Immediate mobilization of distal radius fractures stabilized by volar locking plate results in a better short-term outcome than a five week immobilization: A prospective randomized trial

Abstract

Objective: To evaluate the impact of immediate (first day after surgery) mobilization compared to standard five weeks cast immobilization on the functional outcome after volar locking plate fixation of distal radius fractures. Design: Prospective randomized parallel group comparative trial. Setting: Trauma Hospital, Austria. Participants: Patients with isolated unstable distal radius fractures, stabilized with volar angular stable locking plate. Interventions: The immediate mobilization group received a removable forearm splint for one week and active supervised group physiotherapy and home exercises for the shoulder, elbow, wrist, and fingers from the first postoperative day. The cast immobilization group received a non-removable cast for five weeks. In the first five weeks supervised group physiotherapy and home exercises were performed for shoulder, elbow, and fingers. Thereafter additional supervised and home exercises for the wrist were started. Main measures: At regular intervals of six and nine weeks, three and six months, and one year post surgery range of motion, grip strength, and x-rays were evaluated. Additionally, the shortened disabilities of the arm, shoulder and hand ( QuickDASH) score, Patient-rated Wrist Evaluation, Mayo Wrist score, and pain according to the Visual Analog Scale score were analyzed. Results: One hundred and sixteen patients were prospectively randomized into two study groups. At the one-year follow-up, patients in the immediate mobilization group showed a significantly higher range of motion in extension/flexion (mean difference 10.2°, 99% confidence interval 0.6–19.8), grip strength (mean difference 5.1 kg, 99% confidence interval −0.5 to 10.7), and Mayo Wrist score (mean difference 7.9 points, 99% confidence interval 2.3–13.5) than the cast immobilization group. Range of motion in supination/pronation (mean difference 13.4°, 99% confidence interval 1.5–25.3) and in radial/ulnar deviation (mean difference 6.3°, 99% confidence interval 0.9–11.7) differed significantly up to nine weeks favoring the immediate mobilization group. The Patient-rated Wrist Evaluation revealed significantly better scores after three months (mean difference 9.3 points, 99% confidence interval 0.5–18.1) and QuickDASH after six months (mean difference 7.3 points, 99% confidence interval 0.3–14.3) in the immediate mobilization group. All other subsequent follow-up examinations indicated no significant differences in respect of pain, range of motion, and patient-reported outcome measurements between the study groups. There were no significant differences in respect of radiological loss of reduction and complications between the groups. Conclusions: Immediate mobilization in combination with supervised physiotherapy of the wrist after volar locking plate fixation of unstable distal radius fractures results in a significantly improved range of motion and grip strength after one year compared to cast immobilization. No increased risk for loss of reduction and other complications was observed.

Three-Dimensional Planning and Patient-Specific Instrumentation for the Fixation of Distal Radius Fractures

“…However, for complex distal radius fractures in young high-demand patients, this technique might result in more accurate reduction and better outcomes. The results of our patient group are in line with several reports in the literature, with a comparable or even slightly better postoperative range of motion [29][30][31][32][33][34][35][36]. However, we obtained no clinical outcome parameters, had no control group and established our ratings for radiographic outcomes only as either healed or not healed.…”

Three Column Fixation Through a Single Incision in Distal Radius Fractures

“…Immediate mobilization seems to be the best choice after DRF internal fixation to have a quicker recovery of ROM and strength. 43 In our cases, we choose to immobilize the wrist for 2 weeks to protect the dorsal cortex which is often comminuted. Additionally, in cases of concomitant ulnar styloid fracture, this immobilization seems to facilitate the healing of the triangular fibrocartilage complex tear and the stability of the DRUJ.…”

Acute on Chronic Distal Radius Fracture: A Case Series and Technique Description

“…The benefits of immediate postoperative motion after VLP fixation have been thoroughly elucidated. 15 , 16 , 17 These advantages may be even more pronounced in patients with distal radius malunion given the functional detriment that has been described in these cases. 18 …”