Re: Kramer et al. Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans. J Hand Surg Eur. 2022, 47: 142–9.

Abstract

We read this article with great interest. We commend the authors for undertaking an important comparison of the impact of Colles' versus scaphoid casts on hand function. This article provides a valuable contribution to the literature, however we have some questions regarding the methodology.The authors use the Jebsen-Taylor Hand Function Test (JHFT) to compare hand function between the Colles' and scaphoid cast types. Sears and Chung (2010) found that JHFT times poorly correlate with patient perception of hand functioning. For many patients, the time required to complete an activity is of little relevance; the ability to perform an action at all is the primary concern. The authors concluded that the JHFT should not be used alone to assess a patient's ability to perform activities of daily living. We kindly ask whether the authors considered alternative scoring approaches. The Michigan Hand Outcome Questionnaire (MHQ) assesses overall hand function in addition to other parameters, including patient-reported satisfaction and pain scores. While this study consisted of healthy volunteers, this scoring system may better reflect the day-today functioning of patients following a scaphoid fracture.We commend the authors for utilizing additional measures of hand function to better reflect the requirements of modern-day activities, however most smartphone devices have the option of reducing the need for manual typing via the use of voice notes. Did the authors consider arguably more crucial assessments, including the ability to turn a key or use cutlery? Additionally, subjects may improve their ability and speed in carrying out tasks with repeated attempts. We wonder whether the authors could disclose the order in which casting was performed. A more frequent application of the Colles' cast after the scaphoid cast could introduce bias to the results obtained.The authors only performed post-hoc analysis on results that were statistically significant and chose to not perform any testing on the negative findings from subsets 9-11. We kindly ask the authors to disclose the reason for this omission. Additionally, it is generally not advised to estimate power following study completion (Griffith and Feyman, 2021), and we ask the authors whether they considered alternative types of post-hoc test.Overall, this article answers an important research question, however caution should be taken regarding the conclusions drawn due to the questionable validity of the JHFT. Clarification of methodology, including the order of casting, and the application of post-hoc testing to negative findings may strengthen the study.