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Lorenzo Massimo Oldrini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Pietro Feltri Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Jacopo Albanese Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Stefano Lucchina Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Surgical Department - Hand Surgery Unit EOC, Locarno's Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland

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Giuseppe Filardo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Christian Candrian Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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randomized controlled trials (RCTs) comparing VLP vs cast for the treatment of DRFs in adults, written in English language. Case reports or case series describing less than or equal to five cases and non-comparative articles were excluded. Pre-clinical and

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Thomas J. Holme Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK

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Marta Karbowiak Royal Surrey NHS Foundation Trust, Trauma & Orthopaedics, Guildford, UK

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Jennifer Clements Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK

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Ritesh Sharma Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK

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Johnathan Craik Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK

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Najab Ellahee Epsom & St Helier University Hospitals NHS Trust, Trauma & Orthopaedics, Carshalton, UK

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-reported, subjective scales (e.g. pain), radiographic analysis, failure rates; randomized controlled trials, cohort studies, case series (with greater than 10 patients); mean follow up of at least 12 months. The exclusion criteria were: case reports; case series with

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Zaki Arshad University of Cambridge School of Clinical Medicine, Cambridge, UK

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Edward Jun-Shing Lau University of Cambridge School of Clinical Medicine, Cambridge, UK

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Aiman Aslam University of Cambridge School of Clinical Medicine, Cambridge, UK

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Azeem Thahir Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge, UK

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Matija Krkovic Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge, UK

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score is out of a maximum of 10 points, except for randomized controlled trials which have a maximum score of 13 and are clearly labelled. Table 3. Numerical summary of the Cierny–Mader grade of patients in studies where this information was

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Xiangji Dang Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China
Department of Pharmaceutical, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Mei Liu The First Clinical Medical School, Gansu University of Chinese Medicine, Gansu, P.R. China

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Qiang Yang Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Jin Jiang Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Yan Liu Gansu High Throughput Screening and Creation Center for Health Products, School of Pharmacy, Lanzhou University, Lanzhou, P.R. China

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Hui Sun Cuiying Biomedical Research Center, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Jinhui Tian Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China

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standard treatment, while the control group may receive a placebo or standard care regimen; (iii) the design of included studies should be randomized controlled trials (RCTs), cohort studies (prospective or retrospective); (iv) patients were with

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Maria Tennyson Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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Matija Krkovic Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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Mary Fortune The Department of Public Health & Primary Care, Strangeways Research Laboratory, Cambridge, UK

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Ali Abdulkarim Department of Trauma & Orthopaedic Surgery, Cambridge University Hospital, Cambridge, UK

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review. Mean follow-up time was 21.1 months and mean age of included patients was 40.0 years. Description of studies and demographic characteristics of patients analysed are displayed in Table 1 . No randomized control trails (RCTs) were identified in

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Valentina Viglione Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Angelo Boffa Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Davide Previtali Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland

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Francesca Vannini Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Cesare Faldini Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Giuseppe Filardo Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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in randomized controlled trials (RCTs) in comparison to the inactive treatments implying that their effect, or at least a part of it, may be due to placebo ( 6 ). The impact of the placebo effect has been already investigated in several

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Hua Luo Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Xueli Yan Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Yu Ren Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Han Zhang Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Wenjun Pan Department of Orthopedic, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol for this meta-analysis was registered on PROSPERO (Registration No: CRD 42023459675). Inclusion criteria Study type: randomized controlled trial or cohort

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Amer Sebaaly Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Maroun Rizkallah Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Falah Bachour Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Firas Atallah Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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Pierre Emmanuel Moreau Department of Orthopedic Surgery, Centre Hospitalier Paris Saint Joseph, Paris, France

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Ghassan Maalouf Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

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trial . Lancet 2010 ; 376 : 1085 - 1092 . 19 Farrokhi MR , Alibai E , Maghami Z . Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in

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Rajpal Nandra Health Education West Midlands, Birmingham, UK

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Alan F. Brockie Academic Department of Military Nursing, Birmingham, UK

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Faisal Hussain Royal Orthopaedic Hospital, Birmingham, UK

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continues. 36 Clinical equipoise drives many randomized controlled trials, a scenario of uncertainty that surgeons often find difficult to manage. This may be due to personal beliefs, previous experience or opinions. 35 For similar reasons

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Matthieu Lalevee Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, Mont-Saint-Aignan, France

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Mo Saffarini ReSurg SA, Nyon, Switzerland

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Floris van Rooij ReSurg SA, Nyon, Switzerland

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Luca Nover ReSurg SA, Nyon, Switzerland

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Alexis Nogier Clinique Trénel, Sainte, Colombe, France

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Philippe Beaudet Clinique Trénel, Sainte, Colombe, France

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evidence; PS, prospective study; RS, retrospective study. Quality assessment Of the five eligible studies, one was a randomized controlled trial and four were case series. Statistical analyses were insufficient in two of the five studies, as

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