Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation

Detalhes bibliográficos
Autor(a) principal: Belloti, Joao Carlos [UNIFESP]
Data de Publicação: 2010
Outros Autores: Tamaoki, Marcel Jun Sugawara [UNIFESP], Atallah, Álvaro Nagib [UNIFESP], Albertoni, Walter Manna [UNIFESP], Santos, João Baptista Gomes dos [UNIFESP], Faloppa, Flavio [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://repositorio.unifesp.br/handle/11600/32635
http://dx.doi.org/10.1186/1471-2474-11-137
Resumo: Background: At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation.Methods: We randomly allocated 100 patients into two groups treated surgically with modified de Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified de Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant.Results: Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. the DASH questionnaire evaluation showed a statistically significant result favouring the de Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. the final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with de Palma pinning and three with external fixation.Conclusion: There was a small statistically significant difference favouring the de Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomes
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spelling Belloti, Joao Carlos [UNIFESP]Tamaoki, Marcel Jun Sugawara [UNIFESP]Atallah, Álvaro Nagib [UNIFESP]Albertoni, Walter Manna [UNIFESP]Santos, João Baptista Gomes dos [UNIFESP]Faloppa, Flavio [UNIFESP]Universidade Federal de São Paulo (UNIFESP)2016-01-24T13:59:48Z2016-01-24T13:59:48Z2010-06-29Bmc Musculoskeletal Disorders. London: Biomed Central Ltd, v. 11, 10 p., 2010.1471-2474http://repositorio.unifesp.br/handle/11600/32635http://dx.doi.org/10.1186/1471-2474-11-137WOS000280833100002.pdf10.1186/1471-2474-11-137WOS:000280833100002Background: At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation.Methods: We randomly allocated 100 patients into two groups treated surgically with modified de Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified de Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant.Results: Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. the DASH questionnaire evaluation showed a statistically significant result favouring the de Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. the final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with de Palma pinning and three with external fixation.Conclusion: There was a small statistically significant difference favouring the de Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomesUniversidade Federal de São Paulo, Dept Ortoped & Traumatol, Escola Paulista Med, BR-04038032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ortoped & Traumatol, Escola Paulista Med, BR-04038032 São Paulo, BrazilWeb of Science10engBiomed Central LtdBmc Musculoskeletal DisordersTreatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixationinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPORIGINALWOS000280833100002.pdfapplication/pdf1248884${dspace.ui.url}/bitstream/11600/32635/1/WOS000280833100002.pdf4045a4258326dc3add02164f6cc9acf7MD51open accessTEXTWOS000280833100002.pdf.txtWOS000280833100002.pdf.txtExtracted texttext/plain37519${dspace.ui.url}/bitstream/11600/32635/2/WOS000280833100002.pdf.txt68e9d173e645259cfd89d6f5398640fcMD52open access11600/326352022-11-04 15:45:38.903open accessoai:repositorio.unifesp.br:11600/32635Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:29:56.612747Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.en.fl_str_mv Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
title Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
spellingShingle Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
Belloti, Joao Carlos [UNIFESP]
title_short Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
title_full Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
title_fullStr Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
title_full_unstemmed Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
title_sort Treatment of reducible unstable fractures of the distal radius in adults: a randomised controlled trial of de Palma percutaneous pinning versus bridging external fixation
author Belloti, Joao Carlos [UNIFESP]
author_facet Belloti, Joao Carlos [UNIFESP]
Tamaoki, Marcel Jun Sugawara [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
Albertoni, Walter Manna [UNIFESP]
Santos, João Baptista Gomes dos [UNIFESP]
Faloppa, Flavio [UNIFESP]
author_role author
author2 Tamaoki, Marcel Jun Sugawara [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
Albertoni, Walter Manna [UNIFESP]
Santos, João Baptista Gomes dos [UNIFESP]
Faloppa, Flavio [UNIFESP]
author2_role author
author
author
author
author
dc.contributor.institution.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Belloti, Joao Carlos [UNIFESP]
Tamaoki, Marcel Jun Sugawara [UNIFESP]
Atallah, Álvaro Nagib [UNIFESP]
Albertoni, Walter Manna [UNIFESP]
Santos, João Baptista Gomes dos [UNIFESP]
Faloppa, Flavio [UNIFESP]
description Background: At present, there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius. This study compared the effectiveness of two methods used in surgical treatment of such fractures: percutaneous pinning and external fixation.Methods: We randomly allocated 100 patients into two groups treated surgically with modified de Palma percutaneous pinning and bridging external fixation. Independent but not blinded evaluators administered the DASH quality-of-life questionnaire at postoperative months 6 and 24, performed functional assessment of pain, range of motion, and palm grip strength, and radiographic examinations (volar and radial angle, and height of the radius) before the operation, immediately afterwards, and at 6 and 24 months postoperative. Modified de Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery. Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been randomised according to the intention-to-treat principle. A significance level of 5% (alpha = 0.05). was used for all statistical tests, such that tests presenting a p-value less than 0.05 were considered statistically significant.Results: Ninety one (58.8 mean age and 66 participants were female) were included in the final assessment at 24 months. the DASH questionnaire evaluation showed a statistically significant result favouring the de Palma group (mean difference = -7.1 p = 0.044) after six months, but this was not maintained at 24 months. There were no statistically differences between the groups with respect to palm grip strength. Analysis of the range-of-motion limitation index (uninjured side minus affected side motion of) showed a statistical difference (mean difference = 2.4 p = 0.043) favoring the external fixator group with regard to the supination movement 6 months after the operation; however, this was not maintained at 24 months. the final results of the radiographic evaluation were similar for the two groups. Overall, five patients developed complications: two with de Palma pinning and three with external fixation.Conclusion: There was a small statistically significant difference favouring the de Palma method in early functional at 6 months according to the DASH questionnaire, and for supination movement favouring the fixator group. However, both were not clinical relevant. By 24 months the groups were similar for all outcomes
publishDate 2010
dc.date.issued.fl_str_mv 2010-06-29
dc.date.accessioned.fl_str_mv 2016-01-24T13:59:48Z
dc.date.available.fl_str_mv 2016-01-24T13:59:48Z
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dc.identifier.citation.fl_str_mv Bmc Musculoskeletal Disorders. London: Biomed Central Ltd, v. 11, 10 p., 2010.
dc.identifier.uri.fl_str_mv http://repositorio.unifesp.br/handle/11600/32635
http://dx.doi.org/10.1186/1471-2474-11-137
dc.identifier.issn.none.fl_str_mv 1471-2474
dc.identifier.file.none.fl_str_mv WOS000280833100002.pdf
dc.identifier.doi.none.fl_str_mv 10.1186/1471-2474-11-137
dc.identifier.wos.none.fl_str_mv WOS:000280833100002
identifier_str_mv Bmc Musculoskeletal Disorders. London: Biomed Central Ltd, v. 11, 10 p., 2010.
1471-2474
WOS000280833100002.pdf
10.1186/1471-2474-11-137
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