Observer-reported outcome measures showed that patients ’ driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm .
Conclusions The available evidence provides a best-case scenario for when patients can return to driving .
Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized , indicating that physicians should tell patients to wait longer before driving .
Background Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures , but the data regarding this topic are diverse and sometimes conflicting .
Some studies provide observer-reported outcome measures , such as brake response time or simulators , to estimate when patients can safely resume driving after surgery , and patient survey data describing when patients report a return to driving , but they do not all agree .
We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive .
Questions / purpose sBased on the available evidence , we sought to determine when patients can safely return to driving after ( 1 ) lower extremity orthopaedic surgery and injuries ; ( 2 ) upper extremity orthopaedic surgery and injuries ; and ( 3 ) spine surgery .
Effects of upper-limb immobilisation on driving safety.
Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast . In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance .  Eight healthy volunteers performed four 20-min driving circuits in a driving simulator ( STISIM 400W ) , circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation . Immobilisation involved a lightweight below-elbow cast with the thumb left free . Volunteers were r and omised to right or left immobilisation for circuit 2 , and the contralateral wrist was immobilised for circuit 3 . Circuits included urban and rural environments and specific hazards ( pedestrians crossing , vehicles emerging from a concealed entrance , traffic lights changing suddenly , avoidance of an oncoming vehicle in the driver 's carriageway ) . Limb immobilisation led to more cautious rural and urban driving , with less adjustment of speed and lateral road position than when unrestricted . However when responding to hazards immobilisation caused less safe driving , with higher speeds , a greater proximity to the hazard before action was taken and less steering adjustment . The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation . Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged , but to adversely affect responses to routine hazards . Advice on ability to drive safely should be cautious , as the impact of immobilisation appears to be more subtle and wide ranging than previously thought
Observer-reported outcome measures showed that patients ’ driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm .
Conclusions The available evidence provides a best-case scenario for when patients can return to driving .
Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized , indicating that physicians should tell patients to wait longer before driving .
Background Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures , but the data regarding this topic are diverse and sometimes conflicting .
Some studies provide observer-reported outcome measures , such as brake response time or simulators , to estimate when patients can safely resume driving after surgery , and patient survey data describing when patients report a return to driving , but they do not all agree .
We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive .
Questions / purpose sBased on the available evidence , we sought to determine when patients can safely return to driving after ( 1 ) lower extremity orthopaedic surgery and injuries ; ( 2 ) upper extremity orthopaedic surgery and injuries ; and ( 3 ) spine surgery .