Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

And it was, it was so, yeah. So the aim of this study to, to see whether this type of costing affect the replacement rate as a primary outcome. And if it, if it affects the the end result as a secondary outcome, there was previous studies discussed the same topic with a bit of difference. Uh One of them was Caruso Ital, which dis we we discussed the ran uh randomized control study between above elbow costing and below elbow costing which did not not show any clinical significance difference between between the two. Other one was discussed uh vel in 2009 which discussed dorsal splinting versus circumferential costing. And in this, in this uh study, circumferential costing showed significant difference introduction. So this uh this paper has been registered in the Dutch trial registry in January 2020 protocol was published in the BMC musculoskeletal disorder in 2021 and published the results in the Bono join journal in April 2024 methods regarding the inclusion criteria above 18 years with a displaced disc radius structure that needs to be reduced, uh fracture of the guidelines of the reductions. Regarding the uh it was de decided according to the Dutch guideline which is more than 15 degrees of dorsal angulation, more than 20 degrees of molar angulation, less than 15 degrees of radial inclination and more than three millimeters of radial shortening, uh plus minus two millimeter of intra articular step of or gapping design. This was a multicenter cluster randomized design. All 10 participating hospitals were located in Netherlands Exclusion cri criteria. Any multitrauma patient concomitant fracture away from the under Tylo a concomitant ipsilateral arm injury and inability to complete the study either due to mental status or due to uh insufficient understanding of the Dutch language methods. So first of all, they all patients before reducing the fraction in and then few of them would be excluded according to the sequence afterwards. So if the reduction is not accepted after the first trial, then patients are excluded. If the, if the patient needed surgical intervention also this would be excluded randomization. Uh This was mainly done on the hospital level which means that whether it be a crossover point halfway from one technique to another needed um for f from each hospital after 31 inclusions from each hospital. And this is mainly to decrease the bias regarding the uh professionality of the technique of applying the circumferential costing or the other splint uh to overcome noneligibility in both groups because patients population can differ amongst hospital and in the same which will change how off. OK. Yeah, So type of cost main mainly here. First group was circumferen circumferential costing. And the second was some sort of envelope splinting. So which supports the uh for the radius from front and, and distal uh sorry from the from volar and, and dorsal. Mhm. Regarding the follow up plan patient followed up in at six points which which they they recognize as T zero to T six first one at week one. If the patient had a displaced fracture, then this uh then he may need further surgery at week two, then the patient will be dropped out after uh week one. If it's displaced, then week two, if the follow up showed again dis displacement, then the patient will be dropped. Then not third point at week five. But at that point, there is no point from intervention. So patients are included uh followup plans as well. They completed questionnaire at these three points. So 12 and six weeks and 36 and 12 month, uh complaining complaints related to the cost and the numeric rating scale for pain were recorded at one and two weeks. The quick disability of arm, shoulder and hand and the patient rated wrist hand evaluation were recorded from 6 to 12 month. Adverse events were recorded up to 12 month outcome. The pa the, the Studier de uh divided the outcome from uh to primary and secondary. Primary means that the redisplacement of the initial reduction. Secondary included few items including patient reported outcome from the dash and the pr we uh comfort of the cost uh quality of the life assessed, cost effectiveness and adverse events including the serious ones. Primary outcome regarding the redisplacement of the fracture assessed on poster and here and that radiograph at 12 and five weeks after reduction displacement as defined by the Dutch lines. Again, this is the re redisplacement and and intra and there was no clinical significance between the two types of costs. Regarding the primary uh outcome, which is the redisplacement. 88 structures with lost of splint was red displaced and 90 with circumfer costing which not significantly a statistically significant, sorry. Uh Regarding the secondary outcome uh during the first week, pain at rest was significantly more severe with the cluster splinting rather than the circumferential causing. During the second week. There was no significant difference in in all pain scores from second week and onwards. Also secondary outcome. They, so this is regarding the pain uh at week one and week two where week one showed difference. Uh sorry uh where week one showed difference but week two didn't and onwards didn't show any difference. There were no significant differences in the pros and quick dash and the PR W EHE scores between the groups at any of the time points patient treated in cluster Splint reported significant pain only during the first week of treatment analysis for secondary outcome between baseline and time points, which is T 0 to 26 would be assessed using linear mixed models for repeated measures. This accounts for comfort of the cost recovery of the function and grip strength pain severity. The number of the conversions to surgical fixation and complication will be determined using fissure exact or C square test depending on the magnitude of the results regarding the quality of life. This was with the EQ five D 5 L questionnaire and using analgesics. This clinical outcome included the range of motion of the wrist, grip, strength, sensory nerve testing, opposition of the thumb using cap score, stability of the radio. This the Raul joint and complex regional pain syndrome using poop criteria. Regarding the cost effective. This was measured using the medical consumption questionnaire and the production consumption questionnaire. This was sent to the patient at T three and T six study related serious adverse events, serious adverse events or was was this was this uh defined in this study as compartment syndrome which did not happen in any of the groups ozone different o other other complications like uh a carpal tunnel syndrome occurred in the splinting, sorry carpal tunnel sme release and that needed release uh occurred in four patients in the circumferential costing. So as a conclusion from this study said the the conclusion was there is only significant difference in the in the pain during the first week, but there was no significant difference in rates of complication uh com uh complaints relating to the cost. No significant difference in rate of the re displacement, no significant difference in pain after the first week. And in a lar large cohort study, nearly half of the fracture rate is placed during the second week or later. Therefore, there is no need for regular radiological review during immobilization is therefore, there is need for regular radiological review during immobilis immobilization. No clinically relevant differences were founded.