Distal Radius Fracture Clinical Trial
Official title:
Defining Displacement Thresholds for Surgical Intervention for Distal Radius Fractures - a Delphi Study
Wrist (distal radius fractures) are very common injuries. Despite this there is still much
controversy about the best way to treat them and in particular which ones require
intervention. Many studies have been carried out but there is no strong evidence to answer
these questions. The investigators are carrying out a Delphi study which involves seeking
consensus from experts at treating these injuries about the best way to manage them. UK and
international expert surgeons will take part in three rounds of online questionnaires to help
decide how much displacement of the fracture will trigger treatment for different common
wrist fracture cases. The aim of the study is to obtain expert opinion through consensus from
the expert group about the amount of displacement that is acceptable until intervention is
required.
This will provide guidance and reduce variation between treating surgeons.
The investigators conducted a systematic review following SIGN guidelines with the British
Society for Surgery of the Hand(BSSH) blue book committee looking at the relationship between
measured radiological parameters and functional outcome. 42 studies were identified all of
which were of low quality. The conclusion was; 'Currently there is insufficient evidence to
demonstrate an association between any measured radiological parameters and patient rated
outcome. Further high quality research is required to answer this question.' The review
identified that the most commonly measured parameters were radial height, radial inclination,
volar tilt and intra articular step and gap.
The Delphi process involves seeking consensus from renowned experts to provide an answer to
specific research questions. Through this Delphi study the investigators intend to
investigate and achieve consensus regarding the threshold for intervention in displaced
distal radius fractures. The aim is to quantify how much displacement can be accepted before
intervention is required for different patient groups. This can then help guide surgeons with
their management decisions and help reduce variation.
A three round modified Delphi process will be used. Identified experts will be sent an
invitation email with an attached electronic form which they will be asked to fill in and
return to indicate if they wish to take part.
Invitation emails will be sent on the same day to all experts and they will be given 14 days
to return the acceptance form.
The first round will start 14 days after the invitation email is sent. The first round
electronic survey link will simultaneously be emailed to all participants who have agreed to
take part. After seven days, a second e-mail (reminder) will be sent to the participants who
do not respond to the first invitation. On the 15th day, responses for the first round will
be collected. The investigators will analyse the collected responses and the level of
agreement in the responses will be assessed.
The second round will be conducted 14 days after the first round is finalised and analysed.
Only the responders who take part in the first round will be invited. The participants will
be given the information about the results of the first round ,the methodology used and a
review of the literature. Reminder e-mails will be sent on the 7th day, concluding the second
round at 15th day. The second round results will be evaluated using the same method as that
for the first round. The format of the third round (if required due to persistent
disagreement) will be similar to that of the second round. Consensus is defined as 70%
agreement between participants
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