***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results PURPOSE To compare minimally invasive intramedullary nails ( IMN ) and volar locking plates ( VLP ) for the treatment of unstable distal radius fractures by evaluating postoperative subjective , radiographic , and functional outcomes . The hypothesis was that IMN patients would have less pain and required less pain medication in the early postoperative period and returned to work earlier than VLP patients . METHODS Sixty patients with closed , displaced , unstable , extra-articular , metaphyseal fractures of the distal radius were r and omized to receive a VLP or an IMN for internal fixation . Functional outcomes ( Quick Disabilities of the Arm , Shoulder , and H and , Michigan H and Question naire ) , radiographic measurements ( ulnar variance , radial height , inclination , and volar tilt ) , and range of motion were assessed until final follow-up at 2 years after surgery . Narcotic pain medication use was documented for 5 weeks following surgery . RESULTS There were 2 groups of 30 patients with IMN ( mean age , 55 ± 14 y ) or VLP ( mean age , 55 ± 16 y ) with similar demographics and comorbidities . Patients with IMN  regained extension earlier but had similar range of motion to patients with VLP at final follow-up . There was similar improvement in Michigan H and Question naire , Quick Disabilities of the Arm , Shoulder , and H and , and strength between groups . Five weeks after surgery , fewer IMN patients required narcotic pain medication ( 13 % ) than VLP patients ( 33 % ) . Radiographic outcomes were similar at final follow-up . There were 3 failures with IMN versus 1 failure with VLP . All 10 employed patients with IMN  returned to previous work compared with 10 of the 12 employed patients with VLP . Time to return to work was similar for both groups . CONCLUSIONS In a cohort of similar patients , IMN and VLP provided comparable improvement in functional and radiographic outcomes . Patients with IMN required less narcotic pain medication after surgery than VLP patients . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic II INTRODUCTION Fractures of the distal radius are very common and mainly occur in the elderly . There has been an increasing use of locked volar plate fixations which report satisfactory results . However , some authors advocate the use of nail fixation . HYPOTHESIS The aim of this study is to compare dorsal nail plate versus locked volar plate fixation in the treatment of distal radius fractures with dorsal tilt . MATERIAL S AND METHODS The mean age of the patients was over 50 years . The study included extra-articular distal radius fractures with posterior tilt . We conducted a prospect i ve r and omized study between December 2007 and February 2009 including a group of 16 patients treated with a dorsal nail fixation ( group 1 ) and a group of 15 patients managed with a locked volar plate fixation ( group II ) . We analyzed both the clinical results ( complications , Range of motion [ ROM ] , tightening strength , Disabilities of the Arm , Shoulder and H and [ DASH ] and Mayo Clinic scores ) and the radiographic results from A/P and lateral radiographs in the early postoperative period and at 6-month follow-up . RESULTS ROM toward extension was better in the volar plating subgroup ( group I , 42.5 ° , group II , 57.5 ° ; P<0.05 ) . Pronation mobility was better in the dorsal nail subgroup ( group I , 85 ° ; group II , 80 ° ; P<0.05 ) . The locked volar plate fixation subgroup demonstrated a better recovery of the tightening strength as compared with the uninjured side ( group I , 78 % , group II , 90 % , P=0.03 ) . The DASH score was similar in both groups ( group I , 22.09±22.9 ; group II , 20.62±20.3 , P>0.05 ) . The Mayo Clinic score was better in the locked volar plate fixation subgroup ( group I , 65±13.4 ; group II , 85.6±19.2 ; P=0.002 ) . Radiographic results were good in both groups , however anatomical reduction of the volar tilt was significantly better in group II ( plate ) when compared with the uninjured side . Moreover , we report on two cases of tendinous damages to the long extensor muscle of the thumb in the dorsal nail fixation subgroup despite the use of a minimally invasive implant . CONCLUSION The management of distal radius fractures with locked volar plate fixation in active elderly patients has proved successful and leads to better results than nail fixation regarding both reduction quality and objective functional scores . LEVEL OF EVIDENCE Level II , prospect i ve , r and omized of low-level Purpose This prospect i ve r and omized pilot study reports our institutional experience and early results using Sonoma Wrx ( Sonoma Orthopedic Products , Santa Rosa , CA ) in the treatment of extra-articular and simple intra-articular distal radius fractures . Material and methods A total of 64 patients , were enrolled in the study . They were considered eligible if they had ; unstable extra-articular distal radius fractures and simple intra-articular distal radius fractures suitable for closed reduction ( AO types ; A2.2 , A2.3 , A3.1 C2.1 , C2.2 ) . Patients in group I received intramedullary fixation using the Sonoma Wrx ® device and patients in group II received st and ard volar locking plate fixation . Radiographic criteria of acceptable healing were used for evaluation . Results Two groups were similar in terms of baseline characteristics . Mean time of operation was significantly shorter in Group 1 vs. in group 2 ( 36.81 ± 7.11 vs. 48.97 ± 5.9 minutes , p = 0.001 ) . Time to healing of the fracture was not different between two groups ( 5.45 ± 1.09 vs. 5.70 ± 1.04 weeks for Group 1 vs. 2 , respectively p = 0.36 ) . Overall complications occurred in 9 patients in group 1 and in 15 patients in group 2 ( p = 0.17 ) . Follow-up was completed in all patients with a median time of 12 months and 13 months in group 1 and 2 , respectively . On radiographic evaluation radial inclination , radial height and volar tilt were not significantly different between group 1 and 2 , respectively . There were no significant differences between two groups in regard to wrist rotational degrees measured in last follow-up visit . ConclusionS onoma Wrx Device is reliable and effective in terms of achieving satisfactory outcomes in treatment of distal radius fractures . It may be reasonable to use this device to prevent complications that are related to extensive soft tissue dissection The purpose of this prospect i ve , r and omized and blinded study was to compare the clinical outcomes of distal radial fractures treated with either an intramedullary nail or a volar locking plate .  Sixty two patients were enrolled in the study and r and omized to treatment with a MICRONAILTM ( Group 1 , 31 patients ) or an adaptive plate ( Group 2 , 31 patients ) . Fracture types included were unstable extra-articular metaphyseal distal radial fractures and simple or multifragmentary sagittal articular distal radial fractures ( AO classification types A2 , A3 , B1.1 and B1.2 ) . All patients were evaluated at 6 weeks , 3 months and 12 months after surgery . Outcome measures included st and ard radiographic parameters , active wrist range of motion , the disabilities of the arm , shoulder and h and ( DASH ) and Mayo wrist scores . We concluded that treatment of this subset of distal radius fractures with minimally invasive intramedullary nailing gives better clinical outcomes at 6 weeks after surgery than treatment with a volar locking plate . By 3 and 12 months following surgery , there are no significant differences in outcome between the two treatment methods . Disadvantages of the MICRONAIL ™ fixation system include risk of injury to the superficial branch of the radial nerve and a narrower spectrum of indications than volar locking plates PURPOSE Despite the high prevalence and impact of distal radius fractures ( DRFs ) on older patients , the currently available literature regarding DRFs in older adults lacks adequate comparative treatment data . The purpose of this prospect i ve , controlled outcomes study is to compare outcomes using the volar locking plating system ( VLPS ) for DRFs in both older and younger adults and to assert the eligibility of older patients for surgical management with the VLPS . METHODS Consecutive , eligible patients were enrolled into our prospect i ve study over a 2-year period on the basis of strict inclusion and exclusion criteria . Subjects were entered into 2 cohorts based on age : 20 - 40 years and > 60 years .  Patient outcomes and complication rates were evaluated at 3 , 6 , and 12 months after surgery . Outcome measures included the Michigan H and Outcomes Question naire ( MHQ ) , grip strength , active wrist and forearm range of motion , the Jebsen-Taylor test , and radiographic parameters . RESULTS Fifty-five patients ( 30 young and 25 older adults ) with unilateral , inadequately reduced DRFs were enrolled and received surgical treatment with the VLPS . We observed no statistically significant difference in any of the outcomes for all 3 follow-up periods , except the Jebsen-Taylor test , which displayed a trend toward a worse outcome in the older-age cohort . Whereas older patients continued to improve throughout their 12-month postoperative visits , younger patients achieved their maximum recovery during the 6-month follow-up period , suggesting different recovery patterns . At the 12-month assessment , older patients were able to achieve a higher mean MHQ score than their younger counterparts ( normalized mean : 85 % and 82 % , respectively ) . Complication rates were similar between the 2 groups for all 3 time periods , with most occurring on or before the 3-month postoperative visit . CONCLUSIONS This study indicates that the VLPS is successful in managing DRFs in older patients without increased complications compared to younger patients . For older patients without prohibitive surgical risks , internal fixation using the VLPS yields comparable outcomes to younger patients . However , these conclusions do not necessarily apply to other surgical techniques used to manage DRFs in older adults . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic II Background Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures , but has not been specifically evaluated in a r and omized study in the elderly . The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures . Method The inclusion criteria were women ≥ 50 or men ≥ 60 years , acute extraarticular or intraarticular fracture , and dorsal angulation of ≥20 ° or ulnar variance ≥ 5 mm . The patients completed the disabilities of the arm , shoulder and h and ( DASH ) question naire before and at 10 , 26 and 52 weeks after surgery . Pain ( visual analog scale ) , range of motion and grip strength were measured by a blinded assessor . Results 38 patients ( mean age 71 years , 31 women ) were r and omized at surgery ( 19 to each group ) . Mean operating time was shorter for wrist-bridging fixation by 10 ( 95 % CI 3–17 ) min . There was no significant difference in DASH scores between the groups . No statistically significant differences in pain score , range of motion , grip strength , or patient satisfaction were found . The non-bridging group had a significantly better radial length at 52 weeks ; mean difference in change in ulnar variance from baseline was 1.4 ( 95 % CI 0.1–2.7 ) mm ( p = 0.04 ) . Volar tilt and radial inclination were similar in both groups . Interpretation For moderately or severely displaced distal radius fractures in the elderly , non-bridging external fixation had no clinical ly relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length Objectives : To compare final functional and radiographic outcomes of closed reduction and casting ( CAST ) with open reduction and internal fixation ( ORIF ) with palmar locking plate for unstable Colles type distal radius fractures ( DRFs ) in low-dem and patients older than 70 years . Design : Retrospective , clinical study . Setting 
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Conclusions Compared to VLP , IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome , which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs .