Matthieu Dagenais, Aleksandra Krajnovic, Sarah Galway, Kimberley Gammage
Instructors' Perceptions and Experiences of Teaching Online Exercise Classes to Older Adults: A Qualitative Study
Journal of aging and physical activity
wrist fractures involving distal radius common fractures children buckle fractures stable fractures unlike greenstick usually displaced fractures considerable variation practice extent immobilisation buckle fractures use surgery seriously displaced fractures assess effects benefits harms interventions common distal radius fractures children including skeletally immature adolescents searched cochrane bone joint muscle trauma groups specialised register cochrane central register controlled trials medline embase trial registries reference lists may 2018 included randomised controlled trials rcts quasircts comparing interventions treating distal radius fractures children sought data physical function treatment failure adverse events time return normal activities recovery time wrist pain child parent satisfaction least two review authors independently performed study screening selection risk bias assessment data extraction pooled data appropriate used grade assessing quality evidence outcome 30 included studies 21 rcts seven quasircts two describe randomisation method overall 2930 children recruited typically trials included male children reported mean ages 8 10 years eight studies recruited buckle fractures five recruited buckle stable fractures three recruited minimally displaced fractures 14 recruited displaced fractures typically requiring closed reduction typically requiring closed reduction studies high risk bias mainly reflecting lack blinding studies made 14 comparisons consider five prespecified comparisonsremovable splint versus belowelbow cast predominantly buckle fractures 6 studies 695 childrenone study 66 children reported similar modified activities scale kids performance scores 0 100 disability four weeks median scores splint 9904 cast 9911 lowquality evidence thirteen children needed change reapplication device splint 5225 cast 8219 4 studies lowquality evidence one study 87 children reported refractures six months one study 50 children found betweengroup difference pain treatment lowquality evidence evidence absent recovery time insufficient children minor complications contradictory child parent satisfaction two studies estimated lower healthcare costs removable splintssoft elasticated bandage versus belowelbow cast buckle similar fractures 4 studies 273 childrenone study 53 children reported children limited disability four weeks bandage group lowquality evidence eight children changed device extended immobilisation delayed union bandage 590 cast 391 3 studies lowquality evidence two studies 139 children reported serious adverse events four weeks evidence absent insufficient contradictory recovery time wrist pain children minor complications child parent satisfaction bandagegroup participants found treatment convenient 39 childrenremoval casts home parents versus hospital fracture clinic clinicians 2 studies 404 children mainly buckle fracturesone study 233 children found full restoration physical function four weeks lowquality evidence five treatment changes home 4197 hospital 1200 2 studies lowquality evidence one study found serious adverse effects six months 288 children recovery time number children minor complications reported evidence difference pain four weeks 233 children lowquality evidence one study 80 children found greater parental satisfaction home group lowquality evidence one uk study found lower healthcare costs home removalbelowelbow versus aboveelbow casts displaced unstable bothbone fractures 4 studies 399 childrenshortterm physical function data unavailable lowquality evidence indicated less dependency using belowelbow casts one study 66 children minimally displaced bothbone fractures found little difference abilhandkids scores 0 42 problems mean scores belowelbow 407 aboveelbow 418 lowquality evidence overall treatment failure data unavailable nine 11 remanipulations secondary reductions 366 children 4 studies aboveelbow group lowquality evidence refracture compartment syndrome six months 215 children 2 studies recovery time overall numbers children minor complications reported little difference requiring physiotherapy stiffness 179 children 2 studies lowquality evidence one study 85 children found less pain one week belowelbow casts lowquality evidence one study found treatment aboveelbow cast cost three times nepalsurgical fixation percutaneous wiring cast immobilisation versus cast immobilisation alone closed reduction displaced fractures 5 studies 323 childrenwhere reported aboveelbow casts used shortterm functional outcome data unavailable one study 123 children reported similar abilhandkids scores indicating normal physical function six months mean scores surgery 419 cast 414 lowquality evidence fewer treatment failures defined early problematic removal wires remanipulation early loss position surgery surgery 20124 cast 41129 4 studies lowquality evidence similarly fewer serious advents surgery surgery 28124 cast 43129 4 studies lowquality evidence recovery time wrist pain satisfaction reported lower referral physiotherapy stiffness surgery 1 study lowquality evidence one usa study found similar treatment costs groups available quality rctbased evidence interventions treating wrist fractures children low low however reassuring evidence full return previous function serious adverse events including refracture correctlydiagnosed buckle fractures whatever treatment used review findings consistent move away cast immobilisation injuries highquality evidence needed address key treatment uncertainties notably priority topics already tested ongoing multicentre trials force