Investigators studying this area also found group designation, age and
ulnar variance among the predictors of a patient’s final flexion and
extension.
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
|
David C.
Ring
|
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.