HAND & WRIST
Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial
This report has been verified
by one or more authors of the
original publication.
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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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomização
3/4
Medidas de resultado
4/4
Inclusão/Exclusão
4/4
Descrição do tratamento
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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).
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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.
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