Most patients with a nightstick fracture of the
ulna are treated conservatively. Various techniques of immobilisation or
early mobilisation have been studied. We performed a systematic
review of all published randomised controlled trials and observational
studies that have assessed the outcome of these fractures following
above- or below-elbow immobilisation, bracing and early mobilisation.
We searched multiple electronic databases, related bibliographies and
other studies. We included 27 studies comprising 1629 fractures
in the final analysis. The data relating to the time to radiological
union and the rates of delayed union and nonunion could be pooled
and analysed statistically. We found that early mobilisation produced the shortest radiological
time to union (mean 8.0 weeks) and the lowest mean rate of nonunion
(0.6%). Fractures treated with above- or below-elbow immobilisation
and braces had longer mean radiological times to union (9.2 weeks,
9.2 weeks and 8.7 weeks, respectively) and higher mean rates of
nonunion (3.8%, 2.1% and 0.8%, respectively). There was no statistically
significant difference in the rate of non- or delayed union between
those treated by early mobilisation and the three forms of immobilisation
(p = 0.142 to p = 1.000, respectively). All the studies had significant
biases, but until a robust randomised controlled trial is undertaken
the best advice for the treatment of undisplaced or partially displaced
nightstick fractures appears to be early mobilisation, with a removable
forearm support for comfort as required. Cite this article:
The poor reporting and use of statistical methods in orthopaedic papers has been widely discussed by both clinicians and statisticians. A detailed review of research published in general orthopaedic journals was undertaken to assess the quality of experimental design, statistical analysis and reporting. A representative sample of 100 papers was assessed for compliance to CONSORT and STROBE guidelines and the quality of the statistical reporting was assessed using a validated questionnaire. Overall compliance with CONSORT and STROBE guidelines in our study was 59% and 58% respectively, with very few papers fulfilling all criteria. In 37% of papers patient numbers were inadequately reported; 20% of papers introduced new statistical methods in the ‘results’ section not previously reported in the ‘methods’ section, and 23% of papers reported no measurement of error with the main outcome measure. Taken together, these issues indicate a general lack of statistical rigour and are consistent with similar reviews undertaken in a number of other scientific and clinical research disciplines. It is imperative that the orthopaedic research community strives to improve the quality of reporting; a failure to do so could seriously limit the development of future research.
Following the publication in 2007 of the guidelines from the National Institute for Health and Clinical Excellence (NICE) for prophylaxis against venous thromboembolism (VTE) for patients undergoing surgery, concerns were raised by British orthopaedic surgeons as to the appropriateness of the recommendations for their clinical practice. In order to address these concerns NICE and the British Orthopaedic Association agreed to engage a representative panel of orthopaedic surgeons in the process of developing expanded VTE guidelines applicable to all patients admitted to hospital. The functions of this panel were to review the evidence and to consider the applicability and implications in orthopaedic practice in order to advise the main Guideline Development Group in framing recommendations. The panel considered both direct and indirect evidence of the safety and efficacy, the cost-effectiveness of prophylaxis and its implication in clinical practice for orthopaedic patients. We describe the process of selection of the orthopaedic panel, the evidence considered and the contribution of the panel to the latest guidelines from NICE on the prophylaxis against VTE, published in January 2010.
We performed a comprehensive systematic review of the literature to examine the role of hemiarthroplasty in the early management of fractures of the proximal humerus. In all, 16 studies dealing with 810 hemiarthroplasties in 808 patients with a mean age of 67.7 years (22 to 91) and a mean follow-up of 3.7 years (0.66 to 14) met the inclusion criteria. Most of the fractures were four-part fractures or fracture-dislocations. Several types of prosthesis were used. Early passive movement on the day after surgery and active movement after union of the tuberosities at about six weeks was described in most cases. The mean active anterior elevation was to 105.7° (10° to 180°) and the mean abduction to 92.4° (15° to 170°). The incidence of superficial and deep infection was 1.55% and 0.64%, respectively. Complications related to the fixation and healing of the tuberosities were observed in 86 of 771 cases (11.15%). The estimated incidence of heterotopic ossification was 8.8% and that of proximal migration of the humeral head 6.8%. The mean Constant score was 56.63 (11 to 98). At the final follow-up, no pain or only mild pain was experienced by most patients, but marked limitation of function persisted.
