gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Active Wrist Mobilization after operatively treated distal radius fractures by volar locking plate – a prospective randomized trial

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  • presenting/speaker Stefan Quadlbauer - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Christoph Pezzei - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Josef Jurkowitsch - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Tina Keuchel - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Brigitta Kolmayr - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Eva Spielvogel - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Thomas Beer - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Thomas Hausner - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria
  • Martin Leixnering - AUVA Trauma Hospital Lorenz Böhler, Wien, Austria

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-982

doi: 10.3205/19ifssh0601, urn:nbn:de:0183-19ifssh06018

Published: February 6, 2020

© 2020 Quadlbauer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: Distal radius fractures (DRFs) are very common and surgical treatment by volar locking plates became standard therapy in the last decade. In addition, incidence of DRF will increase until 2030 because of an increased life expectancy. Due to this, surgical treatment and rehabilitation are of great interest.

Main aim of this study was to compare an early postoperative mobilization after DRF with a cast immobilization of 5 weeks. Null hypothesis was that an early mobilization results in an equal outcome in range of motion (ROM) and functional outcome scores than an immobilization of 5 weeks.

Methods: One hundred patients with an isolated distal radius fracture treated by open reduction and internal fixation withvolar locking plate were prospectively randomized in two groups.

One group ("Mobilization group"; Mo) received a removable thermoplastic splint for 1 week and was allowed to move the wrist from the first day after surgery. The other group ("immobilization group"; IM) received a nonremovable forearm cast for 5 weeks.

Both groups underwent physiotherapy 2 times a week. At 6 weeks, 9 weeks, 3 months, 6 months, and 1-year postsurgery, ROM, grip strength, and radiographs had been evaluated. Additionally, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-rated Wrist Evaluation (PRWE), modified Green O'Brien (Mayo) score, and pain according to the visual analog scale (VAS) score was analyzed.

Results: Patients in the EM group showed a significantly better QuickDASH score, ROM in extension/flexion and grip strength at the one year checkup. Radial/ulnar deviation and pain according to the VAS differed significantly up to 9 weeks while supination/pronation and PRWE score was significantly better at 6 months evaluation. Additionally, sick leave and physiotherapy were also significantly shorter in the EM group. There were no significant differences in respect of radiological loss of reduction and complications between the groups.

Conclusions: Early mobilization of the wrist after operatively treated DRFs using volar angular stable locking plates is safe, and results in a significantly better functional outcome up to one year, with shorter duration of sick leave and physiotherapy compared to an immobilization for 5 weeks.