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Randomised controlled trials in hand surgery: a scoping review.

Juuso Heikkinen1, Soumen Das De2, Jarkko Jokihaara3

  • 1Orthopedic and Traumatology, Oulu University Hospital, Oulu, Finland juuso.heikkinen@fimnet.fi.

BMJ Open
|October 10, 2022
PubMed
Summary

Evidence for hand surgery efficacy is scarce, with few trials comparing surgery to placebo or non-operative care. More high-quality randomized controlled trials are needed to determine optimal hand condition treatments.

Keywords:
hand & wristplastic & reconstructive surgerysurgery

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Area of Science:

  • Orthopedic Surgery
  • Evidence-Based Medicine
  • Clinical Trials

Background:

  • Hand surgery is a common intervention for various hand conditions.
  • Assessing the true efficacy and effectiveness of surgical procedures is crucial for patient care.

Purpose of the Study:

  • To identify evidence gaps in the efficacy and effectiveness of hand surgery.
  • To evaluate the landscape of randomized controlled trials (RCTs) in hand surgery.

Main Methods:

  • A comprehensive scoping review was conducted.
  • Systematic searches of MEDLINE, Embase, and CENTRAL databases were performed.
  • RCTs in hand surgery from inception to November 7, 2020, were included.

Main Results:

  • Out of 220 identified RCTs, none were fundamental efficacy trials (surgery vs. placebo).
  • A majority of trials (78%) compared different surgical techniques.
  • Only 21% of trials compared surgery with non-operative care or injections.

Conclusions:

  • There is limited evidence supporting the use of hand surgery, particularly for chronic conditions.
  • Future research should prioritize placebo-controlled and pragmatic effectiveness trials comparing surgical and non-operative interventions for hand conditions.