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Table 2 Treatment questions where there is some underlying evidence of effectiveness

From: From evidence to best practice in the management of fractures of the distal radius in adults: working towards a research agenda

Question Evidence from RCTs
Comparison(s) tested within
the RCTs*
Q8 When is surgery indicated for definitive treatment (at start)?  
a. Percutaneous pinning versus plaster cast alone a. 5 RCTs, 363 participants
  Across fracture pinning 'likely to be beneficial' but circumstances not established. (Unknown effectiveness: Kapandji pinning.)
b. External fixation versus plaster cast alone b. 13 RCTs, 859 participants; 133 redisplaced fractures
  External fixation is "likely to be beneficial" but indications (e.g. fracture type) for treatment, and the type, technique and timing of external fixation are not resolved.
Q9.3 What method(s) of anaesthesia is preferable?  
a. Intravenous regional anaesthesia (IVRA) versus haematoma block a. 5 RCTs, 478 participants
  IVRA is probably more "likely to be beneficial" than haematoma block.
Q17.2 What type of pins should be used?  
Biodegradable rods / pins versus K-wires (for Kapandji / trans-fracture fixation) 2 RCTs, 70 participants
  Biodegradable implants "unlikely to be beneficial".
Q18.1 What method(s) of external fixation is / are preferable?  
a. Non-bridging (of wrist joint) versus bridging external fixation a. 2 RCTs, 80 participants
  Non-bridging external fixation 'likely to be beneficial' when able to place distal pin securely. (Evidence for predominantly redisplaced fractures.)
Q19.1 What method(s) of internal fixation is / are preferable?  
Pi-plate versus 2 1/4 tube plates 1 RCT, 65 participants
  Pi-plate "unlikely to be beneficial" in present form for smaller radii due to operational difficulties in fitting the plate.
  1. * Note that for multi-comparison questions (Q8; Q9.3; Q19.1), only the comparisons yielding evidence are included here.