Cochrane in CORR ®: Surgical Versus Conservative Treatment for Acute Injuries of the Lateral Ligament Complex of the Ankle in Adults (Review)

Chaudhry, Harman; Simunovic, Nicole; Petrisor, Brad

doi:10.1007/s11999-014-4018-7

Cited by 29 publications

(20 citation statements)

References 13 publications

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“…Our endeavor was facilitated by the use of a common and recommended functional outcome instrument across all RCTs, the DASH questionnaire. Inconsistent and varying use of outcome instruments has presented limitations to previous metaanalyses in the orthopaedic and distal radius literature [2,17]. Future trials must continue to use common outcome instruments to allow for meaningful meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Distal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior. Questions/purposes We performed a meta-analysis of randomized controlled trials to determine whether patients treated with volar locking plates (1) achieved better function (2) attained better wrist motion, (3) had better radiographic outcomes, and (4) had fewer complications develop than did patients treated with K-wires for dorsally displaced distal radius fractures. Methods We performed a comprehensive search of MEDLINE (inception to 2014, October Week 2), EMBASE (inception to 2014, Week 42), and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials; we supplemented these searches with manual searches. We included studies of extraarticular and intraarticular distal radius fractures. Adjunctive external fixation was acceptable as long as the intent was to use only K-wires where possible and external fixation was used in less than 25% of the procedures. We considered a difference in the DASH scores of 10 as the minimal clinically important difference. We performed quality assessment with the Cochrane Risk of Bias tool and evaluated the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Seven randomized trials with a total of 875 participants were included in the meta-analysis. Results Patients treated with volar locking plates had slightly better function than did patients treated with K-wires as measured by their DASH scores at 3 months (mean difference [MD], 7.5; 95% CI, 4.4-10.6; p \ 0.001) and 12 months (MD, 3.8; 95% CI, 1.2-6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7°[95% CI, 0.3°-7.1°; p = 0.04] and 4.1°[95% CI, 0.6°-7.

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Section: Discussionmentioning

confidence: 99%

Are Volar Locking Plates Superior to Percutaneous K-wires for Distal Radius Fractures? A Meta-analysis

Chaudhry

Kleinlugtenbelt

Mundi

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Die Therapie von Sprunggelenkinstabilitäten war bereits Gegenstand zahlreicher Studien [5,16]. Insgesamt herrscht derzeit Konsens über die primäre Durchfüh-rung einer individuellen Therapie, die im Regelfall konservativ durchgeführt werden kann [3,5,6].…”

Section: Therapieunclassified

“…Insgesamt herrscht derzeit Konsens über die primäre Durchfüh-rung einer individuellen Therapie, die im Regelfall konservativ durchgeführt werden kann [3,5,6].…”

Section: Therapieunclassified

“…Eine adäquate Bewertung der konservativen und operativen Therapien in Metaanalysen ist jedoch aufgrund von bislang uneinheitlichen Outcome-Kriterien nur eingeschränkt möglich [5].…”

Section: Therapieunclassified

“…Bei bis zu 20-40 % der Patienten entwickelt sich allerdings eine chronische Instabilität und eine damit verbundene Symptomatik bis hin zur Sprunggelenkarthrose [3,5,7,8]. Indikationsstellung, Zeitpunkt und Technik zur operativen Behandlung von Sprunggelenkinstabilitäten werden daher anhaltend diskutiert.…”

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