Volar Locking Plate Fixation of Distal Radius Fractures: Splint versus Immediate Mobilization

Abstract

The goal of this study was to demonstrate that the use of a splint after performing an osteosynthesis of the distal radius with a volar locking plate is unnecessary. The main hypothesis was that postoperative flexion of the wrist was greater without a splint. Secondary hypothesis was that patients who were allowed immediate mobilization got better results in terms of pain, Quick Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), strength, extension, pronation, and supination. Our series included 72 patients, aged 59 years in average of which 59 were female patients. All patients had been operated for a volar locking plate fixation of a distal radius fracture. The first 36 patients (group I) were immobilized by a splint at 30° of extension of the wrist for 2 weeks. The following 36 patients (group II) were not immobilized. At 3 months, all the average variables were better in the group without splint (group I: flexion 74.83%, extension 83.13%, pronation 92.07%, supination 88.11%, pain 1.72/10, Quick DASH 21.78/100, PRWE 22.97/100, strength 62.96%; group II: flexion 85.50%, extension 83.4%, pronation 92.96%, supination 92.96%, pain 1.28/10, Quick DASH 19.57/100, PRWE 20.56/100, strength 66.34%). No complication was reported. Overall, our results demonstrate that wearing a splint after volar locking plate fixation of a distal radius fracture is unnecessary.

A systematic review of how daily activities and exercises are recommended following volar plating of distal radius fractures and the efficacy and safety of early versus late mobilisation

“…Additional information was received from five authors [15][16][17][18][19] and there was no reply from three. [20][21][22] Activity and exercise data were tabulated and reported descriptively. Outcome data were ROM, function, pain, and adverse events.…”

“…Of the eight included studies, five were level II Oxford CEBM levels of evidence 27 randomised controlled trials (RCTs) [16][17][18][19]22 with the remaining three being level four retrospective chart reviews. 15,20,21 The studies all compared early and delayed mobilisation (< or !2 weeks) but varied with respect to purpose. Four studies aimed to determine the optimal period of immobilisation.…”

“…Four studies aimed to determine the optimal period of immobilisation. 16,19,21,22 The purpose of the remaining studies was to evaluate use of analgesia, 18 compare home and outpatient rehabilitation, 17 achievement of minimal clinically important differences for the DASH score 20 or compare numbers of hand therapy appointments. 15 In the early groups, mobilisation was commenced at an average of 4 days (range 1-8) and delayed until an average of 30 days (weeks two, 17,18,20,21 three, 16 five 22 or six 15,16,19 ) in the immobilised groups (see Table 3).…”

“…In all studies, daily activities were advocated, without a splint, from the time of mobilisation. Duprat et al 21 did not describe daily activity performance but because a splint was not given it is assumed participants were free to use the wrist. Iitsuka et al 20 also did not describe splint use or daily activities but the paper implied no splint was used.…”

“…Five studies [16][17][18]20,21 compared mobilisation that commenced prior to two weeks with mobilisation that was delayed until two to three weeks. Of these, three were of good or excellent quality.…”