Study designs of evaluations included in the review
Studies of any design were eligible provided they included at least 10 patients and had a mean follow-up time of at least 12 months.
Specific interventions included in the review
Studies on the treatment of unstable DRFs, consisting exclusively of external fixation (with or without percutaneous pinning) or open reduction and internal fixation with plate osteosynthesis as primary or delayed primary (within 3 weeks) treatment, were eligible for inclusion. Studies that evaluated nonbridging or dynamic external fixators were excluded. In the included studies, most fractures treated by external fixation were fixed without pins. Fractures treated by internal fixation involved volar plating (49%), dorsal plating (46%) or both (4%).
Participants included in the review
Studies of adults with an unstable DRF (defined by seven criteria listed in the paper) were eligible for inclusion. Studies in which patients were undergoing correction of malunited DRFs were excluded. About 54% of the participants in the included studies were women, the mean age of the participants was about 52 years, and most patients had intra-articular fractures.
Outcomes assessed in the review
The included studies were required to report at least one from a list of primary outcomes relating to range of motion and grip strength, radiographic outcome and complications. Studies that only reported outcomes as descriptive categories, or used imprecise measures that could not be pooled, were excluded. The secondary outcomes of interest included pain rating scales, radiographic rating of post-traumatic arthritis and physician-rated outcome scores.
How were decisions on the relevance of primary studies made?
The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.