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Review
. 2021 Apr;14(2):107-129.
doi: 10.1007/s12178-021-09697-5. Epub 2021 Mar 10.

The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis

Helle K Østergaard  1   2 , Inger Mechlenburg  3   4   5 , Antti P Launonen  6 , Marianne T Vestermark  7 , Ville M Mattila  6 , Ville T Ponkilainen  8
Affiliations
Review

The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis

Helle K Østergaard et al. Curr Rev Musculoskelet Med. 2021 Apr.

Abstract

Purpose of review: Fractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials support non-surgical treatment. Evidence behind the best non-surgical treatment strategy has been sparse and raises questions as to when and how to initiate exercises. The purpose of this systematic review and meta-analysis was to assess the benefits and harms of early mobilization versus late mobilization and supervised versus non-supervised exercises therapy after PHF and DRF.

Recent findings: 15 published and 5 unpublished trials were included. Early mobilization after PHF resulted in better function with a mean difference (MD) of 4.55 (95% CI 0.00-9.10) on the Constant Shoulder Score. However, the MD was not found to be clinically relevant. No clear evidence showed that early mobilization after PHF had a positive effect on range of motion or pain. Neither did it lead to more complications. Furthermore, no eligible evidence was found supporting early mobilization to be superior to late mobilization after DRF, or that supervised exercise therapy was superior to non-supervised exercise therapy after PHF and DRF. The quality of evidence on all outcomes was found to be low or very low. Early mobilization after PHF may have a beneficial effect on function. Due to the lack of clear evidence, there is an urgent need for future studies to determine the effect of early mobilization and supervised exercise therapy after PHF and DRF. Prospero ID number: CRD42020167656, date of registration 28.04.2020.

Keywords: Distal radius fracture; Early mobilization; Non-surgical treatment; Proximal humerus fracture; supervised exercise therapy.

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Conflict of interest statement

H.K.Ø., I.M.,, A.P.L., M.T.V., V.M.M., and V.T.P. declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of the included studies
Fig. 2
Fig. 2
Function, 6 months after proximal humerus fracture. Displays pooled weighted mean difference for function (Constant shoulder score). 95% CI = 95% confidence interval
Fig. 3
Fig. 3
Range of shoulder flexion, 6 months after proximal humerus fracture. Displays pooled weighted mean difference for shoulder flexion (°) of the fractured shoulder. 95% CI = 95% confidence interval
Fig. 4
Fig. 4
Range of shoulder abduction, 6 months after proximal humerus fracture. Displays pooled weighted mean difference for shoulder abduction (°) of the fractured shoulder. 95% CI = 95% confidence interval
Fig. 5
Fig. 5
Patient-reported pain, 6 months after proximal humerus fracture. Displays pooled weighted mean difference for shoulder pain (VAS and Likert scale/0-10). 95% CI = 95% confidence interval
See this image and copyright information in PMC

References

    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–697. doi: 10.1016/j.injury.2006.04.130. - DOI - PubMed
    1. Launonen AP, Lepola V, Saranko A, Flinkkila T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Arch Osteoporos. 2015;10:209. doi: 10.1007/s11657-015-0209-4. - DOI - PubMed
    1. Rundgren J, Bojan A, Mellstrand Navarro C, Enocson A. Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord. 2020;21(1):88. doi: 10.1186/s12891-020-3097-8. - DOI - PMC - PubMed
    1. Lander ST, Mahmood B, Maceroli MA, Byrd J, Elfar JC, Ketz JP, Nikkel LE. Mortality rates of humerus fractures in the elderly: does surgical treatment matter? J Orthop Trauma. 2019;33(7):361–365. doi: 10.1097/bot.0000000000001449. - DOI - PMC - PubMed
    1. Launonen AP, Sumrein BO, Reito A, Lepola V, Paloneva J, Jonsson KB, et al. Operative versus non-operative treatment for 2-part proximal humerus fracture: a multicenter randomized controlled trial. PLoS Med. 2019;16(7):e1002855. doi: 10.1371/journal.pmed.1002855. - DOI - PMC - PubMed

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