ORIF for distal radius fractures may improve function vs. external fixation .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):102 Injury. 2013 Jan 5. pii: S0020-1383(12)00536-0. doi: 10.1016/j.injury.2012.12.003In this meta-analysis, 10 randomized controlled trials were examined to determine which treatment for distal radius fractures - external fixation or open reduction and internal fixation (ORIF) using plates - provided better outcomes. Following comparisons of the two treatments, results indicated that ORIF with plate fixation provided slightly better functional results with fewer complications.
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?
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Ja = 1
Ungewiss = 0.5
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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.
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Introduction
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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
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?
The standard treatment for distal radius fractures is closed reduction and external fixation. Lately though, an alternative technique, ORIF using plates, has gained popularity. However, it is still unknown which of the two treatments is better for treating distal radius fractures. Hence, this meta-analysis was aimed to determine which method of treatment was more effective in treating distal radius fractures, in terms of functional and radiographic outcomes.
Was war die wichtigste Forschungsfrage?
From included randomized trials, did ORIF with plate fixation provide better functional and radiographic outcomes than external fixation when treating distal radius fractures?
- The type of plate used in the ORIF groups in this meta-analysis was not controlled. Four studies used only volar plates. The other 6 studies used either radial pin-plates, radial column plates, or dorsal Pi Plates.
- The maximum follow-up time was 12 months in 5 of the studies, 24 in 4 of the studies, and not specified in one of the studies.
- There was a significant difference in pooled treatment effect for mean difference in DASH scores between the two treatments, favouring the ORIF technique, with minimal heterogeneity (MD: -5.92; 95% CI: -9.89 to -1.96; p=0.003; I squared: 39%).
- The pooled treatment effect from 3 studies for mean difference in range of motion (flexion, extension, radial and ulnar deviation, and pronation and supination) did not differ significantly between the two treatments techniques (p=0.26-0.98).
- No significant differences existed between the two treatment methods regarding pooled treatment effect for mean difference in grip strength, but there was moderate heterogeneity (MD: 1.60; 95% CI: --6.59 to 9.80; p=0.70; I squared: 59%).
- The pooled treatment effect for mean difference in ulnar variance differed significantly between the two treatments techniques, favouring the ORIF method (MD: -0.70; 95% CI: -1.20 to -0.19; p=0.006; I squared: 0%).
- Using 9 studies, the pooled treatment effect for risk ratios of the rate of complications favoured neither intervention (RR = 0.86; 95%CI 0.57-1.31; p=0.48, I squared: 0%). However, removal of the only study to use dorsal plates exclusively in ORIF procedure indicated that the ORIF technique had significantly lower risk ratios than the external fixation method (RR: 0.65; 95% CI: 0.47-0.91; p=0.01; I squared: 0%).
- Based on data from 7 studies, the pooled treatment effect for risk ratios of the rate of infections indicated that the ORIF technique had significantly lower risk ratios than the external fixation method (RR: 0.37; 95% CI: 0.19-0.73; p=0.004; I squared: 0%).
Was sollte ich mir besonders merken?
Results displayed that the ORIF with plate fixation technique for treating distal radius fractures provided lower DASH scores, and reduced infection rates than external fixation. Overall though, there was little clinical difference between the two methods.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
There is little clinical difference between outcomes using ORIF with plate fixation and external fixation groups, treatment should be assessed on a case by case basis and should be determined by both treating physician and the patient preference. Extent of mobilization and cost would be factors to take into consideration. Should any RCTs be conducted in the future then larger sample sizes, longer follow-up, and better blinding will be required.
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