Immobilization Following Volar Plate Fixation Of Distal Radius Fractures: A Prospective, Randomized Clinical Trial.
Jeffrey R. Hill, BS1, Gabriel Bouz, BA2, Paul Daniel Navo, MPH 2, 3; Ram K. Alluri, MD4; Alidad Ghiassi, MD2
1Keck School of Medicine of the University of Southern California, Los Angeles, CA; 2Keck School of Medicine of USC, Los Angeles, CA; 3Lewis Katz School of Medicine at Temple University, Philadelphia, PA; 4Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA
Hypothesis No consensus exists regarding the optimal postoperative splinting position to expedite return to function following volar plate fixation of distal radius fractures. The purpose of this study was to determine whether immobilization in supination would result in superior clinical outcomes compared to immobilization with no restriction of forearm range of motion.
Methods A prospective, randomized trial was conducted. All patients greater than eighteen years of age undergoing volar plate fixation for a distal radius fracture were eligible for participation. Patients were excluded if they had an open fracture, concomitant injury to either upper extremity (UE), or functional deficit of either UE. Patients were randomized to 1) immobilization in maximal supination using a plaster sugartong splint, or 2) no restriction of supination/pronation using a plaster short arm volar splint. The operating surgeon was blinded to each patient's postoperative immobilization assignment until the procedure was completed. PRWE and DASH functional outcome scores, VAS pain scores, forearm and wrist range of motion, and grip strength were recorded at two and six weeks postoperatively. All measurements were conducted by a physician blinded to the patient's splint assignment. Range of motion and grip strength were assessed as a percentage of the contralateral extremity. A student's t-test was used to compare mean values of all outcome measures at each time point, with statistical significance set at P < 0.05.
Results Forty-six patients were enrolled in the study. Twenty-eight were immobilized with a short arm volar splint and eighteen were immobilized in supination with a sugartong splint. Complete six-week follow-up data was obtained for thirty-one patients. There were no statistically significant differences in VAS, PRWE, and DASH scores, or range of motion and grip strength measurements between the study groups at two and six weeks postoperatively (Table 1).
- Range of motion, grip strength, and patient-rated subjective outcome measures were similar regardless of immobilization technique in patients with a distal radius fracture stabilized with a volar plate.
- Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function.
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