Volar Locking Plating Compared to Conservative Treatment in Distal Radius Fractures in Elderly Patients (>60 years old): A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
PurposeWe performed a systematic review and meta-analysis to compare the efficacy of volar locking plating (VLP) to conservative treatment in distal radius fractures in patients aged >60 years old.MethodsEnglish articles were searched in electronic databases including MEDLINE, CENTRAL, Embase, Web of science, and ClinicalTrial.gov from inception to October 2020. Relevant article reference lists also were reviewed. Two reviewers independently screened and extracted data from trials comparing VLP to nonsurgical treatment in distal radial fractures in the elderly. Starting with 3052 citations, 5 trials (539 patients) met the inclusion criteria. The primary outcomes were disabilities of the arm, shoulder, and hand, and patient-rated wrist evaluation scores, grip strength, and range of motion.ResultsAll trials of this random effect meta-analysis were at a moderate risk of bias due to the lack of blinding. Differences in the disabilities of the arm, shoulder, and hand score (mean difference [MD] −5,91; 95% confidence interval [CI], −8,83; −3,00), patient-rated wrist evaluation score (MD −9.07; 95% CI, −14.57, −3.57), and grip strength (MD 5,12; 95% CI, 0,59–9,65) were statistically significant and favored VLPs, however without reaching clinical significance. No effect was observed in terms of the range of motion and reoperation rates.ConclusionThis review was not able to demonstrate any clinical benefit to the surgical treatment of distal radius fractures with VLP in patients aged >60 years old compared to nonsurgical treatment.Type of study/level of evidenceTherapeutic I. We performed a systematic review and meta-analysis to compare the efficacy of volar locking plating (VLP) to conservative treatment in distal radius fractures in patients aged >60 years old. English articles were searched in electronic databases including MEDLINE, CENTRAL, Embase, Web of science, and ClinicalTrial.gov from inception to October 2020. Relevant article reference lists also were reviewed. Two reviewers independently screened and extracted data from trials comparing VLP to nonsurgical treatment in distal radial fractures in the elderly. Starting with 3052 citations, 5 trials (539 patients) met the inclusion criteria. The primary outcomes were disabilities of the arm, shoulder, and hand, and patient-rated wrist evaluation scores, grip strength, and range of motion. All trials of this random effect meta-analysis were at a moderate risk of bias due to the lack of blinding. Differences in the disabilities of the arm, shoulder, and hand score (mean difference [MD] −5,91; 95% confidence interval [CI], −8,83; −3,00), patient-rated wrist evaluation score (MD −9.07; 95% CI, −14.57, −3.57), and grip strength (MD 5,12; 95% CI, 0,59–9,65) were statistically significant and favored VLPs, however without reaching clinical significance. No effect was observed in terms of the range of motion and reoperation rates. This review was not able to demonstrate any clinical benefit to the surgical treatment of distal radius fractures with VLP in patients aged >60 years old compared to nonsurgical treatment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.043 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.065 | 0.011 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".