In this the sixth article of the SOCRATES series we present our synopses of reviews from the Cochrane Database of Systematic Reviews relating to orthopaedics and trauma that the working party felt were of particular relevance to emergency medicine practitioners. The methods of our review and the rationale for the forming the SOCRATES working party are as have previously been published.

CONSERVATIVE INTERVENTIONS FOR TREATING DISTAL RADIAL FRACTURES IN ADULTS

Background

Distal radial fractures are common in the emergency department population. The most suitable method of management is not clearly defined and will be influenced by many considerations. This review set out to determine the most appropriate treatment for fractures of the distal radius in skeletally mature people.

Results

Twenty nine studies of disappointing quality were identified involving 3199 patients. Treatment options reviewed included: above versus below elbow plaster, different durations of plaster immobilisation, supination versus pronation, brace versus plaster cast, bandage versus plaster or brace, different cast materials; and for displaced fractures: manipulation versus no manipulation and delayed versus immediate manipulation. There is insufficient evidence to deduce robust conclusions on any of these.

SOCRATES says

Practitioners should use a cost effective treatment, which they are familiar with at present.

PREOPERATIVE TRACTION FOR FRACTURES OF THE PROXIMAL FEMUR

Background

Skeletal or skin traction has been standard practice in some departments following an acute proximal femur fracture. It is thought to reduce pain and assist the reduction of the fracture. Disadvantages include difficulties in nursing the patient …