A Systematic Review and Analysis of the Quality of Randomized Controlled Trials Comparing Infrapatellar and Suprapatellar Approach for Nailing of Tibial Fractures
| Autor: | John J Pisquiy, Andrew G. Chan, DesRaj M Clark, Andres S. Piscoya, John C. Dunn |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Tibia business.industry Gold standard MEDLINE Consolidated Standards of Reporting Trials General Medicine Evidence-based medicine Bone Nails law.invention Fracture Fixation Intramedullary Intramedullary rod Tibial Fractures Cohen's kappa Randomized controlled trial Data extraction law Physical therapy medicine Humans Orthopedics and Sports Medicine Surgery business Randomized Controlled Trials as Topic |
| Zdroj: | Journal of orthopaedic trauma. 35(10) |
| ISSN: | 1531-2291 |
| Popis: | Objectives To evaluate the quality of evidence presented in prospective randomized controlled trials (RCTs) regarding suprapatellar versus infrapatellar approaches to tibia intramedullary nails (IMN) using grading systems other than Oxford Levels of Evidence (LOE). Data sources A systematic review was performed using the phrases "tibial nail OR tibia OR intramedullary" AND "suprapatellar OR infrapatellar" AND "approach OR insertion" to search the PubMed database between 1999-2018 filtering for English language and full articles. Study selection Included articles were prospective trials that compared infrapatellar and suprapatellar approaches to tibial IMN in adult patients. Data extraction Studies were evaluated and scored by two independent observers employing three different systems: Oxford LOE, Modified Coleman Methodology Score, and Revised Consolidated Standards of Reporting Trials (CONSORT). Data synthesis comparison for grading between observers was compared with a correlation coefficient and kappa statistic. Conclusions RCTs are historically regarded as the gold standard for establishing principles of evidence based medicine. However, our evaluation of the evidence shows that though they followed the Oxford LOE, RCTs were considered poor by the other two methods. The majority of studies that were included in our review were considered poor using the Modified Coleman and CONSORT systems. Half the papers supported suprapatellar tibial nailing over the infrapatellar approach, while other half demonstrated equivocal results between the two techniques. This study highlights the importance of evaluating studies judiciously regardless of their study design or level of evidence. Level of evidence Economic Level 1. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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