Timing of Rehabilitation
We suggest that patients do not need to begin early wrist motion routinely following stable fracture fixation.
Rationale
Three studies were included in this recommendation.25, 83, 84 Each study investigated different operative treatment methods: volar plate, trans-styloid fixation or external fixation. Mobilization was commenced at different times, in the two internal fixation studies, therapy was started approximately at 1 week and in the external fixation study, mobilization was commenced at 3 weeks. In 2 studies, the control group was either casted or immobilized with a fixator. In the volar plating study, the control group was immobilized by a thermoplastic splint that they were instructed to remove for showering and therefore are not a reliable control group.
The outcome measures used were pain and function (DASH) and/or complications. None of the outcomes were significantly different between early motion and late motion. These data support the recommendation that patients do not need to begin early wrist motion after stable fracture fixation.
The outcome measures used were pain and function (DASH) and/or complications. None of the outcomes were significantly different between early motion and late motion. These data support the recommendation that patients do not need to begin early wrist motion after stable fracture fixation.
- (25) McQueen MM, Hajducka C, Court-Brown CM. Redisplaced unstable fractures of the distal radius: a prospective randomised comparison of four methods of treatment. J Bone Joint Surg Br 1996;78(3):404-409.
- (83) Allain J, le GP, Le MS, Goutallier D. Trans-styloid fixation of fractures of the distal radius. A prospective randomized comparison between 6- and 1-week postoperative immobilization in 60 fractures. Acta Orthop Scand 1999;70(2):119-123.
- (84) Lozano-Calderon SA, Souer S, Mudgal C, Jupiter JB, Ring D. Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am 2008;90(6):1297-1304.