Rehabilitation Protocols After Distal Radius Fracture

Key Points

Current evidences show no significant difference of clinical outcomes between patients treated with versus without additional physiotherapeutic intervention, but high-quality studies are lacking.
Patient education and exercise (so-called home exercise program) seems sufficient after distal radius fracture (DRF) based on current evidence, suggesting that there is no need to prescribe a routine supervised physiotherapy session for all patients.
The subgroup who would obtain significant benefit from supervised physiotherapy session has not yet been identified. Future studies should aim to identify for whom this costly intervention is needed.
Earlier rehabilitation after surgery leads to early recovery and return to work at short-term follow-up.

Panel 1

Case 1

A 56-year-old homemaker presented to the emergency department with a displaced extra-articular distal radius fracture (DRF). Closed reduction and immobilization with a sugar-tong splintwas achieved. Reduction was subsequently maintained via 5-week cast immobilization ( Fig. 1 ). Is exercise prescribed by a therapist required for this patient during cast immobilization or after cast removal?

$Fig. 1, (A) Anteroposterior (AP) and (B) lateral wrist radiograph of Case 1, a 56-year-old woman with a displaced mainly extra-articular distal radius fracture. (C) AP and (D) lateral wrist radiograph after successful closed reduction and immobilization with sugar-tong splint.$

Case 2

An 86-year-old woman presented to emergency department with DRF. An orthopedic resident attempted closed reduction and applied a sugar-tong splint, but loss of reduction was observed at the first outpatient visit. Thus, we decided to perform open reduction and internal fixation because of her high activity before injury, which appeared to achieve acceptable reduction and stable fixation of the fracture fragments ( Fig. 2 ). Would there be any benefit of early start of mobilization and physiotherapy in this patient?

$Fig. 2, (A) Anteroposterior (AP) and (B) lateral wrist radiograph of Case 2, an 86-year-old woman with a displaced distal radius fracture whose initial reduction was not maintained within a sugar-tong splint applied in the emergency department. (C) AP and (D) lateral wrist radiograph after successful operation with a volar locking plate. Reduction was satisfactory and fixation strength seemed stable.$

Importance of the Problem

DRF is a very common injury. Nonoperative treatment with a cast remains the most popular treatment for stable fracture. However, surgical treatment has been increasingly adopted as a reliable modality since the volar locking plate (VLP) was introduced as a robust implant. Although many studies have focused on immobilization methods or surgical approaches, little attention has been given to rehabilitation protocols during or after those definitive treatments. However, achieving successful outcomes requires both sound definitive treatment and timely appropriate rehabilitation. Rehabilitation prevents fracture-related complications and optimizes functional recovery to maintain activities of daily living. Despite rehabilitation being critical to the final prognosis of DRF, sufficient evidence of its application and efficacy is lacking. This issue will become increasingly important because of the predicted increase in the number of affected patients and demand for cost-effective healthcare.

Main Question

What is the effect of rehabilitation protocols (home exercise program [HEP] versus supervised physiotherapy session [SPS]) on functional outcome after DRF, and when should they be initiated?

Current Opinion

HEP and SPS are the two most frequently prescribed forms of rehabilitation. HEP consists of basic education and advice including fracture protection, cast care, and edema control as well as instructions to engage in progressive exercise at home. This is the simplest and most cost-effective form of rehabilitation after DRF. This measure is the minimal intervention usually provided to patients during or after immobilization, and many randomized controlled trials (RCTs) adopted HEP to the control group. In contrast, SPS consists of exercises performed in specific places, such as a hospital under the supervision of a physiotherapist or other medical personnel, for a certain period. Although it is assumed that patients who receive early structured physiotherapy achieve a faster recovery, it is unclear whether SPS is truly beneficial over natural recovery or HEP.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here