A Prospective Randomized Controlled Trial of Manual Lymph Drainage (MLD) for the Reduction of Hand Oedema after Distal Radius Fracture

Abstract

The effectiveness of MLD in reducing oedema of the hand after a traumatic injury was evaluated. Patients with oedema of the hand, which is defined as having a volume greater than 40ml compared to the uninjured hand, were chosen when the fixation period was completed after a fracture of the distal radius. Fractures were treated either with plaster or with an external fixator. A total of 51 patients were included in the study over a period of three years and were randomized into an experimental or control group. Therapy started on average three and a half days after mobilization. All patients received the same conventional treatment, including exercises, activities, oedema control and education. In addition, the experimental group received six treatments of MLD. Oedema of the injured hand was measured with a volumeter at 14 days and 60 days after commencement of treatment, and this was compared to the pre-treatment volume. There was a significantly greater reduction in oedema in the experimental group (median difference 30ml) compared to the control group (median difference 20ml) at the first measurement (p=0.005) taken at 14 days. These results indicate that MLD is a useful method for reducing post-traumatic oedema of the hand in the early phase.

Abordaje de las fracturas de escafoides

“…Siguiendo los trabajos de Vodder, otros autores también investigaron la función linfática y en las últimas décadas se incorpora el uso del microscopio electrónico para estudiar el sistema linfático (12). -Movilización manual del edema (MEM): esta técnica se usa para prevenir o reducir el alto contenido proteico en el edema subagudo o crónico, estimulando los nódulos linfáticos, absorbiendo así el exceso de líquido y grandes moléculas del intersticio (13). Para edemas con alto contenido preoteico, es necesario llevar ese exce-so de proteínas fuera del intersticio para romper el escenario de inflamación que lleva a la fibrosis.…”

Variation in the Use of Therapy following Distal Radius Fractures in the United States

“… 9 , 10 DRF therapy protocols vary widely and can include massage, soft-tissue compression, manual therapy techniques, heat/cold modalities, electrical simulation, ultrasound, whirlpool, and training (eg, self-care/home management training and community/work reintegration training). 4 , 11 – 23 In some studies, participation in formal occupational therapy following DRF is correlated with improved wrist motion and grip strength. 14 , 24 Yet, others do not show a clear benefit of therapist-directed therapy, and a recent randomized trial failed to demonstrate any advantage of a formal occupational therapy program for patients who underwent internal fixation following DRF.…”