[Treatment of primary anterior shoulder dislocation; do not always treat conservatively]. / Behandeling van een eerste anterieure schouderluxatie. Niet altijd conservatief.

According to the current guidelines, primary anterior shoulder dislocations are treated conservatively after repositioning by short-term immobilisation of the shoulder. Shoulder stabilization surgery--either open or arthroscopically--reduces the risk of recurrence and improves the functional outcome over the long term. Active young adults are known to have up to a 90% increased risk of recurrent dislocation after the conservative treatment of a primary shoulder dislocation. Active young men particularly benefit from shoulder stabilization surgery. When comparing operative techniques, there is no difference between an open procedure and an arthroscopic procedure in terms of recurrence. The choice between open treatment and arthroscopic treatment depends on the preference of the patient and the experience of the surgeon.

Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a meta-analysis.

The aim of this study was to compare bridging external fixation with volar locked plating in patients with unstable distal radial fractures regarding functional outcome. A systematic search was performed in the Cochrane Central Register of Controlled Trials, Medline and EMBASE. All randomized controlled trials that compared bridging external fixation directly with volar locked plating in patients with distal radial fractures were considered. Three reviewers extracted data independently from eligible studies using a data collection form. Studies in which the primary endpoint was measured on the disabilities of the arm shoulder and hand (DASH) score at 3, 6 and 12 months were included in the analysis. To this end, mean scores and standard deviations were extracted. The software package Revman 5 provided by the Cochrane Collaboration was used for data analysis. Three studies involving 174 patients were analyzed. Ninety patients were treated with an (augmented) bridging external fixator and 84 with a volar locking plate. Data were analyzed with the random effects model. The robustness of the results was explored using a sensitivity analysis. Patients treated with a volar locking plate showed significantly lower DASH scores at all times. A difference of 16 (p = 0.006), six (p = 0.008) and eight points (p = 0.06) was found at 3, 6 and 12 months follow-up, respectively. Patients treated with a volar locking plate showed significantly better functional outcome throughout the entire follow-up. However, this difference was only clinically relevant during the early postoperative period (3 months).