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Rehabilitation for distal radial fractures in adults

  • Review
  • Intervention

Authors


Abstract

Background

Fracture of the distal radius is a common clinical problem, particularly in older white women with osteoporosis.

Objectives

To examine the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005), MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker and other databases, conference proceedings and reference lists of articles. No language restrictions were applied.

Selection criteria

Randomised or quasi-randomised controlled trials evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians.

Data collection and analysis

The authors independently selected and reviewed trials. Study authors were contacted for additional information. No data pooling was done.

Main results

Fifteen trials, involving 746 mainly female and older patients, were included. Initial treatment was conservative, involving plaster cast immobilisation, in all but 27 participants whose fractures were fixed surgically. Though some trials were well conducted, others were methodologically compromised.

For interventions started during immobilisation, there was weak evidence of improved hand function for hand therapy in the days after plaster cast removal, with some beneficial effects continuing one month later (one trial). There was weak evidence of improved hand function in the short term, but not in the longer term (three months), for early occupational therapy (one trial), and of a lack of differences in outcome between supervised and unsupervised exercises (one trial).

For interventions started post-immobilisation, there was weak evidence of a lack of clinically significant differences in outcome in patients receiving formal rehabilitation therapy (four trials), passive mobilisation (two trials), ice or pulsed electromagnetic field (one trial), or whirlpool immersion (one trial) compared with no intervention. There was weak evidence of a short-term benefit of continuous passive motion (post external fixation) (one trial), intermittent pneumatic compression (one trial) and ultrasound (one trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (one trial).

Authors' conclusions

The available evidence from randomised controlled trials is insufficient to establish the relative effectiveness of the various interventions used in the rehabilitation of adults with fractures of the distal radius.

摘要

背景

成年人橈骨遠端骨折之復健(文?回顧)

橈骨遠端骨折是常見的臨床問題,特別是在患有骨質疏鬆的老年女性白人。

目標

檢視在成年人之橈骨遠端骨折,經由保守或手術治療後之復健成效。

搜尋策略

搜尋了Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (2005年12月),Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2005),MEDLINE, EMBASE, CINAHL,AMED,PEDro,OTseeker及其他資料庫,會議摘錄,論文參考目錄。並且無語文種類之設限。

選擇標準

舉凡準隨機或隨機對照試驗,是以評估復健療效為治療成年人橈骨遠端骨折之部份者。復健包括了主動式及被動式之運動,日常活動之訓練;不管是單一項目或是合併方式,或是經由臨床醫師以其他各種不同方法來實施。

資料收集與分析

作者們各自獨立地選擇及回顧有關的試驗。並聯絡原著作者徵詢其餘相關之資訊。但並未將所有資料匯總整理。

主要結論

共有十五個試驗,包括了746位以女性及老年人為主要之病患。?大多數一開始是接受包括石膏固定之保守治療;但有27位是接手術固定治療。有些試驗執行良好,另外有些則方法上有缺失。在活動限制期間開始復健治療者,有簿弱證據顯示石膏剛拆除後因手部復健而得到功能改善;在治療持續一個月之後,則有相當的助益(一項試驗證實)。有簿弱證據顯示早期職能治療在短期之內有手部功能之改善,但長期則否(一項試驗證實)。而在監督式與非監督式復健運動之間則無差異(一項試驗證實)。在結束活動限制後開始復健者,有簿弱證據顯示與不作復健治療的結果相比較時,缺乏顯著臨床差別結果者有:正式復健治療(四項試驗證實),被動式運動(兩項試驗證實),冰敷及脈衝電磁場(一項試驗證實),或漩渦浸潤法(一項試驗證實)。有簿弱證據顯示外固定拆除之被動式活動復健(一項試驗證實)、間斷的氣壓式復健(一項試驗證實)、及超音波治療(一項試驗證實)有短期之成效。有簿弱證據顯示:接受物理治療的病患與僅由外科醫生告知在家中作運動者比較,在短期結果是有差別。

作者結論

從隨機對照試驗所可取得的證據並無法證實對成年人橈骨遠端骨折之各種復健方式之成效。

翻譯人

本摘要由林口長庚醫院陳昭宇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以復健作為成年人腕部骨折治療之一部份 特別是在較年老之女性,跌倒時以過度伸張之手腕支撐可能導致腕部骨折(兩支前臂骨之一的遠端骨折)。治療通常包括了將移位之骨折復位,並以石膏固定腕部。復健運動及其他物理治療經常被用來幫助功能的恢復及加速復原。在本文所涵蓋的15個隨機對照試驗中,總共包括了746位以女性及老年人為多數之病患,並作了13項之比較測試。初始治療除了27位接受手術之病患外,都以石膏固定治療。有些研究執行良好,而部份研究則方法上有缺失;所有研究都無法提供有結論之證據。在活動限制期間開始復健治療者(手部治療或以任務為指標的治療),有簿弱證據顯示石膏剛拆除時因手部復健而得到功能改善;但長期則否(兩項試驗證實)。在活動限制期間開始復健治療者,有簿弱證據顯示其結果在監督式與非監督式復健運動之間則無差異(一項試驗證實)。在結束活動限制後開始復健者,有簿弱證據顯示:正式復健治療(四項試驗證實),被動式運動(兩項試驗證實),冰敷及脈衝電磁場(一項試驗證實),或漩渦浸潤法(一項試驗證實) 皆無法有功能之改善。有簿弱證據顯示外固定拆除之被動式活動復健(一項試驗證實)、間斷的氣壓式復健(一項試驗證實)、及超音波治療(一項試驗證實)有短期之成效。有簿弱證據顯示:接受物理治療的病患,與僅由外科醫生告知在家中作運動者比較,有短期的較佳手部功能(一項試驗證實)。 結論:尚無充份資料佐證腕部骨折之最佳復健方式。

Plain language summary

Rehabilitation as part of treatment for adults with a broken wrist

Particularly in older women, a broken wrist (comprising a fracture at the lower end of one of the two forearm bones) can result from a fall onto an outstretched hand. Treatment usually includes putting the bone fragments back in place, if badly displaced, and immobilising the wrist in a plaster cast. Exercises and other physical interventions are used to help restore function and speed up recovery.

The 15 randomised controlled trials included in this review tested 13 comparisons in a total of 746 mainly female and older people. Initial treatment was plaster cast immobilisation in all but 27 participants who had surgery. Some trials were well conducted but others were methodologically compromised and none provided conclusive evidence.

There was weak evidence that rehabilitation (hand therapy or task-orientated therapy) started during immobilisation improved hand function after plaster cast removal but not in the longer term (two trials). There was weak evidence that outcome after supervised exercises started during immobilisation did not differ from outcome after unsupervised exercises (one trial).

The rest of the interventions under test were started post-immobilisation, mainly after removal of the plaster cast. There was weak evidence indicating that formal rehabilitation therapy (four trials), passive mobilisation of the wrist joint complex by the therapist while the patient remained inactive (two trials), ice or pulsed electromagnetic field (one trial), or whirlpool immersion of the injured forearm (one trial) did not improve outcome. There was weak evidence of a short-term benefit of using a continuous passive motion device (after external fixation) (one trial), intermittent pneumatic compression (one trial) and ultrasound (one trial). There was weak evidence of better short-term hand function in participants given physiotherapy than in those given instructions for home exercises by a surgeon (one trial).

We concluded that there was not enough evidence available to determine the best form of rehabilitation for people with wrist fractures.