Evaluation of patients with carpal tunnel syndrome treated by endoscopic technique

Objective:To evaluate the postoperative results of patients with carpal tunnel syndrome by the endoscopic release technique with single portal.Methods:78 patients (80 wrists) were evaluated preoperatively and postoperatively at 1, 3 and 6 months by the Boston questionnaire, the visual analogue scale (VAS) for pain, monofilament test sensitivity, grip strength, lateral pinch, pulp to pulp pinch and tripod pinch.Results:Statistical analysis was significant (p <0.05) in the progressive decline of pain and improved function (Boston) during follow-up. The sensitivity significantly improved comparing the data pre and postoperatively. The grip strength, lateral pinch, pulp to pulp pinch and tripod pinch decreased in the first month after surgery, returning to preoperative values around the third month postoperatively.Conclusion:The technique proved to be safe and effective in improving pain, function, and return sensitivity and strength. Level of Evidence II, Prospective studyUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial

Introdução: Embora a fratura do rádio distal seja uma das mais frequentes do membro superior, o melhor método de imobilização dessas fraturas ainda não foi definido. Objetivo: Avaliar a efetividade do tratamento conservador, com tala longa (TL), em comparação com a tala curta (TC), considerando-se a função do membro superior medido pelo DASH na 24ª semana após a redução da fratura do rádio distal. Método: Ensaio clínico randomizado. Foram avaliadas duas intervenções não cirúrgicas: TL e TC. Um total de 128 pacientes adultos com fraturas agudas, desviadas, classificadas em AO 23A2-3, C1-3 foram incluídos. O desfecho primário foi o questionário DASH na 24ª semana. Como desfechos secundários, analisaram se a manutenção da redução da fratura, a dor pela escala visual analógica, o PRWE, a avaliação funcional e a taxa de efeitos adversos. Resultados: Não houve diferença entre os grupos nas avaliações do questionário DASH na 24ª semana. O grupo tala curta apresentou uma uma diminuição significativa no escore DASH de duas semanas; p < 0,001. A avaliação funcional objetiva, as taxas de perda de redução, a função do punho medida pelo PRWE, a média de dor no punho, cotovelo e ombro foram clinicamente semelhantes entre os grupos. A tala acima do cotovelo resultou em mais efeitos adversos. Conclusão: Não houve diferença no tratamento com TL e TC, quanto à função medida pelo DASH do membro superior após 6 meses. No entanto, a TC foi menos debilitante durante o tratamento e igualmente eficaz em comparação à TL na manutenção da redução da fratura com menos efeitos adversos.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)2019/04546-

A systematic review of the quality of distal radius systematic reviews: Methodology and reporting assessment.

BackgroundMany systematic reviews (SRs) have been published about the various treatments for distal radius fractures (DRF). The heterogeneity of SRs results may come from the misuse of SR methods, and literature overviews have demonstrated that SRs should be considered with caution as they may not always be synonymous with high-quality standards. Our objective is to evaluate the quality of published SRs on the treatment of DRF through these tools.MethodsThe methods utilized in this review were previously published in the PROSPERO database. We considered SRs of surgical and nonsurgical interventions for acute DRF in adults. A comprehensive search strategy was performed in the MEDLINE database (inception to May 2017) and we manually searched the grey literature for non-indexed research. Data were independently extracted by two authors. We assessed SR internal validity and reporting using AMSTAR (Assessing the Methodological Quality of Systematic Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes). Scores were calculated as the sum of reported items. We also extracted article characteristics and provided Spearman's correlation measurements.ResultsForty-one articles fulfilled the eligibility criteria. The mean score for PRISMA was 15.90 (CI 95%, 13.9-17.89) and AMSTAR was 6.48 (CI 95% 5.72-7.23). SRs that considered only RCTs had better AMSTAR [7.56 (2.1) vs. 5.62 (2.3); p = 0.014] and PRISMA scores [18.61 (5.22) vs. 13.93 (6.47), p = 0.027]. The presence of meta-analysis on the SRs altered PRISMA scores [19.17 (4.75) vs. 10.21 (4.51), p = 0.001] and AMSTAR scores [7.68 (1.9) vs. 4.39 (1.66), p = 0.001]. Journal impact factor or declaration of conflict of interest did not change PRISMA and AMSTAR scores. We found substantial inter observer agreement for PRISMA (0.82, 95% CI 0.62-0.94; p = 0.01) and AMSTAR (0.65, 95% CI 0.43-0.81; p = 0.01), and moderate correlation between PRISMA and AMSTAR scores (0.83, 95% CI 0.62-0.92; p = 0.01).ConclusionsDRF RCT-only SRs have better PRISMA and AMSTAR scores. These tools have substantial inter-observer agreement and moderate inter-tool correlation. We exposed the current research panorama and pointed out some factors that can contribute to improvements on the topic

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial and study protocol

Abstract Background A variety of cast options are available for the non-surgical treatment of distal radius fractures (DRF) in adults. However, the literature is inconclusive regarding the need to immobilize the elbow joint after reduction in order to prevent rotation of the forearm in order to maintain the reduction of DRF. This study aimed to evaluate the best method of immobilization between above-elbow (AE) and below-elbow (BE) cast groups at the end of six-month follow-up. Methods This is a randomized clinical trial with parallel groups and a blinded evaluator. There are two non-surgical interventions: AE and BE. Patients will be randomly assigned. A hundred twenty eight consecutive adult patients with acute (up to 7 days) displaced DRF of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification will be included. The primary outcome will be the maintenance of reduction by evaluation of radiographic parameters and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). Secondary outcomes include function measured by Patient Rated Wrist Evaluation (PRWE), pain measured by the Visual Analogue Scale (VAS), objective functional evaluation (goniometry and dynamometry) and rate of complications. Evaluations will be performed at 1, 2, 3, 4, 6, 8, 12 and 24 weeks. For the Student’s t-test, a difference of 10 points in DASH score, with 95% confidence interval, a statistical power of 95%, and 20% sampling error. We consider an extra 10% for balancing follow up losses results in 64 patients per group. Discussion Results from this study protocol will help to define the need for elbow immobilization in maintenance of reduction, as well as functional performance of below elbow cast versus above elbow cast immobilization during the immobilization period. Trial registration NCT03126175 (http://clinicaltrials.gov). April 24, 2017

Prospective non-randomized studies in Orthopaedics and Traumatology: systematic assessment of its methodological quality Estudos prospectivos e não randomizados na ortopedia e traumatologia: avaliação sistemática da qualidade metodológica

In surgical interventions, randomization and blinding may be difficult to implement. In this situation, non-randomized prospective studies (EPNR) can generate the best evidence. The objective of this study is to evaluate, by means of the scale proposed by Downs &amp; Black, the quality of EPNR published in our country and to assess the interobserver reproducibility of this scale. EPNR published in Acta Ortopedica Brasileira and Revista Brasileira de Ortopedia until 2011 and prior to 2006 were included. Two of us independently applied the Downs &amp; Black scale. The studies were stratified by period of publication, journal and type of intervention. The scores obtained were considered to assess the reliability of the scale and groups comparison. 59 studies were considered, seven excluded during the assessments. There were no differences between the scores, except for the type of intervention, which showed better methodological quality for studies involving clinical interventions (p Nas interven&#231;&#245;es cir&#250;rgicas, a randomiza&#231;&#227;o e o mascaramento podem ser de dif&#237;cil aplicabilidade. Nessa situa&#231;&#227;o, os estudos prospectivos e n&#227;o randomizados (EPNR) podem gerar a melhor evid&#234;ncia dispon&#237;vel. O objetivo deste estudo &#233; avaliar, por meio da escala proposta por Downs &amp; Black, a qualidade dos EPNR publicados em nosso meio e avaliar a reprodutibilidade interobservadores dessa escala. EPNR publicados na Acta Ortop&#233;dica Brasileira e Revista Brasileira de Ortopedia at&#233; 2011 e anteriores a 2006 foram inclu&#237;dos e aplicou-se a escala de Downs &amp; Black - de forma independente por dois pesquisadores. Os estudos foram estratificados pelo per&#237;odo de publica&#231;&#227;o, peri&#243;dico e tipo de interven&#231;&#227;o. Os escores obtidos de Downs &amp; Black foram considerados para a avalia&#231;&#227;o da reprodutibilidade da escala. Foram considerados 59 estudos, sendo sete exclu&#237;dos durante as avalia&#231;&#245;es. N&#227;o houve diferen&#231;as entre os escores, exceto para o tipo de interven&#231;&#227;o, que demonstrou melhor qualidade metodol&#243;gica para os estudos que envolvem interven&#231;&#245;es cl&#237;nicas (p < 0,001). O &#237;ndice de correla&#231;&#227;o intraclasse para o escores de Downs &amp; Black foi de 0,79 (IC95% 0,65-0,88), demonstrando boa reprodutibilidade. EPNR apresentam qualidade metodol&#243;gica semelhante quando estratificados pelo peri&#243;dico de publica&#231;&#227;o e per&#237;odo de publica&#231;&#227;o. Estudos com interven&#231;&#245;es cl&#237;nicas apresentam melhor qualidade metodol&#243;gica. A escala de Downs &amp; Black apresenta boa reprodutibilidade interobservadores

Estudos prospectivos e nao randomizados na ortopedia e traumatologia: avaliacao sistematica da qualidade metodologica

In surgical interventions, randomization and blinding may be difficult to implement. In this situation, non-randomized prospective studies (EPNR) can generate the best evidence. The objective of this study is to evaluate, by means of the scale proposed by Downs & Black, the quality of EPNR published in our country and to assess the interobserver reproducibility of this scale. EPNR published in Acta Ortopedica Brasileira and Revista Brasileira de Ortopedia until 2011 and prior to 2006 were included. Two of us independently applied the Downs & Black scale. The studies were stratified by period of publication, journal and type of intervention. The scores obtained were considered to assess the reliability of the scale and groups comparison. 59 studies were considered, seven excluded during the assessments. There were no differences between the scores, except for the type of intervention, which showed better methodological quality for studies involving clinical interventions (p < 0.001). The correlation coefficient for the Downs & Black score was 0.79 (95% CI 0.65 to 0.88), demonstrating good reliability. EPNR present methodological quality similar when stratified by the periodic publication and publication period. Studies with clinical interventions have better methodological quality. The Downs & Black scale shows good interobserver reproducibility.Nas intervenções cirúrgicas, a randomização e o mascaramento podem ser de difícil aplicabilidade. Nessa situação, os estudos prospectivos e não randomizados (EPNR) podem gerar a melhor evidência disponível. O objetivo deste estudo é avaliar, por meio da escala proposta por Downs & Black, a qualidade dos EPNR publicados em nosso meio e avaliar a reprodutibilidade interobservadores dessa escala. EPNR publicados na Acta Ortopédica Brasileira e Revista Brasileira de Ortopedia até 2011 e anteriores a 2006 foram incluídos e aplicou-se a escala de Downs & Black - de forma independente por dois pesquisadores. Os estudos foram estratificados pelo período de publicação, periódico e tipo de intervenção. Os escores obtidos de Downs & Black foram considerados para a avaliação da reprodutibilidade da escala. Foram considerados 59 estudos, sendo sete excluídos durante as avaliações. Não houve diferenças entre os escores, exceto para o tipo de intervenção, que demonstrou melhor qualidade metodológica para os estudos que envolvem intervenções clínicas (p < 0,001). O índice de correlação intraclasse para o escores de Downs & Black foi de 0,79 (IC95% 0,65-0,88), demonstrando boa reprodutibilidade. EPNR apresentam qualidade metodológica semelhante quando estratificados pelo periódico de publicação e período de publicação. Estudos com intervenções clínicas apresentam melhor qualidade metodológica. A escala de Downs & Black apresenta boa reprodutibilidade interobservadores.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Ortopedia e TraumatologiaUNIFESP, EPM, Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologyUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaSciEL