Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-05-2020 | Distal Radius Fracture | Handsurgery

Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy?

Authors: S. Quadlbauer, Ch. Pezzei, J. Jurkowitsch, R. Rosenauer, B. Kolmayr, T. Keuchel, D. Simon, T. Beer, T. Hausner, M. Leixnering

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2020

Abstract

Although the literature generally agrees that displaced distal radius fractures require surgery, no single consensus exists concerning the length of immobilization and type of post-operative physiotherapeutic rehabilitation program. Palmar locking plate fixation represents a very stable fixation of the distal radius, and was assessed biomechanically in various studies. Surprisingly, most authors report additional immobilization after plate fixation. One reason might be due to the pain caused during active wrist mobilization in the early post-operative stages or secondly to protect the osteosynthesis in the early healing stages preventing secondary loss of reduction. This article addresses the biomechanical principles, current available evidence for early mobilization/immobilization and impact of physiotherapy after operatively treated distal radius fractures.

MacIntyre NJ, Dewan N (2016) Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther 29:136–145. https://doi.org/10.1016/j.jht.2016.03.003 CrossRefPubMed

Schermann H, Kadar A, Dolkart O et al (2018) Repeated closed reduction attempts of distal radius fractures in the emergency department. Arch Orthop Trauma Surg 138:591–596. https://doi.org/10.1007/s00402-018-2904-2 CrossRefPubMed

Weil NL, El Moumni M, Rubinstein SM et al (2017) Routine follow-up radiographs for distal radius fractures are seldom clinically substantiated. Arch Orthop Trauma Surg 137:1187–1191. https://doi.org/10.1007/s00402-017-2743-6 CrossRefPubMedPubMedCentral

Quadlbauer S, Pezzei C, Hintringer W et al (2018) Clinical examination of the distal radioulnar joint. Orthopade 47:628–636CrossRefPubMed

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: A review. Injury 37:691–697CrossRefPubMed

Hohendorff B, Knappwerth C, Franke J et al (2018) Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138:1479–1485. https://doi.org/10.1007/s00402-018-2999-5 CrossRefPubMed

Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar Radioscapholunate Arthrodesis and Distal Scaphoidectomy After Malunited Distal Radius Fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031 CrossRef

Rotman D, Schermann H, Kadar A (2019) Displaced distal radius fracture presenting with neuropraxia of the dorsal cutaneous branch of the ulnar nerve (DCBUN). Arch Orthop Trauma Surg 139:1021–1023. https://doi.org/10.1007/s00402-019-03191-x CrossRefPubMed

Suda AJ, Schamberger CT, Viergutz T (2019) Donor site complications following anterior iliac crest bone graft for treatment of distal radius fractures. Arch Orthop Trauma Surg 139:423–428. https://doi.org/10.1007/s00402-018-3098-3 CrossRefPubMed

10.

Schlickum L, Quadlbauer S, Pezzei C et al (2018) Three-dimensional kinematics of the flexor pollicis longus tendon in relation to the position of the FPL plate and distal radius width. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3081-z CrossRefPubMed

11.

Wegmann K, Harbrecht A, Hackl M et al (2019) Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03313-5 CrossRefPubMed

12.

Hernekamp JF, Schönle P, Kremer T et al (2019) Low-profile locking-plate vs. the conventional AO system: early comparative results in wrist arthrodesis. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03314-4 CrossRefPubMed

13.

Figl M, Weninger P, Liska M et al (2009) Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 129:661–669. https://doi.org/10.1007/s00402-009-0830-z CrossRefPubMed

14.

Figl M, Weninger P, Jurkowitsch J et al (2010) Unstable distal radius fractures in the elderly patient-volar fixed-angle plate osteosynthesis prevents secondary loss of reduction. J Trauma Inj Infect Crit Care 68:992–998. https://doi.org/10.1097/TA.0b013e3181b99f71 CrossRef

15.

Esenwein P, Sonderegger J, Gruenert J et al (2013) Complications following palmar plate fixation of distal radius fractures: A review of 665 cases. Arch Orthop Trauma Surg 133:1155–1162CrossRefPubMed

16.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2018) Early complications and radiological outcome after distal radius fractures stabilized by volar angular stable locking plate. Arch Orthop Trauma Surg 138:1773–1782. https://doi.org/10.1007/s00402-018-3051-5 CrossRefPubMed

17.

Weschenfelder W, Friedel R, Hofmann GO, Lenz M (2019) Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban. Arch Orthop Trauma Surg 139:435–438. https://doi.org/10.1007/s00402-019-03116-8 CrossRefPubMed

18.

Gologan RE, Koeck M, Suda AJ, Obertacke U (2019) %3e 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT. Arch Orthop Trauma Surg 139:877–881. https://doi.org/10.1007/s00402-019-03186-8 CrossRefPubMed

19.

Lameijer CM, Ten Duis HJ, van Dusseldorp I et al (2017) Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 137:1499–1513. https://doi.org/10.1007/s00402-017-2765-0 CrossRefPubMedPubMedCentral

20.

Lameijer CM, Ten Duis HJ, Vroling D et al (2018) Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 138:1699–1712. https://doi.org/10.1007/s00402-018-3046-2 CrossRefPubMedPubMedCentral

21.

Lafontaine M, Hardy D, Delince P (1989) Stability assessment of distal radius fractures. Injury 20:208–210CrossRefPubMed

22.

Tahririan MA, Javdan M, Nouraei MH, Dehghani M (2013) Evaluation of instability factors in distal radius fractures. J Res Med Sci 18:892–896PubMedPubMedCentral

23.

Walenkamp MMJ, Aydin S, Mulders MAM et al (2016) Predictors of unstable distal radius fractures: a systematic review and meta-analysis. J Hand Surg Eur Vol 41:501–515. https://doi.org/10.1177/1753193415604795 CrossRefPubMed

24.

Song J, Yu A-X, Li Z-H (2015) Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 8:17023–17035PubMedPubMedCentral

25.

Vannabouathong C, Hussain N, Guerra-Farfan E, Bhandari M (2019) Interventions for distal radius fractures. J Am Acad Orthop Surg 27:e596–e605. https://doi.org/10.5435/JAAOS-D-18-00424 CrossRefPubMed

26.

Le ZS, Kan SL, Su LX, Wang B (2015) Meta-analysis for dorsally displaced distal radius fracture fixation: Volar locking plate versus percutaneous Kirschner wires. J Orthop Surg Res. https://doi.org/10.1186/s13018-015-0252-2 CrossRef

27.

Wei DH, Raizman NM, Bottino CJ et al (2009) Unstable distal radial fractures treated with external fixation, a radial column plate, or a volar plate: A prospective randomized trial. J Bone Jt Surg Ser A 91:1568–1577. https://doi.org/10.2106/JBJS.H.00722 CrossRef

28.

Rubin G, Orbach H, Chezar A, Rozen N (2017) Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique. Arch Orthop Trauma Surg 137:49–54. https://doi.org/10.1007/s00402-016-2592-8 CrossRefPubMed

29.

Gabl M, Arora R, Klauser AS, Schmidle G (2016) Characteristics of secondary arthrofibrosis after intra-articular distal radius fracture. Arch Orthop Trauma Surg 136:1181–1188. https://doi.org/10.1007/s00402-016-2490-0 CrossRefPubMed

30.

Jupiter JB, Lipton H (1993) The operative treatment of intraarticular fractures of the distal radius. - PubMed - NCBI. Clin Orthop Relat Res 292:48–61CrossRef

31.

Manway J, Highlander P (2015) Fractures of the distal radius. Foot Ankle Spec 8:59–64CrossRefPubMed

32.

Jongs RA, Harvey LA, Gwinn T, Lucas BR (2012) Dynamic splints do not reduce contracture following distal radial fracture: a randomised controlled trial. J Physiother 58:173–180. https://doi.org/10.1016/S1836-9553(12)70108-X CrossRefPubMed

33.

Erhart S, Toth S, Kaiser P et al (2018) Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation. Arch Orthop Trauma Surg 138:879–885. https://doi.org/10.1007/s00402-018-2925-x CrossRefPubMed

34.

Jupiter JB (1991) Fractures of the distal end of the radius. J Bone Joint Surg Am 73:461–469CrossRefPubMed

35.

Lozano-Calderón SA, Souer S, Mudgal C et al (2008) Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Jt Surg - Ser A 90:1297–1304. https://doi.org/10.2106/JBJS.G.01368 CrossRef

36.

Brehmer JL, Husband JB (2014) Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study. J Bone Joint Surg Am 96:1621–1630. https://doi.org/10.2106/JBJS.M.00860 CrossRefPubMed

37.

Krischak GD, Krasteva A, Schneider F et al (2009) Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Arch Phys Med Rehabil 90:537–544. https://doi.org/10.1016/j.apmr.2008.09.575 CrossRefPubMed

38.

Kakarlapudi TK, Santini A, Shahane SA, Douglas D (2000) The cost of treatment of distal radial fractures. Injury 31:229–232CrossRefPubMed

39.

Wong JYP (2008) Time Off Work in Hand Injury Patients. J Hand Surg Am 33:718–725. https://doi.org/10.1016/j.jhsa.2008.01.015 CrossRefPubMed

40.

Putnam MD, Meyer NJ, Nelson EW et al (2000) Distal radial metaphyseal forces in an extrinsic grip model: implications for postfracture rehabilitation. J Hand Surg Am 25:469–475. https://doi.org/10.1053/jhsu.2000.6915 CrossRefPubMed

41.

Dahl WJ, Nassab PF, Burgess KM et al (2012) Biomechanical properties of fixed-angle volar distal radius plates under dynamic loading. J Hand Surg Am 37:1381–1387. https://doi.org/10.1016/j.jhsa.2012.03.021 CrossRefPubMed

42.

Osada D, Kamei S, Masuzaki K et al (2008) Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 33:691–700. https://doi.org/10.1016/j.jhsa.2008.01.024 CrossRefPubMed

43.

Wright TW, Horodyski M, Smith DW (2005) Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am 30:289–299. https://doi.org/10.1016/j.jhsa.2004.11.014 CrossRefPubMed

44.

Knox J, Ambrose H, McCallister W, Trumble T (2007) Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanic study using a cadaver model. J Hand Surg Am 32:813–817. https://doi.org/10.1016/j.jhsa.2007.03.015 CrossRefPubMed

45.

Fritz T, Heyer T, Krieglstein C et al (1997) Biomechanics of combined Kirschner wire osteosynthesis in the human model of unstable dorsal, distal radius fractures (Colles type). Chirurg 68:496–502. https://doi.org/10.1007/s001040050219 CrossRefPubMed

46.

Osada D, Fujita S, Tamai K et al (2004) Biomechanics in uniaxial compression of three distal radius volar plates. J Hand Surg Am 29:446–451. https://doi.org/10.1016/j.jhsa.2003.12.010 CrossRefPubMed

47.

Osada D, Viegas SF, Shah MA et al (2003) Comparison of different distal radius dorsal and volar fracture fixation plates: a biomechanical study. J Hand Surg Am 28:94–104. https://doi.org/10.1053/jhsu.2003.50016 CrossRefPubMed

48.

Dacombe PJ, Amirfeyz R, Davis T (2016) Patient-reported outcome measures for hand and wrist trauma: is there sufficient evidence of reliability, validity, and responsiveness? Hand (N Y) 11:11–21. https://doi.org/10.1177/1558944715614855 CrossRef

49.

Sorensen AA, Howard D, Tan WH et al (2013) Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am 38:641–649. https://doi.org/10.1016/j.jhsa.2012.12.032 CrossRefPubMedPubMedCentral

50.

Goldhahn J, Beaton D, Ladd A et al (2014) Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research. Arch Orthop Trauma Surg 134:197–205. https://doi.org/10.1007/s00402-013-1767-9 CrossRefPubMed

51.

Smith-Forbes EV, Howell DM, Willoughby J et al (2016) Specificity of the minimal clinically important difference of the quick disabilities of the arm shoulder and hand (QDASH) for distal upper extremity conditions. J Hand Ther 29:81–88. https://doi.org/10.1016/j.jht.2015.09.003(quiz 88) CrossRefPubMed

52.

Marks M, Rodrigues JN (2017) Correct reporting and interpretation of clinical data. J Hand Surg Eur Vol 42:977–979. https://doi.org/10.1177/1753193417733154 CrossRefPubMed

53.

Calfee RP, Adams AA (2012) Clinical research and patient-rated outcome measures in hand surgery. J Hand Surg Am 37:851–855. https://doi.org/10.1016/j.jhsa.2012.01.043 CrossRefPubMedPubMedCentral

54.

Rodrigues JN, Mabvuure NT, Nikkhah D et al (2015) Minimal important changes and differences in elective hand surgery. J Hand Surg Eur Vol 40:900–912. https://doi.org/10.1177/1753193414553908 CrossRefPubMed

55.

Chaudhry H, Kleinlugtenbelt YV, Mundi R et al (2015) Are volar locking plates superior to percutaneous K-wires for distal radius fractures? A meta-analysis. Clin Orthop Relat Res 473:3017–3027. https://doi.org/10.1007/s11999-015-4347-1 CrossRefPubMedPubMedCentral

56.

Walenkamp MMJ, de Muinck Keizer R-J, Goslings JC et al (2015) The minimum clinically important difference of the patient-rated wrist evaluation score for patients with distal radius fractures. Clin Orthop Relat Res 473:3235–3241. https://doi.org/10.1007/s11999-015-4376-9 CrossRefPubMedPubMedCentral

57.

Kim JK, Park MG, Shin SJ (2014) What is the minimum clinically important difference in grip strength? Clin Orthop Relat Res 472:2536–2541. https://doi.org/10.1007/s11999-014-3666-y CrossRefPubMedPubMedCentral

58.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 06:102–112. https://doi.org/10.1055/s-0036-1587317 CrossRef

59.

Schnetzke M, Fuchs J, Vetter SY et al (2018) Intraoperative three-dimensional imaging in the treatment of distal radius fractures. Arch Orthop Trauma Surg 138:487–493. https://doi.org/10.1007/s00402-018-2867-3 CrossRefPubMed

60.

Kirchberger MC, Unglaub F, Mühldorfer-Fodor M et al (2015) Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 135:427–437. https://doi.org/10.1007/s00402-015-2153-6 CrossRefPubMed

61.

Bennett EH (1892) On the raker forms of fracture of the carpal extremity of the radius. Br Med J 1:902–903. https://doi.org/10.1136/bmj.1.1635.902 CrossRefPubMedPubMedCentral

62.

MacDermid JC, Roth JH, Richards RS (2003) Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskelet Disord 4:1–13. https://doi.org/10.1186/1471-2474-4-24 CrossRef

63.

Kenwright J, Goodship AE, Kelly DJ et al (1986) Effect of controlled axial micromovement on healing of tibial fractures. Lancet 328:1185–1187. https://doi.org/10.1016/S0140-6736(86)92196-3 CrossRef

64.

Klein SM, Prantl L, Koller M et al (2015) Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation. Acta Chir Orthop Traumatol Cech 82:33–40PubMed

65.

Handoll HHG, Elliott J (2015) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003324.pub3 CrossRefPubMed

66.

Handoll HHG, Madhok R, Howe TE (2006) Rehabilitation for distal radial fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003324.pub2 CrossRefPubMedPubMedCentral

67.

Chung KC (2006) Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Jt Surg 88:2687. https://doi.org/10.2106/JBJS.E.01298 CrossRef

68.

Kwan K, Lau TW, Leung F (2011) Operative treatment of distal radial fractures with locking plate system—a prospective study. Int Orthop 35:389–394. https://doi.org/10.1007/s00264-010-0974-z CrossRefPubMed

69.

Duprat A, Diaz J, Vernet P et al (2018) Volar locking plate fixation of distal radius fractures: splint versus immediate mobilization. J Wrist Surg 07:237–242. https://doi.org/10.1055/s-0037-1620271 CrossRef

70.

Watson N, Haines T, Tran P, Keating JL (2018) A Comparison of the effect of one, three, or six weeks of immobilization on function and pain after open reduction and internal fixation of distal radial fractures in adults. J Bone Jt Surg 100:1118–1125. https://doi.org/10.2106/JBJS.17.00912 CrossRef

71.

Andrade-Silva FB, Rocha JP, Carvalho A et al (2019) Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial. Injury 50:386–391. https://doi.org/10.1016/j.injury.2018.12.001 CrossRefPubMed

72.

Lichtman DM, Bindra RR, Boyer MI et al (2011) American academy of orthopaedic surgeons clinical practice guideline on: the treatment of distal radius fractures. J Bone Joint Surg Am 93:775–778. https://doi.org/10.2106/JBJS.938ebo CrossRefPubMed

73.

Dresing K (2015) Distale Speichenfraktur. In: Leitlin. der Dtsch. Gesellscahft für Unfallchirrugie. https://www.awmf.org/uploads/tx_szleitlinien/012-015l_S2e_Di- stale_Radiusfraktur_2015–02.pdf2015

74.

Bruder AM, Shields N, Dodd KJ, Taylor NF (2017) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. J Physiother 63:205–220. https://doi.org/10.1016/j.jphys.2017.08.009 CrossRefPubMed

75.

Taylor NF, Dodd KJ, Shields N, Bruder A (2007) Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002–2005. Aust J Physiother 53:7–16CrossRefPubMed

76.

Knygsand-Roenhoej K, Maribo T (2011) A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius. J Hand Ther 24:184–193. https://doi.org/10.1016/j.jht.2010.10.009(quiz 194) CrossRefPubMed

77.

Bruder AM, Shields N, Dodd KJ et al (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. J Physiother 62:145–152. https://doi.org/10.1016/j.jphys.2016.05.011 CrossRefPubMed

78.

Watt CF, Taylor NF, Baskus K (2000) Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg 120:413–415CrossRefPubMed

79.

Souer JS, Buijze G, Ring D (2011) A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius. J Bone Joint Surg Am 93:1761–1766. https://doi.org/10.2106/JBJS.J.01452 CrossRefPubMed

80.

Valdes K, Naughton N, Burke CJ (2015) Therapist-supervised hand therapy versus home therapy with therapist instruction following distal radius fracture. J Hand Surg Am 40:1110–6.e1. https://doi.org/10.1016/j.jhsa.2015.01.036 CrossRefPubMed

81.

Kay S, McMahon M, Stiller K (2008) An advice and exercise program has some benefits over natural recovery after distal radius fracture: a randomised trial. Aust J Physiother 54:253–259CrossRefPubMed

82.

Clementsen SØ, Hammer O-L, Šaltytė Benth J et al (2019) Early mobilization and physiotherapy Vs. late mobilization and home exercises after ORIF of distal radial fractures. JBJS Open Access 4:e0012. https://doi.org/10.2106/JBJS.OA.19.00012 CrossRefPubMedPubMedCentral

83.

Harvey LA, Katalinic OM, Herbert RD et al (2017) Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007455.pub3 CrossRefPubMedPubMedCentral

Title: Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy?
Authors: S. Quadlbauer
Ch. Pezzei
J. Jurkowitsch
R. Rosenauer
B. Kolmayr
T. Keuchel
D. Simon
T. Beer
T. Hausner
M. Leixnering
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keyword: Distal Radius Fracture
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03367-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy?

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2020

Current management of distal radius fractures and their complications

Ulnar shortening osteotomy as a treatment of symptomatic ulnar impaction syndrome after malunited distal radius fractures

Corrective osteotomy after malunited distal radius fractures

Biomechanical considerations on a CT-based treatment-oriented classification in radius fractures

Indications, surgical approach, reduction, and stabilization techniques of distal radius fractures

Distal radioulnar joint instability: current concepts of treatment