Ulus Travma Acil Cerrahi Derg. 2016; 22(3): 233-241 | DOI: 10.5505/tjtes.2015.05995

Internal fixation vs conservative treatment for displaced distal radius fractures: a meta-analysis of randomized controlled trials

Guang-shu Yu¹, Yan-bin Lin¹, Li-sheng Le², Mei-feng Zhan³, Xiao- Xiang Jiang^4
1Department Of Orthopaedics And Traumatology,fuzhou The 2nd Hospital Of Xia Men University,fu Zhou,fujian,p.r.china,350007
²Department Of Orthopaedics And Traumatology,mawei Branch Of Fuzhou The 2nd Hospital,fu Zhou,fujian,p.r.china,350015
³Department Of Orthopaedics And Traumatology,luoyuan County Hospital,luo Yuan,fujian,p.r.china,350600
⁴Graduate School,fujian University Of Traditional Chinese Medicine, Fu Zhou,fujian,p.r.china,350122

BACKGROUND: The aim of the present study was to compare clinical outcomes of internal fixation and conservative approach in the treatment of displaced distal radius fractures.
METHODS: Reports of studies were retrieved from the PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid, CNKI, and Wanfang Data databases, as well as manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Review Manager (RevMan) meta-analysis software (version 5.0; Cochrane Collaboration, London, UK) was used for data analysis.
RESULTS: A total of 10 randomized controlled trials, which included 653 patients, were eligible for inclusion in the present metaanalysis, 7 of which were in English, and 3 of which were in Chinese. The trials had medium risk of bias. Results of meta-analysis showed that patients undergoing conservative treatment for distal radius fractures had better restoration of pronation (MD=1.80, 95% confidence interval [CI]=0.18—3.42, p=0.03; heterogeneity p=0.17, I2=43%), but shorter restoration of radial length (MD=2.62, 95% CI=1.47—3.76, p<0.00001; heterogeneity p=0.02, I2=73%). Wrist range of motion other than pronation, grip strength, radiographic parameters other than radial length, and rates of complications were not significantly different between the 2 treatments.
CONCLUSION: Very few clinical differences were found between results of internal fixation and conservative treatment for displaced distal radius fractures. Best course of of treatment must be determined based on concrete conditions.

Keywords: Conservative treatment, distal radius fracture, internal fixation, meta-analysis.

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Deplase distal radius kýrýklarýnda internal fiksasyona karþýn konservatif tedavi: Randomize kontrollü çalýþmalarýn metaanalizi

Guang-shu Yu¹, Yan-bin Lin¹, Li-sheng Le², Mei-feng Zhan³, Xiao- Xiang Jiang^4
1Xia Men Üniversitesi, Fuzhou Ýkinci Hastanesi, Ortopedi ve Travmatoloji Kliniði, Fu Zhou, Fujian-Çin
²Fuzhou Ýkinci Hastanesi Mawei Þubesi, Ortopedi ve Travmatoloji Kliniði, Fu Zhou, Fujian-Çin
³Luoyuan Ýlçe Hastanesi, Ortopedi ve Travmatoloji Kliniði, Fujian-Çin
⁴Fujian Üniversitesi, Geleneksel Çin Týbbý Yüksek Okulu, Fujian-Çin

AMAÇ: Deplase distal radius kýrýklarýnda internal fiksasyona karþýn konservatif tedavinin klinik sonuçlarýný karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Yapýlan çalýþma sonuçlarý PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid veri tabanlarý ile CNKI ve Wanfang veri tabanýndan derlendi. Çalýþmalarýn metodolojik kalitesi eleþtirel açýdan deðerlendirildi ve ilgili veriler çýkartýldý. Veri analizi için istatistiksel Revman 5.0 yazýlýmý kullanýldý.
BULGULAR: Çalýþmaya katýlýmý uygun görülen toplam 653 hastayý kapsayan randomize kontrollü yedi Ýngiliz ve üç Çin çalýþmasýnýn metaanalizi yapýldý. Çalýþmalarýn sonuçlarý orta derecede yanýlgý payýna sahipti. Metaanaliz sonuçlarý distal radius kýrýklarý için konservatif tedavi gören hastalarda pronasyonun daha iyi (MD=1.80; %95 GA: 0.18–3.42; p=0.03; heterojenite p=0.17; I2=%43) saðlandýðýný, ancak radius boyunun daha kýsa kaldýðýný gösterdi (MD=2.62; %95 GA: 1.47–3.76, p<0.00001; heterojenite p=0.02; I2=%73). Pronasyon dýþýnda el bileðinin hareket erimi, kavrama gücü, radius uzunluðu dýþýndaki radyografik parametreler ve komplikasyon oranlarý iki tedavi grubu arasýnda anlamlý derecede farklý deðildi.
TARTIÞMA: Deplase distal radius kýrýklarýnýn tedavisinde internal fiksasyon ile konservatif tedavi arasýnda çok az klinik farklýlýk olduðu gibi en iyi tedavi seçeneðinin somut koþullara göre kararlaþtýrýlmasý gerekmektedir.

Anahtar Kelimeler: Distal radius kýrýklarý, internal fiksasyon, konservatif tedavi, metaanaliz.

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