Intramedullary Nail Versus Plate Fixation Re-Evaluation Study in Proximal Tibial Fractures: A Multicenter Randomized Trial Comparing IM Nails and Plate Fixation (IMPRESS)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 108
- 试验地点
- 58
- 主要终点
- Participants' Quality of Life at 3 Months
研究概览
简要总结
This study looks at two types of surgical treatments and hopes to answer the question: which is the best way to surgically treat a proximal tibia fracture? Both procedures being studied are standard of care (used routinely) and use FDA approved devices. All medical and surgical treatment will be the same for participants as non-participants.
详细描述
The study is a multicenter randomized controlled trial in which individuals sustaining a fracture of the proximal metaphysis of the tibia will be operatively managed by one of two strategies. The first strategy involves fixation of the fracture with a reamed, interlocking intramedullary nail (Nail Group). The second treatment strategy involves open reduction and internal fixation of the fracture with a locking periarticular plate (Plate Group). The null hypothesis of the study is that there will be no difference in the two groups with respect to the primary and secondary outcome measures. To the degree possible, patients in the two groups will receive post-operative care according to the same standards and protocols.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Skeletally mature,
- •Extra-articular fracture of the proximal tibia extending into the metaphyseal with or without intra-articular extension not requiring open reduction with complete anteroposterior (AP) and lateral radiographs,
- •Major fracture line not closer than 4cm from the proximal tibial articular surface
- •Fracture requiring operative treatment amenable to either IM nail or plate
- •Surgeon agreed to randomize patient
- •Informed consent obtained
- •Patient is English speaking
排除标准
- •Tibial shaft fractures not amenable to intramedullary nailing (i.e.fracture is less than 4 cm from joint surface),
- •Fracture of the proximal tibia with intraarticular extension requiring open reduction,
- •Known metabolic bone disease
- •Separate displaced tibial tubercle fragment,
- •Soft tissue injuries compromising treatment method with nail,plate or both.
- •Fractures with vascular injury (Gustillo Type IIIC injury) requiring repair,
- •Compartment syndrome of the leg diagnosed preoperatively,
- •Pathological fractures,
- •Retained hardware or existing deformity in the affected limb that would complicate IM nailing,plating or both,
- •Symptomatic knee arthritis.
- •Surgical delay greater than 3 weeks for closed fractures or 24 hours for open fractures,
- •Immunocompromised,
- •Unable to comply with postoperative rehabilitation protocols or instructions (i.e. head injured or mentally impaired),
- •Current or impending incarceration,
- •Unlikely to follow-up in surgeon's estimation.
结局指标
主要结局
Participants' Quality of Life at 3 Months
时间窗: 3 months
The European Quality of Life Five Dimension (EQ-5D) Survey will be used to measure the participants' quality of life. The EQ-5D measures the subjects' overall state, including 5 domains: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1= no problems, 2= slight problems, 3=moderate problems, 4=severe problems and 5=extreme problems. The score is determined by a scale and grading systems that can range from 0.01 to 1.00. The lower the score the less quality of life problems.
Participants' Quality of Life at 6 Months
时间窗: 6 months
The European Quality of Life Five Dimension (EQ-5D) Survey will be used to measure the participants' quality of life. The EQ-5D measures the subjects' overall state, including 5 domains: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1= no problems, 2= slight problems, 3=moderate problems, 4=severe problems and 5=extreme problems. The score is determined by a scale and grading systems that can range from 0.01 to 1.00. The lower the score the less quality of life problems.
Participants' Quality of Life at 12 Months
时间窗: 12 months
The European Quality of Life Five Dimension (EQ-5D) Survey will be used to measure the participants' quality of life. The EQ-5D measures the subjects' overall state, including 5 domains: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: 1= no problems, 2= slight problems, 3=moderate problems, 4=severe problems and 5=extreme problems. The score is determined by a scale and grading systems that can range from 0.01 to 1.00. The higher the score the less quality of life problems.
Injury Related Limitations and Concerns at 6 Months
时间窗: 6 months
Participant limitations and bother from the injury will be assessed using the Short Musculoskeletal Function Assessment (SMFA).This survey asks the subject 46 questions, they are broken up into 2 parts. Part 1 relates to the difficulty/limitations the subject has related to their injury. Part 2 is how much the subject is bothered by this injury. Subjects provide score on a scale of 1 (no difficulty/bother) to 5 (highly difficult/bothered). The scoring range is between 0-100. The lower the score the less injury related limitations and bother.
Injury Related Limitations and Concerns at 3 Months
时间窗: 3 months
Participant limitations and bother from the injury will be assessed using the Short Musculoskeletal Function Assessment (SMFA).This survey asks the subject 46 questions, they are broken up into 2 parts. Part 1 relates to the difficulty/limitations the subject has related to their injury. Part 2 is how much the subject is bothered by this injury. Subjects provide score on a scale of 1 (no difficulty/bother) to 5 (highly difficult/bothered). The scoring range is between 0-100. The lower the score the less injury related limitations and bother.
Injury Related Limitations and Concerns at 12 Months
时间窗: 12 month follow-up
Participant limitations and bother from the injury will be assessed using the Short Musculoskeletal Function Assessment (SMFA).This survey asks the subject 46 questions, they are broken up into 2 parts. Part 1 relates to the difficulty/limitations the subject has related to their injury. Part 2 is how much the subject is bothered by this injury. Subjects provide score on a scale of 1 (no difficulty/bother) to 5 (highly difficult/bothered). The scoring range is between 0-100. The lower the score the less difficulty and bother.
次要结局
- Number of Participants With Malunion (>5 Degrees Varus/Valgus)(12 months)
- Number of Participants With Fracture Nonunions(12 months)
- Number of Participants With Deep Infections(6 months)
- Number of Participants With Superficial Infections(6 months)
- Number of Participants With Compartment Syndrome(6 months)