TRAUMA
Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis
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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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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。
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Introduction
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Accessing Data
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Results
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Discussion
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 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.
主な研究課題は何ですか？
Was there a superior surgical option between ORIF with locking plates and bridging external fixation when concerning fractures of the distal radius?
重要な知見は？
- 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).
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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