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Rehabilitation for distal radial fractures in adultsHandoll HHG, Madhok R, Howe TE
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SummaryRehabilitation as part of treatment for adults with a broken wristParticularly in older women, a broken wrist (comprising a fracture at the lower end of one of the two forearm bones) can result from a fall onto an outstretched hand. Treatment usually includes putting the bone fragments back in place, if badly displaced, and immobilising the wrist in a plaster cast. Exercises and other physical interventions are used to help restore function and speed up recovery. The 15 randomised controlled trials included in this review tested 13 comparisons in a total of 746 mainly female and older people. Initial treatment was plaster cast immobilisation in all but 27 participants who had surgery. Some trials were well conducted but others were methodologically compromised and none provided conclusive evidence. There was weak evidence that rehabilitation (hand therapy or task-orientated therapy) started during immobilisation improved hand function after plaster cast removal but not in the longer term (two trials). There was weak evidence that outcome after supervised exercises started during immobilisation did not differ from outcome after unsupervised exercises (one trial). The rest of the interventions under test were started post-immobilisation, mainly after removal of the plaster cast. There was weak evidence indicating that formal rehabilitation therapy (four trials), passive mobilisation of the wrist joint complex by the therapist while the patient remained inactive (two trials), ice or pulsed electromagnetic field (one trial), or whirlpool immersion of the injured forearm (one trial) did not improve outcome. There was weak evidence of a short-term benefit of using a continuous passive motion device (after external fixation) (one trial), intermittent pneumatic compression (one trial) and ultrasound (one trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (one trial). We concluded that there was not enough evidence available to determine the best form of rehabilitation for people with wrist fractures.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 22. 2002 AbstractBackgroundFracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis. ObjectivesTo examine the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures. Search strategyWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Selection criteriaRandomised or quasi-randomised controlled trials evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians. Data collection and analysisThe authors independently selected and reviewed trials. Study authors were contacted for additional information. No data pooling was done. Main resultsFifteen trials, involving 746 mainly female and older patients, were included. Initial treatment was conservative, involving plaster cast immobilisation, in all but 27 participants whose fractures were fixed surgically. Though some trials were well conducted, others were methodologically compromised. For interventions started during immobilisation, there was weak evidence of improved hand function for hand therapy in the days after plaster cast removal, with some beneficial effects continuing one month later (one trial). There was weak evidence of improved hand function in the short term, but not in the longer term (three months), for early occupational therapy (one trial), and of a lack of differences in outcome between supervised and unsupervised exercises (one trial). For interventions started post-immobilisation, there was weak evidence of a lack of clinically significant differences in outcome in patients receiving formal rehabilitation therapy (four trials), passive mobilisation (two trials), ice or pulsed electromagnetic field (one trial), or whirlpool immersion (one trial) compared with no intervention. There was weak evidence of a short-term benefit of continuous passive motion (post external fixation) (one trial), intermittent pneumatic compression (one trial) and ultrasound (one trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (one trial). Authors' conclusionsThe available evidence from randomised controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius. |