ABSTRACT
The aim of this study was to determine the effectiveness of early versus delayed motion on the functional outcomes in patients with distal radius fracture (DRF) treated with a volar locking plate. A systematic review and meta-analysis of randomized clinical trials was performed. An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria included randomized clinical trials that compared the effect of early versus delayed motion on wrist and/or upper limb function, pain, grip strength, and wrist range of motion in subjects older than 18 years with DRF treated with a volar locking plate. Five clinical trials were included that met the eligibility criteria for the quantitative synthesis. At 6 weeks, the PRWE questionnaire showed a mean difference (MD) of -10.6 points (p < 0.001), the MD was -11.1 points for the DASH questionnaire (p < 0.001), -0.56 cm for pain on VAS (p = 0.01), 5.0 kg for grip strength (p = 0.01), 12.5 degrees for wrist flexion (p = 0.07), and 12.8 degrees for wrist extension (p = 0.05). All differences favored the early motion treatment. At 3 months of follow-up, only the DASH, pain on VAS, and grip strength showed significant differences in favor of early motion. At 1 year of follow-up, none of the variables studied were different between groups. In the short term, there was moderate to high evidence of clinically and statistically significant differences in the functional outcomes in favor of early versus delayed motion in patients with DRF treated with a volar locking plate. But these differences were not observed at 1 year of follow-up. PROSPERO registration no.: CRD42020158706.
Subject(s)
Radius Fractures , Bone Plates , Fracture Fixation, Internal , Humans , Radius Fractures/surgery , Range of Motion, Articular , Wrist Joint/surgeryABSTRACT
La fractura de radio distal es un problema clínico común que afecta principalmente a mujeres de edad avanzada, el uso de las diferentes modalidades de fisioterapia en el último tiempo se ha transformado en una indicación de rutina en el proceso de rehabilitación de estos pacientes, se realizará una síntesis de la evidencia a través de una revisión sistemática de ensayos clínicos aleatorizados. Objetivo. Determinar si existe evidencia científica que avale las intervenciones fisioterapéuticas usadas en la rehabilitación de pacientes con fractura de radio distal. Estrategia de búsqueda Solo se incluyeron en la búsqueda ensayos clínicos aleatorizados (ECA) y ensayos clínicos controlados (ECC), las bases de datos usadas fueron: MEDLINE, CINAHL, Central, EMBASE, PEDro y LILACS. Resultados. Se seleccionaron 9 artículos que cumplían con nuestros criterios de elegibilidad. Conclusion. existe moderada evidencia que el ultrasonido de baja intensidad acelera la consolidación ósea y la evidencia es contradictoria que un programa de tratamiento realizado por un fisioterapeuta sea más efectivo que un programa de ejercicios en domicilio a mediano plazo (AU)
The distal radius fracture is a common clinical problem that mainly affects elderly women. The use of different modalities of physiotherapy has recently become a routine indication in rehabilitation process in these patients. A synthesis of the evidence is made using a Systematic Review of Randomized Clinical Trials. Objective. Determine whether there is scientific evidence to support the physiotherapy interventions used in the rehabilitation of patients with distal radius fractures. Search Strategy. Only Randomized Control Trials (RCTs) and Controlled Clinical Trials (CCCs) were included in the search. The databases used were MEDLINE, CINAHL, Central, EMBASE, PEDro and LILACS. Results. A total of 9 papers that met our eligibility criteria were selected. Conclusion. There is moderate evidence that low-intensity ultrasound accelerates bone healing. The evidence that a treatment program by a physical therapist is more effective than a home exercises program in the medium term is contradictory (AU)
