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Table 6 Extract from the document summarising the responses from individuals

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

Q3.1 When should definitive treatment begin?
Issues
Immediate or as soon as possible commencement of definitive treatment, commonly addressed in terms of the need for fracture manipulation, was proposed by seven of the 13 commentators. A further three commentators gave time limits, either within first 24 or 48 hours; one of these implied that there should be no delay if neurovascular damage was present. Reasons put forward for treatment without delay were: consistency with physiology of bone healing, avoidance of complications, significant displacement, surgical delay for emergencies resulting in increased morbidity, patient comfort, and less costly. One respondent, who advocated immediate treatment, suggested less urgency for undisplaced fractures. One respondent proposed a more pragmatic approach ("at first reasonable opportunity given resource and personnel") and one pointed out that if the treatment is ineffective any delay was immaterial and queried "Is manipulation the right treatment?"
Research
Four respondents indicated that research on this was a top priority and three others indicated that it would be worthwhile. Two respondents indicated only that the question was important, and one other that research was worthwhile provided the treatment was of proven effectiveness. The choice of a specific research issue may have been influenced by the comparison tested in the one available RCT. Evaluation of effects (e.g. avoiding complications, patient comfort, costs) of immediate or early treatment (probably, reduction of displaced fractures) was proposed as a research priority by three respondents, and as worthwhile by two others. One respondent suggested that gaining ethical approval for a trial of delayed reduction, similar to the one reviewed, would be difficult.