Controlled active exercise after open reduction and internal fixation of hand fractures

Abstract

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes.Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed.Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up.Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

Rehabilitation following extra-articular proximal phalangeal fractures of the fingers in adults: a scoping review

“…In three studies a dorsal hand-based splint or cast was provided, 52,55,56 while in five studies a forearm-based splint was used. 41,42,53,54,56…”

“…The total follow-up of the included studies ranged between 6 weeks 54 and 15.4 months, 53 with a follow-up of 12 weeks in half of the studies. 41,42,55,56 However, the follow-up time in Ataker’s study varied considerably from 6 months to 48 months. All studies, except for the study by Loosli and Garrick (1987), included some form of quantitative ROM assessment.…”

“…Since this rarely resulted in a loss of fracture reduction ( N = 8/227 (3.5%)), 52,54,56 early motion seems to be a safe approach in this patient population. Initiation of exercise therapy was delayed by 5 days to 3 weeks in the studies where surgical treatment was performed, 41,42,53 but none of the surgical studies provided a clear reason for this delay. It can be questioned whether this is linked to the fact that conservative treatment can only be considered for less severe fractures that are inherently stable.…”

“…Most studies had an observation period ranging between 6 weeks and 12 weeks, 41,42,52,54–56 and although most of the recovery in ROM, pain, strength, hand use and work participation occurs by week 6, smaller gains are still reported by week 12 and week 26. 67 Future studies may wish to consider a longer follow-up period to fully estimate the long-term effects of rehabilitation, as is the case in the upcoming POINT trial with a 1 year follow-up.…”

“…If the available data were insufficient or missing, an attempt was made to contact the author(s) to request the provision of data. Three authors were contacted, [41][42][43] but to date no response has been received. The following categories of information for each study were extracted: study characteristics (year of publication, location, language, study design, population, sample size, eligibility criteria), patient characteristics (age, sex, fracture site, type of fracture, hand dominance), characteristics of the intervention (medical treatment, hand therapy, compliance), Step 5: Collecting, summarising, and reporting results…”