التفاصيل البيبلوغرافية
| العنوان: |
In Acute Closed Tibial Shaft Fractures, Surgery with the Taylor Spatial Frame Versus Reamed Intramedullary Nailing Did Not Differ for Quality of Life or Pain at 2 Years. |
| المؤلفون: |
Frihagen, F., Madsen, J. E., Sundfeldt, M., Flugsrud, G. B., Andreassen, J. S., Andersen, M. R., Andreassen, G. S., Russell, George V. |
| المصدر: |
Journal of Bone & Joint Surgery, American Volume; 8/18/2021, Vol. 103 Issue 16, p1554-1554, 1p |
| مصطلحات موضوعية: |
TIBIAL fractures, ANKLE, INTRAMEDULLARY fracture fixation, BONE shafts, HYDROXYAPATITE coating, ADULTS, QUALITY of life, COMPARTMENT syndrome, ORTHOPEDIC implants, PAIN, HEALTH surveys, RANDOMIZED controlled trials, FRACTURE fixation |
| مصطلحات جغرافية: |
GOTEBORG (Sweden), OSLO (Norway) |
| مستخلص: |
Question: In adults with unstable closed tibial shaft fractures, does the Taylor Spatial Frame (TSF; Smith & Nephew) ring fixator versus reamed intramedullary nailing (IMN) improve quality of life at 2 years? Design: Randomized (allocation concealed*), blinded (data analysts), controlled trial with 2 years of follow-up and intention-to-treat analysis. ClinicalTrials. gov NCT03388879. Setting: 1 university hospital in Oslo, Norway, and 1 in Gothenburg, Sweden. Patients: 65 patients 18 to 70 yearsof age (mean age, 43 years; 67% men) who had an acute closed tibial shaft fracture (OTA/AO classification 42A-B) in the past 3 weeks and could previously walk unaided. Exclusion criteria included pathologic fracture, compartment syndrome before randomization, current use of bone anabolic drugs, or injury or disease that could affect outcomes. 95% of patients completed follow-up. Intervention: Patients were allocated to surgery with a TSF ring fixator, mounted using 2 rings with fine wires and stainless steel 6-mm half-pins without hydroxyapatite coating, and 4 attachments to each ring (n = 32); or IMN, using a lateral parapatellar approach with nails reamed progressively up to 1.0 to 1.5 mm above the nail diameter and X2 static locking screws inserted proximally and distally (n = 33). Main outcome measures: The primary outcome was the 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS), version 2, at 2 years. Secondary outcomes included SF-36 PCS at 6 months and 1 year, other SF-36 subscores, pain based on a visual analog scale (VAS: score range 0 [no pain] to 10 [worst pain]), and complications. 25 to 30 patients per group were needed to detect a 6-point difference between groups in the primary outcome (80% power [2-sided a = 0.05*, assumed standard deviation = 8]*). Main results: The TSF andIMNgroups did not differ for any SF-36 scores orVASpainscores at 2 years (Table I). The TSF group had worse SF-36 physical function scores at 6 months (mean, 68 versus 77, p = 0.02) but not at 1 year; groups did not differ for other SF-36 subscores at any time. The TSF group had lower mean knee pain VAS scores at 6 weeks (0.3 versus 2.6), 3 months (0.7 versus 2.3), 6 months (0.9 versus 2.1), and 1 year (0.5 versus 2.4), all p £ 0.005; groups did not differ for fracture site or ankle VAS pain scores at any time. More patients in the TSF versus IMN group had superficial skin infections (71% versus 13%, p, 0.001), and 2 versus 1 patient(s) had surgery for acute compartment syndrome. No patients had deep infections. Conclusion: In adults having surgery for acute closed tibial shaft fractures, surgerywith the TSF did not differ from surgery with reamed IMN for quality of life or pain at 2 years. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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