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Cochrane Database of Systematic Reviews

Aspiration of the elbow joint for treating radial head fractures

Information

DOI:
https://doi.org/10.1002/14651858.CD009949.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 22 November 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Bone, Joint and Muscle Trauma Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Thanit Foocharoen

    Correspondence to: Division of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand

    [email protected]

  • Chingching Foocharoen

    Department of Medicine, Srinakarind Hospital, Khon Kaen, Thailand

  • Malinee Laopaiboon

    Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand

  • Thavatchai Tiamklang

    Division of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand

Contributions of authors

Thanit Foocharoen drafted the protocol and is the guarantor. Chingching Foocharoen, Thavatchai Tiamklang and Malinee Laopaiboon revised and approved the protocol.

Thanit Foocharoen and Chingching Foocharoen selected studies for the review, extracted data and assessed study risk of bias. Thavatchai Tiamklang resolved any disagreements. Thavatchai Tiamklang also entered data into Review Manager software; this was checked by the other three review authors. Thanit Foocharoen drafted the full review and assessed the quality of the evidence; this was checked by Malinee Laopaiboon.

Sources of support

Internal sources

  • Thai Cochrane Network, Khon Kaen University, Thailand.

External sources

  • No sources of support supplied

Declarations of interest

Thanit Foocharoen: none known
Chingching Foocharoen: none known
Malinee Laopaiboon: none known
Thavatchai Tiamklang: none known

Acknowledgements

We would like to thank Mario Lenza and Helen Handoll for valuable comments on the protocol and review and Paula Harding for her helpful feedback on the review. Thanks, too, to Joanne Elliott for her assistance with the development of the search strategies and Lindsey Elstub and Laura MacDonald for help during editorial processing. We would also like to acknowledge Diane Horsley for her support.

Version history

Published

Title

Stage

Authors

Version

2014 Nov 22

Aspiration of the elbow joint for treating radial head fractures

Review

Thanit Foocharoen, Chingching Foocharoen, Malinee Laopaiboon, Thavatchai Tiamklang

https://doi.org/10.1002/14651858.CD009949.pub2

2012 Jul 11

Aspiration for treating radial head fractures

Protocol

Thanit Foocharoen, Chingching Foocharoen, Malinee Laopaiboon, Thavatchai Tiamklang

https://doi.org/10.1002/14651858.CD009949

Differences between protocol and review

1. Type of outcome measures

  • We clarified that the 'Adverse events' in Secondary outcomes covered those more generally relating to the fracture or subsequent treatment.

  • Timing of outcome measurement: We reported pain outcomes at intermediate times of three and six weeks, as this allowed for an assessment of whether the initial pain relief from aspiration persisted in the short term.

2. Measure of treatment effect

  • We could not report mean differences with 95% confidence intervals due to lack of standard deviations.

3. Unit of analysis issues. As anticipated, the unit of analysis in both included trials was the individual participant.

4. Subgroup analysis. There were insufficient data to perform subgroup analysis.

5. The title has been changed to 'Aspiration of the elbow joint for treating radial head fractures'.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Comparison 1 Aspiration versus no aspiration, Outcome 1 Impaired function at 12 months.
Figures and Tables -
Analysis 1.1

Comparison 1 Aspiration versus no aspiration, Outcome 1 Impaired function at 12 months.

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Comparison 1 Aspiration versus no aspiration, Outcome 2 No or only mild elbow pain.
Figures and Tables -
Analysis 1.2

Comparison 1 Aspiration versus no aspiration, Outcome 2 No or only mild elbow pain.

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Comparison 1 Aspiration versus no aspiration, Outcome 3 'Full' range of motion.
Figures and Tables -
Analysis 1.3

Comparison 1 Aspiration versus no aspiration, Outcome 3 'Full' range of motion.

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Aspiration versus no aspiration for treating radial head fractures

Patient or population: patients being treated for radial head fractures; subsequent management was non‐surgical

Settings: emergency or outpatients (within a day or so post injury)

Intervention: aspiration (early intervention in first one to three days to remove bloody fluid (hematoma) from the elbow joint capsule)

Comparison: no aspiration

Outcomes

Illustrative comparative risks*1 (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Correspondingrisk

No aspiration

Aspiration

Impaired function

Unable to carry heavy weights or > 10° loss in extension (discomfort when carrying objects)

At 12 months

Study population

RR 1.43

(0.57 to 3.58)

108
(2 studies)

⊕⊝⊝⊝
very low2

Neither trial used validated clinical scores to report on patient function.

All participants were treated conservatively.

177 per 1000

254 per 1000
(101 to 634)

No or only mild elbow pain

Immediate (post aspiration or at an equivalent time)

Study population

RR 6.17

(1.97 to 19.36)

28
(1 study)

⊕⊝⊝⊝
very low2

Improvement post aspiration was also reported in the second trial, with 18/38 (47%) with 'excellent' pain relief; 17 (45%) with 'fair' pain relief; and 3 (8%) with no relief. There were no data for the control group in this trial.

134 per 1000

827 per 1000
(264 to 1000)

No or only mild elbow pain

At 3 weeks

Study population

RR 1.47
(1.02 to 2.12)

28
(1 study)

⊕⊝⊝⊝
very low2

667 per 1000

980 per 1000
(654 to 1000)

No or only mild elbow pain

At 6 weeks

Study population

RR 1.14
(0.90 to 1.44)

28
(1 study)

⊕⊝⊝⊝
very low2

867 per 1000

989 per 1000

(781 to 1000)

Adverse effects of procedure

or

Aspiration failure

See comment

See comment

Not estimable

108

(2 studies)

See comment

Neither study provided information on adverse outcomes (e.g. infection, nerve injuries) from the procedure.

One study reported aspiration failure in 3 (7.8%) of 38 participants allocated aspiration.

'Full' range of motion

At 6 weeks

Study population

RR 2.31

(0.9 to 5.92)

28
(1 study)

⊕⊝⊝⊝
very low2

Defined as participants with full extension.

267 per 1000

616 per 1000
(241 to 1000)

'Full' range of motion

At 12 months

Study population

RR 0.92
(0.78 to 1.08)

108

(2 studies)

⊕⊝⊝⊝
very low2

In one study, defined as participants with full extension; in the other study, defined as participants with extension loss less than 10°.

878 per 1000

808 per 1000
(685 to 948)

Adverse effects (of fracture and management)

At 12 months

See comment

See comment

Not estimable

80

(1 study)

See comment

One study (80 participants) reported that no participants had myositis ossificans, joint instability, or late displacement of the fracture.

The other study (28 participants) did not specifically report this outcome.

*The basis for the assumed risk is provided in footnote 1. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1. The assumed control risk is either that of the control group of the individual trials, where data from only one trial are available, or the pooled control group, where data from both trials are available.

2. The evidence was downgraded two levels due to major limitations in study design and implementation (both studies were at very high risk of bias) and one level for imprecision (reflecting wide confidence intervals).

Figures and Tables -
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Comparison 1. Aspiration versus no aspiration

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Impaired function at 12 months Show forest plot

2

108

Risk Ratio (M‐H, Fixed, 95% CI)

1.43 [0.57, 3.58]

1.1 Unable to carry heavy weights

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.06, 5.66]

1.2 > 10° loss in extension (discomfort when carrying objects)

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

1.77 [0.63, 4.94]

2 No or only mild elbow pain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Immediate (post aspiration)

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 At 3 weeks

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 At 6 weeks

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 'Full' range of motion Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 At 6 weeks

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

2.31 [0.90, 5.92]

3.2 At 6 months

1

28

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.75, 1.49]

3.3 At one year

2

108

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.78, 1.08]
Figures and Tables -
Comparison 1. Aspiration versus no aspiration
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