TRAUMA
Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation 'versus' locked volar plating
This report has been verified
by one or more authors of the
original publication.
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これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(10):41 Injury. 2012 Feb;43(2):174-9. Epub 2011 Jun 2575 patients suffering from complex impacted distal radial fractures were randomized to open reduction and internal fixation (ORIF) or to an external fixation (EF) with constant traction to compare clinical and subjective results between these two fixation methods. At 6 month follow-up, the ORIF demonstrated superior clinical outcomes measured by the modified Green and O'Brien rating scale (based on clinical information, scale= 100-0). There were no differences in subjective scores between groups.
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
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
2/4
Statistics
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？
Fixation methods of complex radial fractures have yet to provide completely satisfactory results for patients, often resulting in a loss of radial length and articular issues. The traditional treatment of these fractures is external fixation with constant traction to maintain fixation. ORIF may provide superior results, when compared to EF, but due to the wide range of complex fractures there has yet to be a study comparing these two methods in the treatment of severely impacted fractures.
主な研究課題は何ですか？
Does open reduction and internal fixation provide superior clinical, radiological, and subjective outcomes when compared to external fixation with constant traction for the treatment of complex impacted distal radial fractures?
重要な知見は？
- There were no significant differences in terms of reduction results between the two groups
- 8 patients in each group had a loss of radial length >2 mm EF (20%), ORIF (22%)
- Green and O'Brien's rating were significantly better in the ORIF patients at 6 months (p<0.05) with 53% of patients having good to excellent ratings compared to 23% in the EF group
- Grip strength was greater in the ORIF group at 84% of the ipsilateral side compared to 76% in the EF group (p=0.02)
- A greater number of EF patients had a positive predictive score for Complex Regional Pain Syndrome (CRPS) at 6 week follow-up (p=0.03)
- There were no differences in patient-rated wrist evaluations between the two groups at the 6 month follow-up (p=0.98)
最も覚えておくべきことは？
ORIF provided superior clinical outcomes, measured using the Green and O'Brien rating system, in-comparison to EF. However, there were no differences in subjective results between the two treatments. ORIF also provided greater grip strength for patient, which may be advantageous for young patients returning to regular and intense physical activity.
それが私の患者ケアにどのように影響するか？
ORIF appears to provide superior clinical outcomes and improved grip strength when compared to EF. This should be considered when treating young active patients who are seeking a quick and safe recovery to regular activity. Further research using large samples should be conducted to confirm these results.
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