The Journal of Bone and Joint Surgery (American). 2008;90:1297-1304.
doi:10.2106/JBJS.G.01368
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Wrist Mobilization Following Volar Plate Fixation of Fractures of the Distal Part of the Radius

Santiago A. Lozano-Calderón, MD1, Sebastiaan Souer, MD1, Chaitanya Mudgal, MD1, Jesse B. Jupiter, MD1 and David Ring, MD, PhD1

1 Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org

Investigation performed at Massachusetts General Hospital, Boston, Massachusetts

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the AO Foundation. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from commercial entities (Smith and Nephew, Wright Medical). Also, commercial entities (Small Bone Innovations, Wright Medical, Smith and Nephew, and Joint Active Systems) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Plate fixation of the distal part of the radius is believed to improve wrist motion by allowing earlier exercises. We performed a clinical trial comparing mobilization of the wrist joint within two weeks (early motion) or at six weeks (late motion) after volar plate fixation of a fracture of the distal part of the radius in order to test the null hypothesis that there are no differences in the flexion-extension arc three and six months after surgery.

Methods: Sixty patients with an isolated fracture of the distal part of the radius that was treated with a single, fixed-angle volar plate and screws were enrolled. Thirty patients were randomized to the early motion group, and thirty were randomized to the late motion group. Three and six months after surgery, patients underwent range of motion measurements, grip strength measurements, and radiographic evaluation. The patients also were evaluated according to the modified Gartland and Werley score and the Mayo wrist score, rated pain on a 10-point ordinal scale, and completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results: There were no significant differences between the early motion group and the late motion group with regard to the average flexion-extension arc of the injured wrist at three months (104° compared with 107°; p = 0.61) or six months (124° compared with 126°; p = 0.65) after surgery. In secondary analyses, there were no significant differences in terms of selected other motions, grip strength, radiographic parameters, or the Gartland and Werley, Mayo, pain, or DASH scores.

Conclusions: The initiation of wrist exercises six weeks after volar plate fixation of a fracture of the distal part of the radius does not lead to decreased wrist motion compared with the initiation of wrist motion within two weeks after surgery.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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