ORIF of distal radial fractures leads to better immediate postoperative function .
This report has been verified
by one or more authors of the
original publication.
Questo studio è stato identificato come potenzialmente ad alto impatto.
La metrica High Impact di OE, guidata dall'AI, stima l'influenza che un articolo potrebbe avere integrando i segnali della rivista in cui è stato pubblicato e il contenuto scientifico dell'articolo stesso.
Sviluppato utilizzando un'elaborazione del linguaggio naturale all'avanguardia, il modello High Impact di OE prevede in modo più accurato la futura performance citazionale di uno studio rispetto al solo fattore di impatto della rivista.
Ciò consente di riconoscere prima le ricerche clinicamente significative e aiuta i lettori a concentrarsi sugli articoli che hanno maggiori probabilità di influenzare la pratica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):48 J Bone Joint Surg Am. 2009 Aug;91(8):1837-46.45 patients with displaced unstable fracture of the distal radius were randomized to receive open reduction and internal fixation or closed reduction and pin fixation. This study assessed if ORIF provided better early clinical outcomes compared to closed reduction with pin fixation. The results from this study indicated that ORIF provided better early postoperative outcomes in terms of ROM, strength, and DASH scores. At one year follow-up, both methods resulted in similar functional outcomes.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
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.
3/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
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?
Distal radius fractures are the most common fracture of the upper extremity. Anatomic reduction with stable fixation has long been the treatment of choice for displaced, unstable fractures. Closed reduction with percutaneous pin fixation and/or external fixation has historically been the most common treatment for unstable injuries. However, open reduction and internal fixation has gained popularity, with emergence of volar locking plate technology. Internal fixation may allow immediate range of motion of the wrist. Few randomized trials exist to determine if this method is superior, with emphasis on early functional recovery.
Qual era la domanda di ricerca principale?
In patients undergoing reduction for a distal radial fracture, will open reduction and internal fixation with a volar plate lead to better outcomes when evaluated against closed reduction with percutaneous pin fixation, upto one year?
- Patients in the open reduction and internal fixation group had greater ROM and strength in all parameters compared to patients in the control group at the early postoperative time points (significance was achieved in all measurements, except digital motion to palm, at 6 weeks)
- Mean flexion-extension arc was significantly greater for the open reduction and internal fixation group over time (P<0.01)
- At six weeks postoperatively, average DASH score was 27 in the open reduction and internal fixation group and 53 in the closed reduction and percutaneous pin fixation group (p<0.01). At one year, scores became similar in both groups (4 compared with 9; P=0.18).
Che cosa devo ricordare di più?
Both open reduction and internal fixation with a volar plate and closed reduction with percutaneous pin fixation to treat distal radial fractures resulted in good clinical and radiographical outcomes. Patients managed with a volar plate had better ROM, grip strength, and lower DASH scores in the early postoperative period.
Come influenzerà l'assistenza ai miei pazienti?
This study suggests open reduction and internal fixation with a volar plate, as compared to closed reduction with percutaneous pin fixation, is a superior treatment modality in patients with distal radius fractures. Future methodologically sound studies are required with larger sample sizes to validate such conclusions.
DISCLAIMER
Il contenuto di questa pagina è solo a scopo informativo e non intende sostituire la consulenza, la diagnosi o il trattamento medico professionale. Se ha bisogno di cure mediche, si rivolga sempre al suo medico o al pronto soccorso più vicino. Le opinioni, le convinzioni e i punti di vista espressi dalle persone sui contenuti presenti in questa pagina non riflettono le opinioni, le convinzioni e i punti di vista di OrthoEvidence.
0 di 4 articoli mensili GRATUITI sbloccati
