1. A meta-analysis comparing volar locking plates and cast immobilization for distal radius fractures in the elderly.
- Author
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Yang, Jingyi, Li, Yating, Li, Xiaoyan, and Wulan, Nari
- Subjects
FRACTURE fixation ,ORTHOPEDIC casts ,TREATMENT effectiveness ,META-analysis ,FUNCTIONAL status ,DESCRIPTIVE statistics ,SYSTEMATIC reviews ,MEDLINE ,INTERNAL fixation in fractures ,MEDICAL databases ,REOPERATION ,QUALITY of life ,THERAPEUTIC immobilization ,ONLINE information services ,CONFIDENCE intervals ,DISTAL radius fractures ,GRIP strength ,EVALUATION ,OLD age - Abstract
Background: The long-term outcomes (≥ 2 years of follow-up) of volar locked plate (VLP) fixation versus closed reduction and casting (CRC) for the treatment of displaced distal radial fractures (DRFs) remain unclear. This study aimed to conduct a meta-analysis comparing the long-term clinical outcomes of VLP and CRC in elderly patients (aged ≥ 60 years). Methods: A comprehensive search of PubMed, Web of Science, and Cochrane Library was performed to identify studies comparing the long-term outcomes of VLP and CRC for DRFs. Only randomized controlled trials (RCTs) with a mean follow-up duration of at least 2 years and participants aged 60 years or older were included. The risk of bias in the included studies was assessed. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, EuroQol 5 Dimension 5-level score (EQ-5D-5 L), grip strength, and incidence of reoperation. Results: Four RCTs, comprising 423 patients, were included. The meta-analysis revealed that VLP fixation was associated with significantly improved outcomes compared to CRC in terms of PRWE score (pooled mean difference: -6.21; 95% CI: -10.28 to -2.15; p = 0.003), DASH score (pooled mean difference: -8.18; 95% CI: -13.35 to -3.01; p = 0.002), and grip strength (pooled mean difference: -6.63; 95% CI: 0.25 to 13.01; p = 0.04). There were no significant differences in EQ-5D-5 L score (95% CI: -0.08 to 0.05; p = 0.74) or incidence of reoperation (RR = 0.56; 95% CI: 0.22 to 1.42; p = 0.22). Conclusions: A two-year follow-up of displaced DRFs in elderly patients showed no significant long-term clinical advantage of VLP fixation over CRC. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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