RESUMO
In hand surgery trials, it is often possible to take several measurements from the same patient, because many disorders here affect bilateral or multiple structures, such as the hand itself, the finger joints or the tendons. Most conventional statistical analyses that take place on the level of hands, digit rays or joints rather than patients violate the assumption that observations should be independent. Furthermore, ignoring the multiplicity of data inflates sample size and thus may lead to spurious significance. This article describes three options to deal with such problems. First, the analysis can simply be restricted to only one measurement per patient. Second, a self-controlled design may be advantageous for conditions that usually have a bilateral pattern. Third, complex statistical modelling (involving generalized estimating equations) can be used to analyse all available measurements with adjustment for data dependency.
Assuntos
Dedos/cirurgia , Mãos/cirurgia , Ensaios Clínicos Controlados como Assunto , Estudos Cross-Over , Dedos/anatomia & histologia , Mãos/anatomia & histologia , Humanos , Prótese Articular , Articulação Metacarpofalângica/cirurgia , Modelos Estatísticos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de PesquisaRESUMO
Between 1994 and 1998, we have treated eleven patients with intraarticular fractures of the base of the middle phalanx including impaction, dislocation, and pilon types of injuries. All patients were evaluated after a median follow-up period of 25.8 (8 to 57) months. Treatment was carried out according to Suzuki's technique with a dynamic PIP-joint distraction fixator consisting of Kirschner wires and rubber bands. In five cases, there was additional osteosynthesis (Kirschner wires, resorbable hemicerclage) or cancellous bone-grafting for reconstruction of the joint surface. Early mobilisation commenced with active exercises for the PIP joint on the day of surgery. The dynamic extension fixator was applied for an average duration of 28 (15 to 42) days. By the time of follow-up examinations, we found a range of motion on an average of 64 (0 to 105) degrees including a lack of extension of 11 (0 to 60) degrees and a median flexion capacity of 75 (30 to105) degrees. All fractures healed uneventfully with restored joint stability. Eight patients were completely painfree, three complained of mild occupational pain.
