Immobilisation en rotation latérale versus médiale après luxation scapulo-humérale : méta-analyse des essais randomisés - 19/06/20
Immobilization in external rotation versus internal rotation after shoulder dislocation: A meta-analysis of randomized controlled trials
Abstract |
Introduction |
Recurrence rates after primary traumatic shoulder dislocation are distinctly high. Whether the early external immobilization(ER) is better than the internal immobilization (IR) is still controversial.
Hypothesis |
To perform a systematic review of randomized clinical trials (RCTs) that assessed the ability of external immobilization to reduce the recurrence in patients with primary anterior shoulder instability.
Material and method |
As with the original review, we used the search strategies recommended by the Cochrane Back Review Group for the identification of RCTs. 13 RCTs were included in the systematic review, and 11 studies were included in the quantitative synthesis.
Result |
A total of 1042 participants with primary shoulder dislocation were involved. The meta-analysis of 11 trials revealed that ER therapy leading to less recurrence rates than participants treated with IR therapy (RR=0.55; 95 %CI: 0.36 to 0.82; Z=2.88; p=0.004), and less complications (RR=0.6; 95 %CI: 0.39 to 0.92; Z=2.33; p=0.02) from the 5 independent trials. The meta-analysis of three trials revealed that there are not statistically significant in compliance rate (RR=1.08; 95 %CI: 0.89 to 1.29; Z=0.78; p=0.44). The GRADE level of evidence is high for adverse events, but moderate for recurrence rate and Compliance rate. The Begg test showed that no significant publication bias was detected (p=0.062).
Discussion |
This meta-analysis suggests that external immobilization is recommended to reduce the recurrence rate and prevent complications.
Level of proof |
II, low-powered systematic review and meta-analysis (systematic review, meta-analysis).
Le texte complet de cet article est disponible en PDF.Keywords : Shoulder dislocation, Immobilization, Meta-analysis
☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 106 - N° 4
P. 387 - juin 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?