Early Motion After Volar Fixation for Distal Radius Fractures
Condition: Radius Fracture
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      Many surgeons pursue volar plating of the distal radius to allow earlier post-operative wrist
      motion. Early motion is generally prescribed in the belief that it will result in greater
      final motion without compromising fixation. However, studies have failed to demonstrate
      clinically significant improvement in final wrist motion (> 1 year follow up) compared to
      treatments requiring longer immobilization such as external fixation or bridge plating.
    

Detailed description: 
      Many surgeons pursue volar plating of the distal radius to allow earlier post-operative wrist
      motion. Early motion is generally prescribed in the belief that it will result in greater
      final motion without compromising fixation. However, studies have failed to demonstrate
      clinically significant improvement in final wrist motion (>1 year follow up) compared to
      treatments requiring longer immobilization such as external fixation or bridge plating
      (McQueen 1996, Handoll 2003, Atroshi 2006, Krishnan 2003, Sommerkamp 1994, Grewal 2005).

      Only one study to date has attempted to define the early effects of wrist mobilization
      following volar plate fixation of the distal radius (Lozano-Calderon 2008). That study
      prospectively enrolled 60 patients and randomized them to begin wrist motion at 2 weeks
      (range 7 days - 13 days) or 6 weeks (range 42 to 49 days) postoperatively. This study found
      no significant difference in subjective or objective outcome measures at 3 or 6 months follow
      up. However, the investigation had several weaknesses. First, there was no attempt to confirm
      adherence to the immobilization protocols. Those in the late motion group were not casted but
      remained in orthoplast splints which could be easily removed. Secondly, this investigation
      collected data only at 3 and 6 months which prohibited them from commenting on the rate of
      improvement during the early weeks after mobilization. The authors acknowledged these
      limitations and further noted that no evaluation of patient cost was performed. Finally,
      radiographic evaluations in this study did not include analysis of change in alignment from
      immediate postoperative films.

      Thus, the literature to date suggests that early mobilization of the volarly plated distal
      radius is safe but does not improve final wrist motion. The benefits of mobilization in the
      early postoperative period though have not been clearly defined. This project proposes to
      fill this void in the literature and determine if early mobilization is an effective measure
      to hasten recovery of motion and function.
    

Intervention name(s): Early motion; Immobilization
Intervention type(s): Other; Other
Intervention description(s): One set of patients will begin wrist motion at 1 week after surgery.; This set of patients will be casted for 6 weeks after surgery.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: wrist; fracture; motion; surgery