Early Wrist Mobilization After Distal Radius Fractures Stabilized by Volar Locking Plate

Abstract

Objective/hypothesis: Distal radius fractures (DRFs) are very common, and operative treatment by volar locking plate became the standard therapy in the last decade. Furthermore, incidence of DRF will increase of 50% by 2030. So surgical treatment and aftercare is of great interest. Main reason for open reduction and stabilization with a palmar locking plate is the possibility for early postoperative mobilization. There are only a few studies that compare early postoperative mobilization after DRF with immobilization. Main aim of this study was to compare early postoperative mobilization after DRF with a 5-week cast immobilization. Null hypothesis was that early mobilization leads to equal results in range of motion (ROM) and functional outcome scores than an immobilization of 5 weeks. Materials and Methods: Thirty patients with an isolated DRF treated by open reduction and internal fixation with a single volar locking plate without bone graft were prospectively randomized in 2 groups. One group (“early mobilization” [EM]) received a removable thermoplastic splint for 1 week and was allowed to move the wrist directly postoperative. The other group (“immobilization group” [IM]) received a not removable cast for 5 weeks. Both groups underwent physiotherapy 2 times a week. At 6 weeks, 9 weeks, 3 months, 6 months, and 1-year postsurgery ROM, grip strength and radiographs had been evaluated. In addition, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-rated Wrist Evaluation (PRWE), modified Green O’Brien (Mayo) score, and pain according to the Visual Analog Scale (VAS) score were analyzed. Results: Patients in the EM group had significant better ROM in the sagittal plane and grip strength up to 6 months ( P = .03; P = .04), in the frontal plane up to 9 weeks ( P = .04), and in forearm rotation up to 6 weeks ( P = .03). As well QuickDASH and PRWE Score had been better up to 6 weeks after surgery ( P = .002; P = .02). The modified Green O’Brien score differed significantly up to 1 year ( P = .002). At 1 year, 93% “excellent” and “good” results in the Green and O’Brien score with a mean QuickDASH of 5.98 ± 10.94, and PRWE score of 4.27 ± 9.23 was observed in the EM group. No differences in respect of loss of reduction, pain, duration of physiotherapy, and sick leave had been detected. Conclusion: Early wrist mobilization after DRFs, stabilized by a volar locking plate (without bone graft), is a save postsurgery treatment and leads to an improved ROM and grip strength up to 6 months after surgery compared with a 5-week immobilization.