A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius

Abstract

Background: The effect of formal occupational therapy on recovery after open reduction and volar plate fixation of a fracture of the distal part of the radius is uncertain. We hypothesized that there would be no difference in wrist function and arm-specific disability six months after open reduction and volar plate fixation of a distal radial fracture between patients who receive formal occupational therapy and those with instructions for independent exercises.

Methods: Ninety-four patients with an unstable distal radial fracture treated with open reduction and volar locking plate fixation were enrolled in a prospective randomized controlled trial comparing exercises done under the supervision of an occupational therapist with surgeon-directed independent exercises. The primary study question addressed combined wrist flexion and extension six months after surgery Secondary study questions addressed wrist motion, grip strength, Gartland and Werley scores, Mayo wrist scores, and DASH (Disabilities of the Arm, Shoulder and Hand) scores at three months and six months after surgery.

Results: There was a significant difference in the mean arc of wrist flexion and extension six months after surgery (118° versus 129°), favoring patients prescribed independent exercises. Three months after surgery, there was a significant difference in mean pinch strength (80% versus 90%), mean grip strength (66% versus 81%), and mean Gartland and Werley scores, favoring patients prescribed independent exercises. At six months, there was a significant difference in mean wrist extension (55° versus 62°), ulnar deviation (82% versus 93%), mean supination (84° versus 90°), mean grip strength (81% versus 92%), and mean Mayo score, favoring patients prescribed independent exercises. There were no differences in arm-specific disability (DASH score) at any time point.

Conclusions: Prescription of formal occupational therapy does not improve the average motion or disability score after volar locking plate fixation of a fracture of the distal part of the radius.