Treatment outcomes of casting versus plate for distal radius fracture in adults: a meta-analysis

doi:10.3969/j.issn.2095-4344.0394

Abstract

Abstract:

BACKGROUND: For fracture of distal radius in adults, choosing casting external or open reduction and internal fixation (ORIF) with plates remains controversial.

OBJECTIVE: To analyze the results of closed reduction and casting versus ORIF with plates in treatment of fracture of distal radius in adults.

METHODS: Databases of PubMed, EMbase, The Cochrane Library (Issue 11, 2017), OVID, Web of Science, CNKI and WanFang were searched. The randomized controlled trials about casting and plate for the fracture of distal radius published before March 2018 were collected. The literature screening was conducted by two researchers independently based on the incision and exclusion criteria, followed by data extraction and bias evaluation. Meta-analysis was performed on RevManager 5.3 software.

RESULTS AND CONCLUSION: (1) Fifteen randomized controlled trials were included involving 1 545 patients. (2) Meta-analysis results showed that there were no significant differences in the Disabilities of the Arm, Shoulder and Hand scores (MD=1.83, 95%CI (-0.06, 3.72), P=0.06), Patient-Rated Wrist Evaluation Questionnaire scores (MD=4.01, 95%CI (-4.96, 12.99), P=0.38), range of motion of the wrist joint in dorsiflexion and ulnar deviation (MD=-7.47, 95%CI (-15.40, 0.47), P=0.07; MD=-5.45, 95%CI (-13.82, 2.93), P=0.20) between two groups. The plate groups had a higher Gartland and Werley category (OR=0.52, 95%CI (0.30, 0.90), P=0.02) and grip strength (MD=-10.01, 95%CI (-17.04，-2.99), P=0.005). (3) In the plate group, the incidence of tendinitis (RR=0.10, 95%CI (0.02, 0.51), P=0.006), carpal tunnel syndrome (RR=3.20, 95%CI (1.14, 8.96), P=0.03) and finger stiffness (RR=9.29, 95%CI (1.80, 47.79), P=0.008) were significantly increased. (4) To conclude, for adult patients with fracture of distal, the long-term function between casting and plate is similar. Although the radiological parameters of closed reduction and casting are poor, it does not reduce the range of motion of the wrist joint, nor increase the rate of reoperation, which is firstly chosen for older adults.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Radius Fractures, Internal Fixators, External Fixators, Randomized Controlled Trial, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Gao Wei-xu, Chen Xiao, Wang Qiang. Treatment outcomes of casting versus plate for distal radius fracture in adults: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(31): 5069-5076.

Figures/Tables 6

2.3.2 PRWE评分共有3个研究报道了2种方式治疗后1年时的PRWE评分[8-9，13]，共252例患者，异质性检验结果显示，各研究间有明显异质性(P=0.001，I2=85%)，故采用随机效应模型进行合并，结果显示，2组PRWE评分差异无显著性意义[MD=4.01，95%CI(-4.96，12.99)，P=0.38](图3)。 2.3.3 Gartland and Werley优良率共7个研究报道了2种方式治疗后的优良率[5，11，13，15，17-19]，共867例患者，异质性检验结果显示，各研究间无明显异质性(P=0.06，I2=49%)，故采用固定效应模型进行合并，结果显示，钢板组明显高于石膏组，且差异有显著性意义[OR=0.52，95%CI(0.30，0.90)，P=0.02](图4)。 2.3.4 握力共4个研究报道了2种方式治疗后12个月时的握力情况[5，7，9，20]，共275例患者，异质性检验结果显示，各研究间存在异质性(P=0.02，I2=70%)，故采用随机效应模型进行合并，结果显示，钢板组握力优于石膏组，差异有显著性意义[MD=-10.01，95%CI(-17.04，-2.99)，P=0.005](图5)。 2.3.5 腕关节活动度共有7个研究报道了2种方式治疗后1年时的腕关节活动度情况[5，7，9，12，14，19，21]，仅5篇文献可进行统计量合成[5，9，14，19，21]，共595例患者，异质性检验结果显示，各研究间存在明显异质性(P < 0.10，I2 > 50%)，故采用随机效应模型进行合并，结果显示，钢板组在桡偏、掌屈、旋前及旋后优于石膏外固定组[MD=-6.70，95%CI(-10.97，-2.42)，P=0.002；MD=-8.13，95%CI(-14.35，-1.91)，P=0.01；MD=-2.39，95%CI(-4.10，-0.68)，P=0.006；MD=-4.33，95%CI(-7.83，-0.84)，P=0.02]；2组背伸、尺偏差异无显著性意义[MD=-7.47，95%CI(-15.40，0.47)，P=0.07；MD=-5.45，95%CI(-13.82，2.93)，P=0.20](图6)。 2.3.6 影像学结果纳入研究中有8篇文献报道了2种方式治疗后3个月及1年时的影像学结果[5，7-9，12-16]，详见表3。 2.3.7 并发症纳入研究中有9篇文献报道了2种方式治疗后的并发症[5，7-9，11-12，14-15，19，21]。其中5个研究报道了腕管综合征[5，7，9，11-12]，共448例患者，异质性检验结果显示，各研究间无明显异质性(P=0.53，I2=0%)，故采用固定效应模型进行合并，结果显示，石膏组明显高于钢板组，且差异有显著性意义[MD=3.20，95%CI(1.14，8.96)，P=0.03](图7)，其余并发症详见表4。"

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