Surgical or non-surgical treatment of traumatic skeletal fractures in adults: systematic review and meta-analysis of benefits and harms

Abstract

Background: A comprehensive overview of treatments of common fractures is missing, although it would be important for shared decision-making in clinical practice. The aim was to determine benefits and harms of surgical compared to non-surgical treatments for traumatic skeletal fractures. Methods: We searched Medline, Embase, CINAHL, Web of Science, and CENTRAL until November 2018, for randomized trials of surgical treatment in comparison with or in addition to non-surgical treatment of fractures in adults. For harms, only trials with patient enrollment in 2000 or later were included, while no time restriction was applied to benefits. Two reviewers independently assessed studies for inclusion, extracted data from full-text trials, and performed risk of bias assessment. Outcomes were self-reported pain, function, and quality of life, and serious adverse events (SAEs). Random effects model (Hedges' g) was used. Results: Out of 28375 records screened, we included 61 trials and performed meta-analysis on 12 fracture types in 11 sites: calcaneus, clavicula, femur, humerus, malleolus, metacarpus, metatarsus, radius, rib, scaphoideum, and thoraco-lumbar spine. Seven other fracture types only had one trial available. For distal radius fractures, the standardized mean difference (SMD) was 0.31 (95% CI 0.10 to 0.53, n = 378 participants) for function, favoring surgery, however, with greater risk of SAEs (RR = 3.10 (1.42 to 6.77), n = 436). For displaced intra-articular calcaneus fractures, SMD was 0.64 (0.13 to 1.16) for function (n = 244) and 0.19 (0.01 to 0.36) for quality of life (n = 506) favoring surgery. Surgery was associated with a smaller risk of SAE than non-surgical treatment for displaced midshaft clavicular fractures (RR = 0.62 (0.42 to 0.92), n = 1394). None of the other comparisons showed statistical significance differences and insufficient data existed for most of the common fracture types.

The Efficacy of Targeted Perioperative Management for Diabetic Patients with Traumatic Calcaneal Fractures

“…e study by Zhang Lu et al demonstrated that targeted management showed significant improvements in eliminating negative emotions, lowering the risk of complications, and relieving pain, which boosted postoperative recovery and ameliorated patients' quality of life. Furthermore, patients receiving targeted management in the present study were more satisfied with the treatment, which indicates that the protocol is feasible [20][21][22].…”

Cortical bone thickness of the distal radius predicts the local bone mineral density

“…However, the choice of conservative or operative therapy is not only based on age or fracture pattern, but is also influenced by the local bone quality. 9 Poor bone stock is associated with an increased risk for complications such as failure of fixation, secondary dislocation, and malunion, 9,10 and therefore it is essential to include an initial appraisal of the patient’s bone quality.…”

Different internal fixation methods for unstable distal clavicle fractures in adults: a systematic review and network meta-analysis

“…There is still controversy regarding the optimal internal fixation method for UDCFs. Several meta-analyses have compared the effectiveness and safety of different internal fixation methods for UDCFs [19,[22][23][24][25][26]. However, published meta-analyses did not include combined fixation methods (i.e., LCP + CC) and had a low level of evidence and high heterogeneity among the outcome parameters due to the small number of papers included.…”