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E. Uršej1,2
1SMILE-E, Eva Uršej, s.p., JESENICE, Slovenia, 2Faculty of Health Care Angela Boškin, Physiotherapy, Jesenice, Slovenia
Background: In recent years, recovery time for traumatic surgery is decreasing due to improving materials, technologies and approaches used by surgeons. However, physiotherapy continues to play an important role in improving functionality, muscle strength, and range of motion in rehabilitating patients.
Purpose: The main purpose of this case report was to discover the time taken for a patient to make a full recovery after a surgically-treated distal radial fracture (DRF), using intensive, accelerated, fully supported physiotherapy.
Methods: After three weeks of immobilisation, a patient with an isolated DRF was treated by internal fixation using a volar plate (excluding bone graft) and then began intensive physiotherapy. This consisted of manual therapy, passive stretching and active mobilisation and started two days postoperatively. At two weeks, strengthening exercises, hydrotherapy in salt water and swimming were added to these therapy sessions.
The physiotherapy in the first 6 weeks was performed twice a day, each session lasting for 60 minutes. In weeks 7 to 10, the patient continued with one physiotherapy session of 60 minutes a day (manual therapy, strengthening exercises, passive stretching and active mobilisation), and in the last 8 weeks the patient continued with only strengthening exercises and passive stretching three times a week for 45 minutes.
Range of motion in all wrist movements, and grip strength, were assessed every day for 6 weeks and once a week for the next 12 weeks. Additionally, a Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, a Patient-Rated Wrist Evaluation (PRWE), and pain according to the Visual Analog Scale (VAS) score, were analysed once a week.
The physiotherapy in the first 6 weeks was performed twice a day, each session lasting for 60 minutes. In weeks 7 to 10, the patient continued with one physiotherapy session of 60 minutes a day (manual therapy, strengthening exercises, passive stretching and active mobilisation), and in the last 8 weeks the patient continued with only strengthening exercises and passive stretching three times a week for 45 minutes.
Range of motion in all wrist movements, and grip strength, were assessed every day for 6 weeks and once a week for the next 12 weeks. Additionally, a Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, a Patient-Rated Wrist Evaluation (PRWE), and pain according to the Visual Analog Scale (VAS) score, were analysed once a week.
Results: After 18 weeks, the patient’s range of motion in volar and dorsal flexion was only 5° less than the unaffected wrist, whereas the range of motion in all other wrist movements was completely recovered. Grip strength after 18 weeks was as expected compared to the unaffected hand. QuickDASH, PRWE and VAS scores returned to normal.
Conclusion(s): In literature, full recovery time after surgically treated DRFs, using standard rehabilitation protocols, is stated to be between 6 and 12 months. With an intensive, accelerated physiotherapy after surgically-treated DRF, full recovery can be achieved in less than 6 months.
Without any postoperative complications, our patient fully recovered functionality, grip strength and range of motion in 18 weeks. A randomised controlled study, with sample size big enough, needs to be done to confirm differences between an intensive therapy group and a control group undergoing standard rehabilitation protocol.
Without any postoperative complications, our patient fully recovered functionality, grip strength and range of motion in 18 weeks. A randomised controlled study, with sample size big enough, needs to be done to confirm differences between an intensive therapy group and a control group undergoing standard rehabilitation protocol.
Implications: The results of this study report suggest that intensive physiotherapy protocol after surgically-treated DRF can lead to better and faster recovery. Everyday therapy with a combination of manual therapy, active and passive mobilisation and hydrotherapy immediately after the surgery together with progressively added strengthening exercises, could be used more often in order to shorten the time to full recovery.
Funding, acknowledgements: The work was unfunded.
Keywords: full recovery, distal radius fracture, volar fixation
Topic: Sport & sports injuries
Did this work require ethics approval? No
Institution: Ministry of Health
Committee: National Medical Ethics Committee of Slovenia
Reason: Case report is not considered as research project and ethics committee gives opinion for research projects only.
All authors, affiliations and abstracts have been published as submitted.
