Search

Costa ML, Achten J, Parsons NR, Rangan A, Griffin D, Tubeuf S, Lamb SE; DRAFFT Study Group. Percutaneous Fixation with Kirschner Wires Versus Volar Locking Plate Fixation in Adults with Dorsally Displaced Fracture of Distal Radius: Randomised Controlled Trial. BMJ. 2014 Aug 5;349:g4807. ### Question: In patients with a dorsally displaced fracture of the distal part of the radius, how does volar locking-plate fixation compare with Kirschner-wire fixation? ### Design: Randomized (allocation concealed), blinded (data collectors and outcome assessors), controlled trial with twelve months of follow-up (Distal Radius Acute Fracture Fixation Trial [DRAFFT]). ### Setting: 18 centers in the United Kingdom. ### Patients: 461 patients ≥18 years of age (mean age, 59 years; 84% women) who had a dorsally displaced fracture of the distal part of the radius within 3 cm of the radiocarpal joint in the past 2 weeks. Exclusion criteria were a fracture extending >3 cm from the radiocarpal joint, open fracture, inability of the fracture to be reduced with indirect techniques, or contraindication to anesthesia. 416 patients (90%) completed follow-up. ### Intervention: Patients were allocated to volar locking-plate fixation (n = 231) or Kirschner-wire fixation (n = 230). Locking-plate fixation involved an incision over the volar …

Orthopaedic outcomes research is increasingly emphasizing the use of standardized patient-rated questionnaires. In prospective study designs, investigators collect such measures of disability prospectively before the intervention and also after the intervention to quantify treatment effect. However, case series, case-control studies, retrospective cohorts, and even cross-sectional studies may rely on patients’ ability to recall preintervention impairment in order to determine an intervention’s effectiveness1,2. Despite the convenience of using recall patient-rated questionnaires, this reliance on patient memory introduces the possibility of recall bias. Recall bias is a well-known form of systematic error. In orthopaedic surgery, this may bias results secondary to differential recall of a prior health state that is either skewed by the current health state or by the severity of the pretreatment condition. Alternatively, random error related to the duration of time elapsed since the health state of interest may be introduced during recall. Few studies have measured agreement between patients’ recalled and actual preintervention function on validated orthopaedic patient-rated outcome measures2-4. Furthermore, these studies have not evaluated recall bias as a function of time. The existing studies that have attempted to measure recall accuracy at a single time point after intervention demonstrate varying levels of agreement between what the patient recorded at the time of initial assessment and what the patient remembers2,3,5-7. There is also limited evidence on factors that may contribute to the reliability of patient recall6. Without this knowledge, the validity of clinical research based upon post hoc patient recall of their preintervention state of function remains uncertain. The QuickDASH questionnaire, a shortened version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, is a validated, standardized questionnaire that is a responsive and reliable assessment of patients’ upper extremity disability8-12. The eleven-question set is a subset of the DASH, one of the most commonly utilized patient-rated outcome measures in recent hand surgical series13. This study was designed to determine if patients could accurately recall prior self-rated function (QuickDASH scores) between three months and twenty-four months after their initial office visits (IOVs). We hypothesized that patient recall accuracy would decrease with increasing time since the IOV. Our null hypothesis was that there would be no effect of recall duration (time from the IOV) on the patient’s accuracy in recalling their preintervention functional state. Second, we sought to test the null hypothesis that patient factors would not affect patient recall accuracy. We expected that recall bias would exist, with recall error being positively correlated with current health such that patients with better current function would underestimate past impairment.