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Better results with independent exercise vs. formal therapy after volar plating for distal radius fractures
Investigators studying this area also found group designation, age and ulnar variance among the predictors of a patient’s final flexion and extension.
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LAS VEGAS — The results of a level 1 study showed greater wrist function after volar plating for distal radius fracture in patients who performed surgeon-directed independent exercises than those who underwent formal occupational therapy.
“Three months after, the patients who did independent exercises were statistically better, and we were looking for a large effect size so a reasonably large difference [was seen] in pinch, grip, and Gartland and Werley scores,” David C. Ring, MD, PhD, said during the 2011 Annual Meeting of the American Society for Surgery of the Hand, here.
“Then, at 6 months, the patients who did their exercises independently were better on just about everything,” he said.
Randomized controlled study
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Ring and colleagues prospectively studied two groups of about 45 patients who underwent open reduction and locked volar plating for distal radius fractures, and randomized them to either independently perform exercises directed by a surgeon or perform exercises supervised by an occupational therapist. The groups were comparable regarding demographic information, Ring said.
The investigators used combined wrist flexion and extension at 6 months postoperatively as their primary outcome and results in grip and pinch strength, Mayo wrist, DASH and Gartland and Werley scores at 3 months and 6 months as their secondary outcomes.
In addition to finding better results for patients who performed independent exercises, Ring, a member of the Editorial Board of Orthopedics Today, noted that predictors of final flexion and extension included group designation, patient age and ulnar variance.
Why the differences?
Ring speculated in his presentation that patients who performed independent exercises had better results due to a sense of self-efficacy and proactivity about their recovery.
“It is the sense that you can do it, and everything will be OK. That you can take this on and do it yourself,” Ring said. “I think that is important. The other thing I want to speculate on is that therapists do tend to be a little more cautious. You may hear them talk about, ‘Work to pain, not beyond’ or ‘Do not overdo it. You will cause inflammation.’ That may be a factor worth studying.” – by Gina Brockenbrough, MA
Reference:
- Souer S, Ring DC, Buijze GA. A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal radius. Paper #17. Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. Sept. 8-10. Las Vegas.
- David C. Ring, MD, PhD, can be reached at Massachusetts General Hospital, Yawkey 2100, 55 Fruit Street, Boston, MA 02114 USA; +1 617-643-7527; email: dring@partners.org.
- Disclosure: Ring receives consulting fees from Wright Medical, Biomet, Skeletal Dynamics and Acumed and honoraria from AO North America and AO International; has stock options with Illuminos and Mime; and receives royalty support from Wright Medical, Biomet and Skeletal Dynamics.
The recovery of wrist and hand function remains an integral part of the treatment concept after volar plating of a distal radius fracture. There is still a relevant risk of long-term impairment which might be critical, especially for the working population. It is common practice to leave occupational therapy to supervision of a therapist. However, there is still a wide range of function from excellent to poor results. As a consequence, there is reasonable and increasing need for surgeons to keep responsibility for the functional outcome of their patients.
Wrist fractures seem to be particularly suitable for independent occupational therapy that is instructed by the surgeon. One of the main reasons might be that the integration of patients in postoperative therapy assumes greater participation and responsibility for their own health. Other factors like frequency and intensity of exercises and economic considerations might also contribute. But patient selection should be considered because the cognitive and motivational level is fundamental to treatment success.
— Prof. Dr. med. Gert Krischak
Director
Institute of Rehabilitation Medicine and Allied Science at Ulm University
Bad Buchau, Germany
Disclosure: Krischak has no relevant
financial disclosures.