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Majlesara A, Aminizadeh E, Ramouz A, Khajeh E, Shahrbaf M, Borges F, Goncalves G, Carvalho C, Golriz M, Mehrabi A. Evaluation of quality and quantity of randomized controlled trials in hepatobiliary surgery: A scoping/mapping review. Eur J Clin Invest 2024; 54:e14210. [PMID: 38624140 DOI: 10.1111/eci.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
AIM To evaluate the quantity and quality of randomized controlled trials (RCTs) in hepatobiliary surgery and for identifying gaps in current evidences. METHODS A systematic search was conducted in MEDLINE (via PubMed), Web of Science, and Cochrane Controlled Register of Trials (CENTRAL) for RCTs of hepatobiliary surgery published from inception until the end of 2023. The quality of each study was assessed using the Cochrane risk-of-bias (RoB) tool. The associations between risk of bias and the region and publication date were also assessed. Evidence mapping was performed to identify research gaps in the field. RESULTS The study included 1187 records. The number and proportion of published randomized controlled trials (RCTs) in hepatobiliary surgery increased over time, from 13 RCTs (.0005% of publications) in 1970-1979 to 201 RCTs (.003% of publications) in 2020-2023. There was a significant increase in the number of studies with a low risk of bias in RoB domains (p < .01). The proportion of RCTs with low risk of bias improved significantly after the introduction of CONSORT guidelines (p < .001). The evidence mapping revealed a significant research focus on major and minor hepatectomy and cholecystectomy. However, gaps were identified in liver cyst surgery and hepatobiliary vascular surgery. Additionally, there are gaps in the field of perioperative management and nutrition intervention. CONCLUSION The quantity and quality of RCTs in hepatobiliary surgery have increased over time, but there is still room for improvement. We have identified gaps in current research that can be addressed in future studies.
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Affiliation(s)
- Ali Majlesara
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ehsan Aminizadeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Mohammadamin Shahrbaf
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Filipe Borges
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Gil Goncalves
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Clinical Oncology, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Shafi SQ, Yoshimura R, Harrison CJ, Wade RG, Shaw AV, Totty JP, Rodrigues JN, Gardiner MD, Wormald JCR. Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) protocol. Bone Jt Open 2024; 5:361-366. [PMID: 38655761 PMCID: PMC11040518 DOI: 10.1302/2633-1462.54.bjo-2023-0144.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Aims Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma. Methods This will be an international, multicentre audit comparing antimicrobial practices in hand trauma to the standards outlined by WHO. Through the Reconstructive Surgery Trials Network (RSTN), hand surgeons across the globe will be invited to participate in the study. Consultant surgeons/associate specialists managing hand trauma and members of the multidisciplinary team will be identified at participating sites. Teams will be asked to collect data prospectively on a minimum of 20 consecutive patients. The audit will run for eight months. Data collected will include injury details, initial management, hand trauma team management, operation details, postoperative care, and antimicrobial techniques used throughout. Adherence to WHO global guidelines for SSI will be summarized using descriptive statistics across each criteria. Discussion The Hand and Wrist trauma: Antimicrobials and Infection Audit of Clinical Practice (HAWAII ACP) will provide an understanding of the current antimicrobial practice in hand trauma surgery. This will then provide a basis to guide further research in the field. The findings of this study will be disseminated via conference presentations and a peer-reviewed publication.
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Affiliation(s)
- Shiraz Q. Shafi
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
| | - Ryo Yoshimura
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Conrad J. Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Ryckie G. Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
| | - Abigail V. Shaw
- Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
| | - Joshua P. Totty
- Centre for Clinical Sciences, Hull York Medical School, York, UK
| | - Jeremy N. Rodrigues
- Clinical Trials Unit, University of Warwick Medical School, Warwick, UK
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Matthew D. Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
- Department of Plastic and Reconstructive Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham, UK
| | - Justin C. R. Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
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Kabir A, Sofi-Mahmudi A, Karimi Behnagh A, Eidkhani V, Baradaran HR, Kabiri P, Haghdoost A, Mesgarpour B. Risk of Bias in Iranian Randomized Trials Included in Cochrane Reviews. ARCHIVES OF IRANIAN MEDICINE 2022; 25:375-382. [PMID: 35943017 DOI: 10.34172/aim.2022.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 09/15/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Among interventional studies, randomized controlled trials (RCTs) provide the highest level of evidence. However, RCTs can be susceptible to the risk of bias (RoB). Systematic reviews can be performed to appraise RoB in the included articles using evaluative tools. This study aimed to describe the main characteristics and focus on the RoB of RCTs conducted in Iran and included in Cochrane Reviews (CRs). METHODS We searched "Iran" by selecting the "Search All Text" and "Review" fields in the Cochrane Database of Systematic Reviews within Ovid. CRs that included the RCTs conducted in Iran were retrieved. A trial was selected only if it was included in CRs, described as a controlled clinical trial, involved human subjects and CR authors assessed its RoB. The trials were characterized by investigating the relevant articles and the table "Characteristics of included studies" in each CR. The RoB was investigated by collecting the review authors' judgments based on RoB assessment tables in the CRs. RESULTS Out of 1166 Iranian RCTs included by 571 CRs, low RoB was found in 44.9% for random sequence generation, 20.8% for allocation concealment, 32.3% for blinding of participants/personnel, 36.5% for blinding of outcome assessors, 56.3% for incomplete outcome data, 41.3% for selective outcome reporting and 53.8% for other sources of bias. CONCLUSION The RoB in Iranian RCTs was found to be mostly high or unclear. While this is similar to the global situation, it is recommended that the methodological quality of conducting and reporting RCTs be addressed in Iran.
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Affiliation(s)
- Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Ahmad Sofi-Mahmudi
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Arman Karimi Behnagh
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Eidkhani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Payam Kabiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - AliAkbar Haghdoost
- Social Determinants of Health Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Bita Mesgarpour
- Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
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Deblois S, Zhu L, Mastropasqua B, Thibaudeau S, Ziegler D, Pomp A. The clinical effectiveness and safety of intravenous unfractionated heparin following digital replantation and revascularization: A narrative systematic review. Microsurgery 2022; 42:622-630. [PMID: 35553450 DOI: 10.1002/micr.30895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 02/16/2022] [Accepted: 04/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Digital replants and revascularization (DRV) have been performed since the 1960s but there are no recognized standard peri-operative anticoagulation practices. A narrative systematic review of the clinical effectiveness and safety of therapeutic peri-operative unfractionated heparin following DRV was undertaken. METHODS A review of the literature from 1985 to March 2022 was conducted using Medline, Embase, CINAHL and EBM reviews. Unfractionated heparin (UFH) use following DRV was compared to low-molecular weight heparin, other anticoagulants or no anticoagulation. Randomized trials, observational studies as well as guidelines were selected and independently screened. The Revised Cochrane risk-of-bias (RoB 2) tool and ROBINS-I were used to appraise risk of bias. RESULTS While the search strategy identified 1490 references, only six studies met the inclusion criteria. Significant heterogeneity and the low methodological quality of the evidence precluded a meta-analysis. Among the four studies that documented the surgical success rate associated with the use of a therapeutic dose of UFH post DRV, only two reported improved clinical outcomes. Evidence of a higher complication rate related to UFH use was found in four studies. Low quality evidence suggests that a therapeutic dose of unfractionated heparin leads to a higher risk of complications when compared with heparin given as an intermittent bolus of unfractionated heparin or subcutaneous heparin, or prostaglandin E1 or no heparin. CONCLUSIONS Current evidence suggests that IV UFH use following DRV has no significant impact on the success of the intervention. Heparin use may not be innocuous as some studies showed increased bleeding complications.
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Affiliation(s)
- Simon Deblois
- Health Technology Assessment Professional, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Linda Zhu
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Bruno Mastropasqua
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Thibaudeau
- Plastic Surgery Division McGill, University Health Center, Montréal, Québec, Canada
| | - Daniela Ziegler
- Library, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Alfons Pomp
- Health Technology Assessment Professional, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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Collaborative hand surgery clinical research without sharing individual patient data; proof of principle study. J Plast Reconstr Aesthet Surg 2022; 75:2242-2250. [PMID: 35351392 DOI: 10.1016/j.bjps.2022.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022]
Abstract
High-quality research in hand surgery is increasingly important. A vital component is national and international multicenter collaborative research because of better generalizability and larger sample sizes. However, sharing patient data between centers can be hampered by regulations and privacy issues or reluctance to share patient data. Therefore, in this paper, we illustrate an approach for collaborative clinical research without sharing patient data while obtaining similar outcomes. To illustrate that this collaborative clinical research approach without sharing patient data leads to similar outcomes compared to aggregating all individual patient data in one database, we simulate an approach of performing meta-analyses on summary statistics of individual-center data. In the simulation, we compare the results to conventional analyses in an existing multicenter database of patients treated for Dupuytren's disease at three different centers with either limited fasciectomy (LF) or needle aponeurotomy (PNF). We share example data and all analysis code in a public GitHub Library. We found similar results for the meta-analysis approach without sharing individual patient data as in the conventional approach for 1) the proportion of patients treated for recurrences, 2) the Total MHQ score after both treatments, 3) the comparison of Total MHQ score after both treatments, and 4) the comparison of both treatments when correcting for confounders with regression analysis. CLINICAL SIGNIFICANCE: We illustrate how collaborative studies can be performed without sharing individual patient data while obtaining similar results as with conventional analyses. This approach can help speed up collaborative research without losing precision in outcome analysis.
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Cavalcante MC, Moraes VYD, Osés GL, Nakachima LR, Belloti JC. Quality analysis of prior systematic reviews of carpal tunnel syndrome: an overview of the literature. SAO PAULO MED J 2022; 141:e20211020. [PMID: 36541951 PMCID: PMC10065117 DOI: 10.1590/1516-3180.2021.1020.r2.10102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil. METHODS We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328).
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Affiliation(s)
- Marcelo Cortês Cavalcante
- MD. Physician, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Vinicius Ynoe de Moraes
- MD, PhD. Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Guilherme Ladeira Osés
- MD. Physician, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - Luis Renato Nakachima
- MD, PhD. Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
| | - João Carlos Belloti
- MD, MSc, PhD. Adjunct Professor, Department of Orthopedics and Traumatology, Discipline of Hand and Upper Limb Surgery, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
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Frueh FS, Wong JK, Megerle K, Luria S, Farnebo S. Striving for scientific excellence in hand surgery. J Hand Surg Eur Vol 2020; 45:890-891. [PMID: 32469680 PMCID: PMC7542995 DOI: 10.1177/1753193420927581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Florian S. Frueh
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Jason K. Wong
- Blond McIndoe Laboratories and Department of Plastic Surgery, University of Manchester and Manchester University Foundation Trust, Manchester, UK
| | - Kai Megerle
- Divison of Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden,
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Collaboration in Hand Surgery: Experiences From Silicone Arthroplasty in Rheumatoid Arthritis, Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness, Wrist and Radius Injury Surgical Trial, and Surgery of the Ulnar Nerve. J Am Acad Orthop Surg 2020; 28:e670-e678. [PMID: 32732659 DOI: 10.5435/jaaos-d-20-00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Outcomes research has historically been driven by single-center investigations. However, multicenter studies represent an opportunity to overcome challenges associated with single-center studies, including generalizability and adequate power. In hand surgery, most clinical trials are single-center studies, with few having randomized controls and blinding of both participants and assessors. This pervasive issue jeopardizes the integrity of evidence-based practice in the field. Because healthcare payers emphasize applying the best available evidence to justify medical services, multicenter research collaborations are increasingly recognized as an avenue for efficiently generating high-quality evidence. Although no study design is perfect, the potential advantages of multicenter trials include generalizability of the results, larger sample sizes, and a collaboration of experienced investigators poised to optimize protocol development and study conduct. As the era of single-center studies shifts toward investment in multicenter trials and clinical registries, investigators will inevitably be faced with the challenges of conducting or contributing to multicenter research collaborations. We present our experiences in conducting multicenter investigations to provide insight into this demanding and rewarding frontier of research.
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Affiliation(s)
- Nick Johnson
- 1 Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester, UK
| | - Paul Leighton
- 2 NIHR Research Design Service for the East Midlands, University of Nottingham, Nottingham, UK
| | - Joseph Dias
- 1 Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester, UK
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Johnson NA, Dias J. The current evidence-based management of distal radial fractures: UK perspectives. J Hand Surg Eur Vol 2019; 44:450-455. [PMID: 30991865 DOI: 10.1177/1753193419843201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal radial fractures are extremely common injuries, yet many basic questions remain unanswered about their optimum management. Recently in the United Kingdom several guideline development groups have produced national standards and best-practice guidelines based on review of the best available evidence and expert knowledge. All guideline groups agree that when surgery is needed for dorsally displaced distal radial fractures, that can be reduced closed, K-wire fixation and cast immobilization, should be offered. Further research questions have been identified. The important findings and recommendations are summarized in this article.
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Affiliation(s)
- Nick A Johnson
- 1 Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, UK.,2 Pulvertaft Hand Unit, Royal Derby Hospital, Derby, UK
| | - Joseph Dias
- 1 Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, UK
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