6, and 12 months follow-up showed that patients in the operative treatment group had significantly greater grip strength than those in the non-operative group (P<0.05, 2 studies), however at follow-up greater than 12 months the difference was not significant (P=0.33, 3 studies)
- Patients receiving operative treatment had an advantage in terms of duration of absence from work (4 studies, WMD= -6.01, 95% CI [-9.17,-2.85], P<0.001)
- Overall complication did not significantly differ between treatments (6 studies, RR= 0.91, 95% CI [0.51, 1.62], P=0.75), yet risk of delayed union was significantly lower with operative treatment (P=0.049) with a 74.9% reduction in risk (4 studies, RR= 0.25, 95% CI [0.07, 0.99])
- Analysis of time to fracture union showed a significant difference, and the time was shorter with operative treatment (WMD= -4.99, 95% CI [-5.45 to -4.53], P<0.001)
- Analysis of nonunion, further surgery, malunion, osteoarthritis and symptomatic osteoarthritis revealed no significant differences between treatments
Was sollte ich mir besonders merken?
Short-term functional outcomes favored operative treatment for minimally-displaced and acute undisplaced scaphoid fractures compared with non-operative treatment. while longer-term outcomes were generally similar between groups. Additionally, patients who underwent operative treatment had a more rapid return to work. Complications did not differ between treatments, yet surgery was advantageous in avoiding delayed union of fractures.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Patients with minimally-displaced and acute undisplaced scaphoid fractures who were treated surgically exhibited earlier recovery, suggesting that primary operative treatment could be considered in patients that require fast restoration of normal function. Nevertheless, outcome beyond one year appeared to be similar between treatment options. Additional large-scale trials are needed to address factors such as patient age, cost, and fracture type, which may more clearly illustrate which method of treatment - operative or nonoperative - should be considered in primary treatment of this population of patients.
HAFTUNGSAUSSCHLUSS
Der Inhalt dieser Seite dient nur zu Informationszwecken und ist nicht als Ersatz für professionelle medizinische Beratung, Diagnose oder Behandlung gedacht. Wenn Sie eine medizinische Behandlung benötigen, wenden Sie sich immer an Ihren Arzt oder suchen Sie die nächstgelegene Notaufnahme auf. Die Meinungen, Überzeugungen und Standpunkte, die von den Personen auf dieser Seite geäußert werden, spiegeln nicht die Meinungen, Überzeugungen und Standpunkte von OrthoEvidence wider.
0 von 4 monatliche KOSTENLOSE Artikel freigeschaltet
