Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #90, 4:33 pm OTA-2011
A Prospective Randomized Controlled Trial Comparing Occupational Therapy With Independent Exercises After Volar Plate Fixation of a Fracture of the Distal Radius
J. Sebastiaan Souer, MD; Geert A. Buijze, MD; David C. Ring, MD, PhD;
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital,
Boston, Massachusetts, USA
Background: The effect of formal occupational therapy on recovery after open reduction and volar plate fixation of a fracture of the distal radius is uncertain. We hypothesized there would be no difference in wrist function and arm-specific disability between patients who receive formal occupational therapy and those with instructions for independent exercises 6 months after open reduction and volar plate fixation of a distal radius fracture.
Methods: 96 patients with an unstable fracture of the distal radius fracture treated with open reduction and volar locking plate fixation were enrolled in a prospective randomized controlled trial comparing exercises done under the supervision of an occupational therapist with surgeon-directed independent exercises. The primary study question addressed combined wrist flexion and extension 6 months after surgery. Secondary study questions addressed wrist motion, grip strength, Gartland and Werley scores, Mayo wrist scores, and DASH (Disabilities of the Arm, Shoulder and Hand) scores at 3 months and 6 months after surgery.
Results: There was a significant difference in the arc of wrist flexion and extension 6 months after surgery (118° vs 129°) favoring patients prescribed independent exercises. Three months after surgery, there was a significant difference in pinch strength (80% vs 90%), grip strength (66% vs 81%), and Gartland and Werley scores favoring patients prescribed independent exercises. At 6 months, there was a significant difference in wrist extension (55% vs 62%), ulnar deviation (82% vs 93%), supination (84° vs 90°), grip strength (81% vs 92%), and Mayo score favoring patients prescribed independent exercises. There were no differences in arm-specific disability (DASH score) at any time point.
Conclusions: Prescription of formal occupational therapy does not improve the average motion or disability after volar locked plate fixation of a fracture of the distal radius.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.