ORIF with volar locking plates provide better functional outcome than external fixation .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(16):42 Strategies Trauma Limb Reconstr. 2013 Aug;8(2):67-75. doi: 10.1007/s11751-013-0169-4. Epub 2013 Jul 28Three randomized clinical trials were included in this meta-analysis which compared open reduction and internal fixation (ORIF) with volar locking plates to bridging external fixation in the treatment of unstable distal radius fractures. Disabilities of the Arm, Shoulder and Hand (DASH) scores at 3, 6, and 12 months were significantly better in patients who received ORIF. There was no significant difference between treatments for complication rates.
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Discussion
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?
Distal radius fractures are fairly common, and controversy exists as to the most effective surgical treatment. Bridging external fixation, either with or without Kirschner wires, has traditionally been seen as a fast and effective procedure. However, proponents of open reduction and internal fixation (ORIF) with locking plates underline that the immediate stable fixation with ORIF may allow for better recovery. To date, there has been no conclusive evidence to advocate one surgical treatment over the other.
¿Cuál era la pregunta principal de la investigación?
Was there a superior surgical option between ORIF with locking plates and bridging external fixation when concerning fractures of the distal radius?
- A total of 3 studies were included in this meta-analysis
- Differences in DASH score significantly favoured ORIF with volar locking plates over bridging external fixation at 3 months (MD -15.58 (95%CI -24.52 to -6.64); P=0.006), 6 months (MD -6.20 (95%CI -9.83 to -2.58); P=0.008), and 12 months (MD -8.00 (95%CI -15.55 to -0.44); P=0.04) following surgery.
- The heterogeneity in the analyses of DASH scores at 3 months (I^2 = 72%) and 12 months (I^2 = 63%) was substantial.
- There was no significant difference between treatments when considering pooled complication rate (OR 0.71 (95%CI 0.34-1.46); P=0.35).
¿Qué es lo que más debo recordar?
Open reduction and internal fixation with volar locking plates resulted in a significantly better functional outcome on the Disabilities of the Arm, Shoulder, and Hand (DASH) measurement at 3, 6, and 12 months postoperatively compared to bridging external fixation. Clinical significance of the mean difference in DASH scores at 6 and 12 months is yet unclear as it falls below the threshold of 10 points for definite clinical significance.
¿Cómo afectará esto al cuidado de mis pacientes?
Early functional recovery appears to be benefited by ORIF for unstable distal radial fractures. This intervention may, therefore, be more appealing to patients with a higher postoperative functional demand. Future analyses should consider a wider array of outcome variables to add to the body of evidence concerning ORIF and external fixation for distal radius fractures.
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