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

Comparison(s) tested within

the RCTs*

Interpretation

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.