Efficacité du traitement chirurgical par rapport au traitement conservateur des fractures du radius distal chez les patients âgés: revue systématique et méta-analyse - 23/08/22
Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: a systematic review and meta-analysis
, Felipe Araya-Quintanilla b, Cristian Olguín-Huerta b, Rodrigo Gutiérrez-Monclus c, Juan Valenzuela-Fuenzalida d, Javier Román-Veas e, Christian Campos-Jara aAbstract |
Background |
The aim of this study was to determine whether surgical treatment is more effective than conservative treatment in terms of functional outcomes in elderly patients with distal radius fractures (DRFs).
Methods |
An electronic search of the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases was performed, from inception until July 2021. The eligibility criteria for selecting studies were randomized clinical trials that compared surgical versus conservative treatment in subjects older than 60 years with DRFs. Two authors independently performed the search, data extraction, and assessed risk of bias (RoB) using the Cochrane RoB tool.
Results |
Twelve trials met the eligibility criteria, and nine studies were included in the quantitative synthesis. For volar plate versus cast immobilization at 1-year follow-up, the mean difference (MD) for PRWE was -5.36 points (P=0.02), for DASH was -4.03 points (P=0.02), for grip strength was 8.32 % (P=0.0004), for wrist flexion was 4.35 degrees (P=0.10), for wrist extension was -1.52 degrees (P=0.008), for pronation was 2.7 degrees (P=0.009), for supination was 4.88 degrees (P=0.002), and for EQ-VAS was 2.73 points (P=0.0007), with differences in favor of volar plate. For K-wire versus cast immobilization at 12 months, there were no statistically significant differences in wrist range of motion (P>0.05).
Conclusions |
There was low to high evidence according to GRADE ratings, with a statistically significant difference in functional outcomes in favor of volar plate versus conservative treatment at 1-year follow-up. However, these differences are not minimally clinically important, suggesting that both types of management are equally effective in patients older than 60 years with DRFs.
Level of Evidence |
I; Therapeutic (Systematic review and meta-analysis of randomized clinical trials).
Le texte complet de cet article est disponible en PDF.Keywords : Distal radius fracture, Elderly, Surgical procedures, Operative, Cast immobilization, Meta-analysis
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology : Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 108 - N° 5
P. 574 - septembre 2022 Retour au numéro
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