Conservative management of fractured condyles in children gives better clinical results than using same approach in adolescents.

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Last  Friday we looked at a review that looked at the evidence for the management of fractured condyles in adults.  The aim of this review was to give a comprehensive overview of the international literature, including case reports and clinical studies, focusing on management and outcome of CFs in children and adolescents.

What did they do

 A detailed search strategy was conducted using PubMed only with additional references being added from the references of those identified in the search.  Patients up the age of 20 were included. Those over the age of 12 years were considered to be adolescents.  A qualitative summary of the studies was presented.

What did the find

73 articles were included

  • 7 case reports and 2 retrospective clinical studies regarding surgical management,
  • 1 case reports, 1 prospective and 3 retrospective clinical studies comparing operative and conservative treatment,
  • 20 case reports, 35 retrospective and 4 prospective clinical studies dealing with conservative management.

They concluded

Despite frequently encountered radiologic abnormalities, conservative management of CFs in children usually yields satisfactory to excellent clinical results. However, in adolescents the outcome is often reported to be less favourable. Good prospective randomized multicentre studies would clarify from which age on patients could probably benefit from operative treatment.

 Management and outcome of condylar fractures in children and adolescents: A review of the literature Emanuel Bruckmoser, Gerhard Undt   2 April 2012 (Article in Press DOI: 10.1016/j.oooo.2011.08.003)

Comment

Both this review and the one on the management of condylar fractures in adults suffer from similar issues in that there are few randomised controlled trials in this area, a fact not to dissimilar to other areas of surgical practice. There are also issues with the way in which the studies are reported, lacking key elements of information needed to enable the reader or reviewers to make sense of the available information.  In addition this review only looked at a single database and the decision to extend the age of adolescence to 20 and the wide range of included paper types and no information on the quality assessment of the studies mean this is more traditional narrative reviews in style than systematic review.

A series of articles published in the Lancet in 2009 gives some direction to making surgical research more robust  and in addition the Equator Network is a great resource for  guidelines for reporting a wide range of different studies.

Surgical research: the reality and the IDEAL. Lancet. 2009 Sep 26;374(9695):1037. PubMed PMID: 19782850.

Barkun JS, Aronson JK, Feldman LS, Maddern GJ, Strasberg SM; Balliol Collaboration, Altman DG, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Flum DR, Glasziou P, Marshall JC, McCulloch P, Nicholl J,Reeves BC, Seiler CM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Grant A, Gray M, Greenhalgh R,Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K,Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, TrohlerU, Vandenbroucke J. Evaluation and stages of surgical innovations. Lancet. 2009 Sep 26;374(9695):1089-96. PubMed PMID: 19782874.

 Ergina PL, Cook JA, Blazeby JM, Boutron I, Clavien PA, Reeves BC, Seiler CM; Balliol Collaboration, Altman DG, Aronson JK, Barkun JS, Campbell WB, Cook JA,Feldman LS, Flum DR, Glasziou P, Maddern GJ, Marshall JC, McCulloch P, Nicholl J,Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M,Chalkidou K, Chalmers I, de Leval M, Deeks J, Grant A, Gray M, Greenhalgh R,Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K,Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J. Challenges in evaluating surgical innovation. Lancet. 2009 Sep 26;374(9695):1097-104. PubMed PMID: 19782875; PubMed Central PMCID: PMC2855679.

 McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J; Balliol Collaboration, Aronson JK, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Feldman LS, Flum DR, Maddern GJ, Nicholl J, Reeves BC, Seiler CM, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J,Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Ergina PL,Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Meakins J, Rothwell P, Summerskill B, Taggart D,Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009 Sep 26;374(9695):1105-12. PubMed PMID: 19782876.

 

 

 

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