Clinical Trial: Early Motion After Volar Fixation for Distal Radius Fractures
Study Status: Completed
Recruit Status: Completed
Study Type: Interventional
Official Title: Early Motion After Volar Fixation for Distal Radius Fractures: A Prospective Trial
Brief Summary: Many surgeons pursue volar plating of the distal radius to allow earlier post-operative wrist motion. Early motion is generally prescribed in the belief that it will result in greater final motion without compromising fixation. However, studies have failed to demonstrate clinically significant improvement in final wrist motion (> 1 year follow up) compared to treatments requiring longer immobilization such as external fixation or bridge plating.
Detailed Summary:
Many surgeons pursue volar plating of the distal radius to allow earlier post-operative wrist motion. Early motion is generally prescribed in the belief that it will result in greater final motion without compromising fixation. However, studies have failed to demonstrate clinically significant improvement in final wrist motion (>1 year follow up) compared to treatments requiring longer immobilization such as external fixation or bridge plating (McQueen 1996, Handoll 2003, Atroshi 2006, Krishnan 2003, Sommerkamp 1994, Grewal 2005).
Only one study to date has attempted to define the early effects of wrist mobilization following volar plate fixation of the distal radius (Lozano-Calderon 2008). That study prospectively enrolled 60 patients and randomized them to begin wrist motion at 2 weeks (range 7 days - 13 days) or 6 weeks (range 42 to 49 days) postoperatively. This study found no significant difference in subjective or objective outcome measures at 3 or 6 months follow up. However, the investigation had several weaknesses. First, there was no attempt to confirm adherence to the immobilization protocols. Those in the late motion group were not casted but remained in orthoplast splints which could be easily removed. Secondly, this investigation collected data only at 3 and 6 months which prohibited them from commenting on the rate of improvement during the early weeks after mobilization. The authors acknowledged these limitations and further noted that no evaluation of patient cost was performed. Finally, radiographic evaluations in this study did not include analysis of change in alignment from immediate postoperative films.
Thus, the literature to date suggests that early mobilization of the volarly plated distal radius is safe but does not improve final wrist motion. The benefits of mobilization in the early postopera
Sponsor: Washington University School of Medicine
Current Primary Outcome: Wrist Motion [ Time Frame: 2 weeks - 1 year ]
Original Primary Outcome: Same as current
Current Secondary Outcome:
- Patient Function [ Time Frame: 2 weeks - 1 year ]
- Patient Pain [ Time Frame: 2 weeks - 1 year ]
- Fracture reduction [ Time Frame: 2 week - 1 year ]
Original Secondary Outcome: Same as current
Information By: Washington University School of Medicine
Dates:
Date Received: August 7, 2009
Date Started: June 2009
Date Completion:
Last Updated: June 26, 2015
Last Verified: June 2015
