Early Mobilization After Volar Locking Plate Osteosynthesis of Distal Radial Fractures in Older Patients—A Randomized Controlled Trial

Sørensen, Thomas Juul; Ohrt-Nissen, Søren; Ardensø, Kecia; Laier, Gunnar Hellmund; Mallet, Susanne

doi:10.1016/j.jhsa.2020.05.009

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…The remaining 22 full-text articles were carefully evaluated, and 13 were excluded after the final screening due to variable reasons. Finally, 9 RCTs meeting the inclusion criteria were taken for comprehensive evaluation of this meta-analysis [ 10 , 12 – 15 , 17 , 18 , 26 , 27 ]. Quality assessment of the included studies is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Fig. 3 , DASH scores were available in 8 studies [ 10 , 12 – 15 , 17 , 18 , 26 ] for total of 546 patients. The DASH scores in EM were significantly better when compared with LM at 6 and 24 weeks postoperatively, with mean differences (MDs) of − 10.15 (95% CI − 15.74 to − 4.57, P < 0.01) and − 1.77 (95% CI − 3.09 to − 0.45, P < 0.01), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Fig. 6 , seven studies [ 10 , 12 – 14 , 17 , 26 , 27 ] with 518 patients described data on the grip strength (Kg). The summarized outcomes were evaluated as a slightly moderate or lower heterogeneity, with I 2 = 0%, 55%, 10%, 75%, and 0% at the 2nd, 6th, 12th, 24th, and 48th week postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…However, rehabilitation type and immobilization duration following the plate fixation of DRFs remain uncertain [ 8 ], whereas persistent plaster fixation has been repeatedly questioned as a conventional rehabilitation program [ 9 ]. For patients in the early mobilization (EM) group, the satisfaction level remains higher due to the self-opportunity of maintaining basic hygiene without any protective measures [ 10 ]. However, EM is controversial due to the local pain-associated complications, poor wound healing, implant loosening, loss of reduction, and internal fixation failure [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, it did not require multiple follow-ups and guidance from physiotherapists during rehabilitation [ 13 ]. Another study reported that the LM does not lead to decreased wrist motion compared to initial wrist motion [ 10 , 14 ]. Furthermore, Andrade et al, have reported the comparative more use of opioids in the early active groups [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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In adults, early mobilization may be beneficial for distal radius fractures treated with open reduction and internal fixation: a systematic review and meta-analysis

Deng

Tang

et al. 2021

J Orthop Surg Res

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Objectives It remains debatable if early mobilization (EM) yields a better clinical outcome than the late mobilization (LM) in adults with an acute and displaced distal radial fracture (DRF) of open reduction internal fixation (ORIF). Therefore, we aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs), comparing clinical results with the safety of EM with LM following ORIF. Methods Databases such as Medline, Cochrane Central Register, and Embase were searched from Jan 1, 2000, to July 31, 2021, and RCTs comparing EM with LM for DRF with ORIF were included in the analysis. The primary outcome of study included disabilities of the Arm, Shoulder, and Hand (DASH) score at different follow-up times. Wherever the secondary outcomes included patient-rated wrist evaluation (PRWE), grip strength (GS), visual analog scale (VAS), wrist range of motion (WROM), and associated complications, the two independent reviewers did data extraction for the analysis. Effect sizes of outcome for each group were pooled using random-effects models; thereafter, the results were represented in the forest plots. Results Nine RCTs with 293 EM and 303 LM participants were identified and included in the study. Our analysis showed that the DASH score of the EM group was significantly better than LM group at the six weeks postoperatively (− 10.15; 95% CI − 15.74 to − 4.57, P < 0.01). Besides, the EM group also had better outcomes in PRWE, GS and WROM at 6 weeks. However, EM showed potential higher rate for implant loosening and/or fracture re-displacement complication (3.00; 95% CI 1.02–8.83, P = 0.05). Conclusion Functionally, at earlier stages, EM for patients with DRF of ORIF may have a beneficial effect than LM. The mean differences in the DASH score at 6 weeks surpassed the minimal clinically important difference; however, the potentially higher risk of implant loosening and/or fracture re-displacement cannot be ignored. Due to the lack of definitive evidence, multicenter and large sample RCTs are required for determining the optimal rehabilitation protocol for DRF with ORIF. PROSPERO registration number: CRD42021240214 2021/2/28.

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