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Title: A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)-a study protocol.
Authors: Richardson, Martin
Other Authors: Harris, Ian
Naylor, Justine
Lawson, Andrew
Buchbinder, Rachel
Ivers, Rebecca
Balogh, Zsolt
Smith, Paul
Mittal, Rajat
Xuan, Wei
Howard, Kirsten
Vafa, Arezoo
Yates, Piers
Rieger, Bertram
Smith, Geoff
Elkinson, Ilia
Kim, Woosung
Chehade, Mellick
Sungaran, Jai
Latendresse, Kim
Wong, James
Viswanathan, Sameer
Shrestha, Kush
Drobetz, Herwig
Tran, Phong
Loveridge, Jeremy
Page, Richard
Hau, Raphael
Bingham, Roger
Mulford, Jonathan
Incoll, Ian
Keywords: Older Population
Fracture Fixation
Patient Reported Outcome
Radius Fractures
Falls Risk
Treatment Management
Cast Immobilisation
Closed Reduction
Open Reduction
Plate Fixation
Surgical Treatments
Surgical Fixation
Conservative Treatments
Surgical Management
Practice Variation
Clinical Outcomes
Distal Radius Fractures
Standards of Care
Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jun-2017
Publisher: BMJ Publishing
Citation: BMJ Open. 2017 Jun 23;7(6):e016100
Abstract: Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. METHODS AND ANALYSIS: This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. ETHICS AND DISSEMINATION: CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. REGISTRATION: CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460).
DOI: 10.1136/bmjopen-2017-016100
PubMed URL:
ISSN: 2044-6055
Journal Title: BMJ Open
Type: Journal Article
Affiliated Organisations: Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
University of New South Wales, Sydney, Australia
Monash University, Melbourne, Australia
Cabrini Institute, Melbourne, Australia
The George Institute, Sydney, Australia
University of Sydney, Sydney, Australia
John Hunter Hospital, Newcastle, Australia
Canberra Hospital, Canberra, Australia
Fiona Stanley Hospital, Perth, Australia
St George and Sutherland Hospitals, Sydney, Australia
Wellington Hospital, Wellington, New Zealand
Royal Adelaide Hospital, Adelaide, Australia
Concord Hospital, Sydney, Australia
Nambour Hospital and Sunshine Coast University Hospital, Nambour, Australia
Westmead Hospital, Sydney, Australia
Campbelltown Hospital, Sydney, Australia
Darwin Hospital, Darwin, Australia
Mackay Base Hospital, Mackay, Australia
Western Health, Melbourne, Australia
Cairns Hospital, Cairns, Australia
University Hospital Geelong/Barwon Health, Geelong, Australia
Northern Health, Melbourne, Australia
St Vincent’s Hospital, Melbourne, Australia
Launceston Hospital, Launceston, Australia
Gosford and Wyong Hospitals, Gosford, Australia
Type of Clinical Study or Trial: Multicentre Studies
Appears in Collections:Musculoskeletal

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