Name (reference ID)

Brief outline

Comment

AO (Arbeitsgemeinschaft fur Osteosynthesefragen) (Muller 1991)

This system is organised in order of increasing fracture severity. It divides the fractures into three major groups: group A (extra‐articular), group B (simple/partial intra‐articular), and group C (complex/complete intra‐articular). These three groups are then subdivided, yielding 27 different fracture types.

There is no assessment of the extent of fracture displacement.

Frykman
(Frykman 1967)

This system distinguishes between extra‐articular fractures and intra‐articular fractures of the radiocarpal and radio‐ulnar joints, and the presence or absence of an associated distal ulnar (ulnar styloid) fracture. There are 8 types labelled I to VIII (1 to 8): the higher the number, the greater complexity of the fracture.

There is no assessment of the extent or direction of fracture displacement, or of comminution.

Melone
(Melone 1993)

This system identifies 5 fracture types, based on 4 major fracture components: the radial shaft, the radial styloid, and the dorsal‐medial and volar‐medial fragments.

This is for intra‐articular fractures only.

Older
(Older 1965)

This system divides fractures into 4 types, labelled I to VI (1 to 4) of increasing severity. The types are defined according to extent of displacement (angulation and radial shortening) and comminution.

There is no consideration of radio‐ulnar joint involvement.

'Universal Classification' (Cooney 1993)

This system divides fractures into 4 main types, labelled I to VI (1 to 4), distinguishing between extra‐articular and intra‐articular fractures and displaced and non‐displaced fractures. Displaced fracture types II and IV are further subdivided based on reducibility (whether the fracture can be reduced; that is whether the bone fragments can be put back in place) and stability (whether, once reduced, the fragments will remain so).

This does not distinguish between the radiocarpal and radio‐ulnar joints. Additionally, there is a 'trial by treatment'.

Parameter

Definition

Normal value

Dorsal angulation (dorsal or volar or palmar tilt)

Angle between a) the line which connects the most distal points of the dorsal and volar cortical rims of the radius and b) the line drawn perpendicular to the longitudinal axis of the radius. Side view of wrist.

Palmar or volar tilt: approximately 11‐12 degrees.

Radial length

Distance between a) a line drawn at the tip of the radial styloid process, perpendicular to the longitudinal axis of the radius and b) a second perpendicular line at the level of the distal articular surface of the ulnar head. Frontal view.

Approximately 11‐12 mm.

Radial angle or radial inclination

Angle between a) the line drawn from the tip of the radial styloid process to the ulnar corner of the articular surface of the distal end of the radius and b) the line drawn perpendicular to the longitudinal axis of the radius. Frontal view.

Approximately 22‐23 degrees.

Ulnar variance

Vertical distance between a) a line drawn parallel to the proximal surface of the lunate facet of the distal radius and b) a line parallel to the articular surface of the ulnar head.

Usually negative variance (e.g. ‐1 mm) or neutral variance.

CINAHL

EMBASE

1. Radius Fractures/
2. Wrist Injuries/
3. or/1‐2
4. (((distal adj3 (radius or radial)) or wrist or colles or smith$2) adj3 fracture$).ti,ab.
5. or/3‐4
6. exp Clinical Trials/
7. exp Evaluation Research/
8. exp Comparative Studies/
9. exp Crossover Design/
10. clinical trial.pt.
11. or/6‐10
12. ((clinical or controlled or comparative or placebo or prospective or randomi#ed) adj3 (trial or study)).tw.
13. (random$ adj7 (allocat$ or allot$ or assign$ or basis$ or divid$ or order$)).tw.
14. ((singl$ or doubl$ or trebl$ or tripl$) adj7 (blind$ or mask$)).tw.
15. (cross?over$ or (cross adj1 over$)).tw.
16. ((allocat$ or allot$ or assign$ or divid$) adj3 (condition$ or experiment$ or intervention$ or treatment$ or therap$ or control$ or group$)).tw.
17. or/12‐16
18. or/11,17
19. and/5,18

1. (((distal adj3 (radius or radial)) or wrist or colles$2 or smith$2) adj3 fracture$).tw.
2. Colles Fracture/ or Radius Fracture/ or Wrist Fracture/ or Wrist Injury/
3. or/1‐2
4. exp Randomized Controlled Trial/
5. exp Double Blind Procedure/
6. exp Single Blind Procedure/
7. exp Crossover Procedure/
8. or/4‐8
9. ((clinical or controlled or comparative or placebo or prospective$ or randomi#ed) adj3 (trial or study)).tw.
10. (random$ adj7 (allocat$ or allot$ or assign$ or basis$ or divid$ or order$)).tw.
11. ((singl$ or doubl$ or trebl$ or tripl$) adj7 (blind$ or mask$)).tw.
12. (cross?over$ or (cross adj1 over$)).tw.
13. ((allocat$ or allot$ or assign$ or divid$) adj3 (condition$ or experiment$ or intervention$ or treatment$ or therap$ or control$ or group$)).tw.
14. or/9‐13
15. or/8,14
16. Animal/ not Human/
17. 15 not 16
18. and/3,17

Items

Scores

Notes

(1) Was the assigned treatment adequately concealed prior to allocation?

Y = method did not allow disclosure of assignment.
? = small but possible chance of disclosure of assignment or unclear.
N = quasi‐randomised, or open list or tables.

Cochrane code (see Handbook): Clearly yes = A; Not sure = B; Clearly no = C.

(2) Were the outcomes of participants who withdrew described and included in the analysis (intention‐to‐treat)?

Y = withdrawals well described and accounted for in analysis.
? = withdrawals described and analysis not possible, or probably no withdrawals.
N = no mention, inadequate mention, or obvious differences and no adjustment.

(3) Were the outcome assessors blinded to treatment status?

Y = effective action taken to blind assessors.
? = small or moderate chance of unblinding of assessors, or some blinding of outcomes attempted.
N = not mentioned or not possible.

(4) Were important baseline characteristics reported and comparable?

Y = good comparability of groups, or confounding adjusted for in analysis.
? = confounding small, mentioned but not adjusted for, or comparability reported in text without confirmatory data.
N = large potential for confounding, or not discussed.

Although many characteristics including hand dominance are important, the principal confounders are considered to be age, gender, type of fracture.

(5) Were the trial participants blind to assignment status after allocation?

Y = effective action taken to blind participants.
? = small or moderate chance of unblinding of participants.
N = not possible, or not mentioned (unless double‐blind), or possible but not done.

(6) Were the treatment providers blind to assignment status?

Y = effective action taken to blind treatment providers.
? = small or moderate chance of unblinding of treatment providers.
N = not possible, or not mentioned (unless double‐blind), or possible but not done.

(7) Were care programmes, other than the trial options, identical?

Y = care programmes clearly identical.
? = clear but trivial differences, or some evidence of comparability.
N = not mentioned or clear and important differences in care programmes.

Examples of clinically important differences in other interventions are: time of intervention, duration of intervention, anaesthetic used within broad categories, operator experience, difference in rehabilitation.

(8) Were the inclusion and exclusion criteria for entry clearly defined?

Y = clearly defined (including type of fracture).
? = inadequately defined.
N = not defined.

(9) Were the outcome measures used clearly defined?

Y = clearly defined.
? = inadequately defined.
N = not defined.

(10) Were the accuracy and precision, with consideration of observer variation, of the outcome measures adequate; and were these clinically useful and did they include active follow up?

Y = optimal.
? = adequate.
N = not defined, not adequate.

(11) Was the timing (e.g. duration of surveillance) clinically appropriate?

Y = optimal. (> 1 year)
? = adequate. (6 months ‐ 1 year)
N = not defined, not adequate. (< 6 months)

Rank

Category

Definition

1

Beneficial

Interventions for which effectiveness has been demonstrated by clear evidence from randomised controlled trials, and for which expectation of harms is small compared with the benefits.

2

Likely to be beneficial

Interventions for which effectiveness is less well established than for those listed under "beneficial".

3

Trade off between benefits and harms

Interventions for which clinicians and patients should weigh up the beneficial and harmful effects according to individual circumstances and priorities.

4

Unknown effectiveness

Interventions for which there is currently insufficient data or data of inadequate quality.

5

Unlikely to be beneficial

Interventions for which lack of effectiveness is less well established than for those listed under "likely to be ineffective or harmful"

6

Likely to be ineffective or harmful

Interventions for which ineffectiveness or harmfulness has been demonstrated by clear evidence.