Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures

Abstract

Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol. Literature review A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial cast immobilization. Outcome measures collected included wrist range of motion; grip strength; pinch strength; visual analogue scale for pain with activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities of the arm, shoulder, and hand scores. Results Thirteen patients were enrolled and randomized between the BFR (n = 6) and control (n = 7) groups. The BFR group noted significantly greater reduction in pain with activity compared to the control group after 8 weeks of therapy (Δ −4.0 vs. −2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE scores compared to the control group after 8 weeks of BFR therapy (Δ −57.9 vs. 30.8, p = 0.01). The two groups did not demonstrate any significant difference in radiographic outcomes at any time point or throughout the course of the study. All patients tolerated the BFR therapy program and there were no complications. Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a larger reduction in pain with activity and greater improvement in overall self-perceived function.

Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study

“…Over the course of the program, patients in the BFR group (n ¼ 6) demonstrated a larger reduction in pain with activity and overall improvement in PRWE scores than those patients who underwent a standard rehabilitation protocol (n ¼ 7). 23 Furthermore, these patients had maintenance in the reduction of their fractures demonstrating BFR had no harmful effects during the course of treatment. 23 Similarly, patients with operatively treated DRFs within the BFR group exhibited greater reduction in pain with activity and overall improvement in PRWE scores despite beginning with radiographically worse fracture patterns than the standard rehabilitation group.…”

“…23 Furthermore, these patients had maintenance in the reduction of their fractures demonstrating BFR had no harmful effects during the course of treatment. 23 Similarly, patients with operatively treated DRFs within the BFR group exhibited greater reduction in pain with activity and overall improvement in PRWE scores despite beginning with radiographically worse fracture patterns than the standard rehabilitation group. This is the first prospective, randomized controlled trial evaluating the efficacy of BFR therapy in operatively treated upper extremity fractures.…”

“…Furthermore, unlike previous studies evaluating BFR training, no patients in this study displayed major complications. 17,20,22,23 Though not fully elucidated, BFR has been theorized to work by increasing cellular swelling and Type II muscle fiber recruitment, which may lead to intermittent recurrence of swelling through the course of therapy. 48,49 The patients in this study did not exhibit any recurrence of postoperative swelling following the use of BFR.…”

“…Patients randomized to the non-BFR group underwent a standardized rehabilitation protocol outlined in ►Table 1. 23 The patients in the BFR group underwent the same rehabilitation protocol with the addition of BFR utilizing a portable tourniquet system (Delfi Medical Innovations Inc., Vancouver, Canada, ►Fig. 1; ►Table 1).…”

“…[20][21][22] Previously used in nonoperatively treated DRFs, BFR therapy resulted in a reduction in pain with activity and greater improvement in overall self-perceived function based on patient rated wrist evaluation scores (PRWE) scores with no deleterious effect on fracture stability. 23 Therefore, the purpose of this study was to establish the safety and efficacy of BFR as part of a rehabilitation protocol in comparison to a standardized rehabilitation protocol following operatively treated DRFs.…”