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.
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
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.
¿Cuál era la pregunta principal de la investigación?
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%).
¿Qué es lo que más debo recordar?
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.
¿Cómo afectará esto al cuidado de mis pacientes?
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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