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Early mobilization may not improve motion after plate fixation in the distal radius
Preliminary results show no significant differences between early and late wrist mobilization.
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WASHINGTON — Boston researchers may disprove the belief that early wrist mobilization improves motion following volar plate fixation of distal radius fractures, according to a surgeon speaking here.
Santiago A. Lozano-Calderón, MD, presented the preliminary findings of a prospective, randomized study evaluating early vs. late wrist mobilization at the American Society for Surgery of the Hand 61st Annual Meeting.
The study, which Lozano-Calderón is conducting with colleagues at Massachusetts General Hospital, remains five patients shy of its 60-patient enrollment goal. However, after reviewing follow-up data for the presently enrolled patients, investigators are already seeing no significant differences between treatment groups, Lozano-Calderón said.
The researchers randomized patients to two treatment groups. To date, 26 patients have been included in the early mobilization group, which involves wrist mobilization immediately following suture removal. The second group, or the late mobilization group, includes 28 patients who begin mobilization at 6 weeks postop. All patients undergo follow-up evaluations at 3 and 6 months after surgery.
Lozano-Calderón reported the preliminary results for 46 patients (23 patients in each group) who have completed 3-month evaluations and for 35 patients (19 early mobilization patients and 16 late mobilization patients) who have completed 6-month follow-up.
"There were various small differences in pain, health status, wrist motion, grip and pinch strength," Lozano-Calderón said.
At 3-month follow-up, patients in the late mobilization group had slightly better results for grip and pinch strength and range of motion. But patients in the early mobilization group showed a slightly better improvement in health status and pain. However, none of these differences reach statistical significance, Lozano-Calderón said.
Researchers also saw slightly better grip and pinch strength results at 6 months for patients in the late manipulation group. But, again, this was not statistically significant.
At the most recent or final follow-up, health status and wrist motion evaluations were comparable between the groups, with no statistically significant differences in any wrist-motion arcs, Lozano-Calderón said.
"The differences were so small that we do not anticipate any statistically significant differences as we complete the trial," he sid. "And, in any case, if significant differences are found they are going to be too small and clinically irrelevant."
For more information:
- Lozano-Calderón SA, Mudgal CS, Jupiter J, et al. Prospective randomized comparison of early vs. late wrist mobilization after volar plate fixation of distal radius fractures. #36. Presented at the American Society for Surgery of the Hand 61st Annual Meeting. Sept. 7-9, 2006. Washington.