Analysis of Publication Bias in the Literature for Distal Radius Fracture

Purpose Distal radius fractures are the most commonly treated fracture, and their management remains complex. We aimed to evaluate the presence of publication bias in the literature on distal radius fracture management and to identify specific study variables that may influence the reporting of positive outcomes. Methods We conducted a systematic review on all available journal articles to find primary articles reporting on the management of distal radius fractures. Data collected included the direction of study outcome (positive, neutral, and negative) and various study characteristics including sample size, geographic origin of the study, clinical setting, study design, type of treatment, analysis for statistical significance, evaluation of wrist function, presence of subjective outcome measures, mean follow-up time, adequacy of reduction, complications, mean patient age, and the presence of any extramural funding. Results We reviewed 215 journal articles and found that 70% of articles reported positive outcomes, 25% reported neutral outcomes, and 5% reported negative outcomes Funnel plot analysis suggested the presence of publication bias depicted by the asymmetric distribution of studies. In addition, we found statistically significant differences between study outcomes with respect to treatment type, presence of external funding, reduction adequacy, hand/wrist functional assessment, and patient questionnaires for subjective assessment. Conclusions Publication bias likely exists in the literature for distal radius fracture management. Several study characteristics influence the reporting of positive outcomes, but whether the presence of these characteristics portends a greater chance of publication remains unclear. A standardized approach to measure and track results may improve evidence-based outcomes. (Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)