Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Therapy

Abstract

Objective/Hypothesis: Proprioception and sensorimotor modalities have been used in rehabilitation to treat neurological and joint injuries. Following distal radius fractures (DRF), there is a temporary sensorimotor loss that should be addressed during postoperative therapy. We designed an evaluation and treatment protocol aimed at sensorimotor evaluation and treatment and trialed it on a pilot series of patients following surgery for DRF. The purpose of this prospective study was to compare the outcomes of patients following surgery for DRF treated using our specific sensorimotor treatment protocol with patients treated after surgery according to postoperative standard of care. We hypothesized that patients treated using our treatment protocol will have better functional results at 3 months postsurgery. Methods: Because sensorimotor response loops are complex and it is difficult to isolate the effect of the different types of input, both the evaluation and the treatment protocols included a comprehensive sensorimotor panel. The patients were treated once a week in therapy and pursued a home therapy protocol. Thirty-four patients following surgery for DRF were randomized into a focused sensorimotor postoperative protocol and the standard of care protocol. Exclusion criteria included inability to attend therapy or comply with the home therapy protocol and patients with preceding injuries and deficits in the wrist and hand. Patients were evaluated initially in the first days after the operation, at 6 weeks, and at 4 months postsurgery. Results: All patients following surgery for DRF demonstrated similar initial significant deficits in proprioception (72%), stereognosis (36%), and the Moberg pick-up test (30 seconds vs 10.8 seconds). There was documented sensorimotor and functional improvement in both groups with treatment in range of motion (ROM), strength, and sensorimotor testing. The Disabilities of the Arm, Shoulder and Hand (DASH) score was 10.8 (14.2) in the trial group at 3 months and 29.2 (9.6) in the control group P = .05. Wrist ROM at 3 months was significantly better in the trial group ( P = .003). We had no cases of chronic regional pain syndrome (CRPS). Conclusions: (1) Patients after surgery for DRF demonstrate significant sensorimotor deficits that should be evaluated and addressed in therapy. (2) These deficits and function seem to improve more at 3 months when utilizing a comprehensive sensorimotor treatment protocol. (3) Further study is ongoing to evaluate the value of the treatment protocol and to provide sensorimotor therapeutic guidelines following surgery for DRF.