Controlled active exercise after open reduction and internal fixation of hand fractures

Abstract

Background: Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes.

Methods: Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed.

Results: Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up.

Conclusions: Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

Keywords: Exercise; Fracture; Hand; Open reduction.

Fig. 1.. Controlled active exercise with pain-free active traction

Strategic exercises were performed using a Thera-Band in three positions—namely, supination (A, B), neutral (C, D), and pronation (E, F)—between 3 and 5 weeks postoperatively. The proximal and distal interphalangeal joints were flexed to hold the elastic band with minimal force. The patient’s elbow and shoulder joints were utilized to perform the active traction exercises.

Fig. 2.. Minimal loading active exercise with Aquaplast splint

A thermoplastic splint was molded and applied on the proximal phalanx. The link between the splint and rubber band led to gradual flexion of the metacarpophalangeal joint. Active extension (A) and passive flexion (B) were possible.

Fig. 3.. A case of metacarpal bone fracture

A 30-year-old male patient presented with a fifth metacarpal neck fracture of the right hand (A). Open reduction and internal plate fixation were performed. Bony union had been achieved at a postoperative follow-up of 18 weeks (B). The finger joints had a full range of motion (metacarpophalangeal joint 90°, proximal interphalangeal joint 100°, distal interphalangeal joint 70°) without limitation (C, D). The operative wound had a minimal scar (E, F).

Fig. 4.. A case of proximal phalangeal bone fracture

A 56-year-old female patient presented with a fifth proximal phalangeal bone fracture of the left hand (A). Bony alignment was maintained well in the oblique view of the radiological image. Bony union had been achieved at a postoperative follow-up of 20 weeks (B). The plate was removed at 22 weeks after open reduction surgery (C). The finger joints showed a moderate range of motion (metacarpophalangeal joint 72°, proximal interphalangeal joint 88°, distal interphalangeal joint 70°) (D, E). The operative wound had a minimal scar (F, G).