Abstract
ObjectivesIt 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.MethodsDatabases 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.ResultsNine 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).ConclusionFunctionally, 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.
Highlights
Distal radius fracture (DRF) is one of the most common fracture [1, 2]
9 randomized controlled trials (RCTs) meeting the inclusion criteria were taken for comprehensive evaluation of this meta-analysis [10, 12,13,14,15, 17, 18, 26, 27]
Whereas between the 293 early mobilization (EM) and 303 late mobilization (LM) cases, no significant differences were observed in participants demographics or fracture type
Summary
Distal radius fracture (DRF) is one of the most common fracture [1, 2]. Deng et al Journal of Orthopaedic Surgery and Research (2021) 16:691 the existing variations, in the view of significantly better results in the reduction and functional recovery of open reduction internal fixation (ORIF) [5], it has become the primary surgical technique for the treatment of such fractures [6, 7]. Rehabilitation type and immobilization duration following the plate fixation of DRFs remain uncertain [8], whereas persistent plaster fixation has been repeatedly questioned as a conventional rehabilitation program [9]. EM is controversial due to the local pain-associated complications, poor wound healing, implant loosening, loss of reduction, and internal fixation failure [11]
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