Immobilization following Distal Radius Fractures: A Randomized Clinical Trial

Abstract

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.

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

“…7,8 Although there is a consensus in the literature that internal fixation requires shorter immobilization and thus allows an earlier return to daily life activities, only few studies evaluate the possible benefits of shorter immobilization. 9–14 Additionally, the published guidelines do not recommend early mobilization on a routine basis. 15,16…”

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

“…Postoperative EM improved the patient's quality of life and physical comfort [ 10 , 29 ], and therefore assures the individuals early return to activities of daily living and work. Despite the lack of supporting studies demonstrating its effectiveness, immobilization has been empirically used to provide analgesia after surgery [ 30 , 31 ]. The latest Cochrane Database Review published in 2015 by Handoll et al [ 8 ] on rehabilitation for DRFs pointed out that as in 2006 [ 32 ], there is a lack of sufficient evidence about the effectiveness of the various rehabilitation programs after ORIF for DRF.…”