Early Mobilization Versus Splinting After Surgical Management of Distal Radius Fractures

Zeckey, Christian; Späth, Anton; Kieslich, Sebastian; Kammerlander, Christian; Böcker, Wolfgang; Weigert, Maximilian; Neuerburg, Carl

doi:10.3238/arztebl.2020.0445

Cited by 8 publications

(10 citation statements)

References 27 publications

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“…To obtain a comparable and conclusive outcome, researches on EM versus LM after ORIF for DRFs with more high-quality large RCTs were included. The results suggested that patients treated with EM may get better clinical outcomes at an early stages which was in-concurrence with the previous studies [ 13 , 17 , 18 , 26 , 27 ]. As there was no statistical difference observed for the long term between the two groups, the difference in the functional results during the early stages between the two groups might have caused by the residual rigidity of the cast in the LM group [ 17 ].…”

Section: Discussionsupporting

confidence: 91%

“…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. 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%

“…As shown in Fig. 13 , nine RCTs [ 10 , 12 – 15 , 17 , 18 , 26 , 27 ] with 596 patients recorded related complication rates. However, no heterogeneity ( I 2 = 0%, I 2 = 0%) from the implant loosening and/or fracture re-displacement complication and overall complications was detected.…”

Section: Resultsmentioning

confidence: 99%

“…However, the pooled analysis showed that the EM group had a potentially higher risk of implant loosening and/or fracture re-displacement complication ( P = 0.05), which occurred 5.5 times more (11:2) in EM than the LM group. Although the slight difference in implant loosening could be a complication resulting from immature surgical technology [ 10 ], which is still a new discovery compared to the previous literatures that compared EM with LM [ 13 , 17 , 27 ]. EM for patients with DRF after ORIF fracture positively affects functional recovery, but the risk of failure for fracture healing must also be considered [ 17 ], as it increases the risk of secondary surgery for these patients.…”

Section: Discussionmentioning

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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