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Current Reviews in Musculoskeletal Medicine

Erschienen in:

10.03.2021 | Hot Topics

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

verfasst von: Helle K. Østergaard, Inger Mechlenburg, Antti P. Launonen, Marianne T. Vestermark, Ville M. Mattila, Ville T. Ponkilainen

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 2/2021

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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15 published and 5 unpublished trials were included.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.

Summary

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

Nur mit Berechtigung zugänglich

Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691–7. https://doi.org/10.1016/j.injury.2006.04.130.CrossRefPubMed

Launonen AP, Lepola V, Saranko A, Flinkkila T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Arch Osteoporos. 2015;10:209. https://doi.org/10.1007/s11657-015-0209-4.CrossRefPubMed

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. https://doi.org/10.1186/s12891-020-3097-8.CrossRefPubMedPubMedCentral

Lander ST, Mahmood B, Maceroli MA, Byrd J, Elfar JC, Ketz JP, et al. Mortality rates of humerus fractures in the elderly: does surgical treatment matter? J Orthop Trauma. 2019;33(7):361–5. https://doi.org/10.1097/bot.0000000000001449.CrossRefPubMedPubMedCentral

• 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. https://doi.org/10.1371/journal.pmed.1002855This recent trial found no benefits of surgical treatment with locking plate compared to non-surgical treatment after 2-part proximal humerus fractures in the elderly. They suggest non-surgical treatment on the majority of the patients with this kind of fracture, which is in line with the conclusion from a Cochrane Review from 2015 by Handoll et al.CrossRefPubMedPubMedCentral

Handoll HH, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2015;(11):Cd000434. https://doi.org/10.1002/14651858.CD000434.pub4.

Rangan A, Handoll H, Brealey S, Jefferson L, Keding A, Martin BC, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. Jama. 2015;313(10):1037–47. https://doi.org/10.1001/jama.2015.1629.CrossRefPubMed

• Mellstrand Navarro C, Brolund A, Ekholm C, Heintz E, Hoxha Ekstrom E, Josefsson PO, et al. Treatment of radius or ulna fractures in the elderly: a systematic review covering effectiveness, safety, economic aspects and current practice. PLoS One. 2019;14(3):e0214362. https://doi.org/10.1371/journal.pone.0214362This review does not find that surgical treatment after moderately displaced distal radius fracture in the elderly is superior to non-surgical treatment. Furthermore, surgical treatment was found to increase the risk of major complications.CrossRefPubMedPubMedCentral

•• Bruder AM, Shields N, Dodd KJ, Taylor NF. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Aust J Phys. 2017;63(4):205–20. https://doi.org/10.1016/j.jphys.2017.08.009This review suggests that current prescribed exercise regimes do not lead to an improvement of activity following distal radius fracture or proximal humerus fracture. However, patients with these fractures may benefit from early exercises and shorter immobilization.CrossRef

10.

Handoll H, Brealey S, Rangan A, Keding A, Corbacho B, Jefferson L, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial – a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015;19(24):1–280. https://doi.org/10.3310/hta19240.CrossRefPubMedPubMedCentral

11.

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;350:g7647. https://doi.org/10.1136/bmj.g7647.CrossRefPubMed

12.

Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16. https://doi.org/10.1186/1472-6947-7-16.CrossRefPubMedPubMedCentral

13.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Bmj. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

14.

Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94. https://doi.org/10.1016/j.jclinepi.2010.04.026.CrossRefPubMed

15.

Hodgson SA, Mawson SJ, Saxton JM, Stanley D. Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). J Shoulder Elb Surg. 2007;16(2):143–5. https://doi.org/10.1016/j.jse.2006.06.003.CrossRef

16.

Hodgson SA, Mawson SJ, Stanley D. Rehabilitation after two-part fractures of the neck of the humerus. J Bone Joint Surg (Br). 2003;85(3):419–22. https://doi.org/10.1302/0301-620x.85b3.13458.CrossRef

17.

Lefevre-Colau MM, Babinet A, Fayad F, Fermanian J, Anract P, Roren A, et al. Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. J Bone Joint Surg Am. 2007;89(12):2582–90. https://doi.org/10.2106/jbjs.F.01419.CrossRefPubMed

18.

Kristiansen B, Angermann P, Larsen TK. Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization. Arch Orthop Trauma Surg. 1989;108(6):339–41.CrossRefPubMed

19.

Early vs Delayed Physical Therapy (Exercises) for Non-Operatively-Treated Proximal Humerus Fractures: A Prospective Randomized Trial [database on the Internet]. National Library of Medicine (US). 2000 Feb 29, (cited July 2. 2020), Available at: https://clinicaltrials.gov/ct2/show/NCT00438633. Accessed 30 May 2020.

20.

Conservative Treatment of Proximal Humeral Fractures – Immobilization for 1 Week Compared to Three Weeks: Prospective Randomized Study [database on the Internet]. National Library of Medicine (US). 2000 Feb 29 , (cited July 2, 2020), Available from: https://clinicaltrials.gov/ct2/show/study/NCT03217344. Accessed 30 May 2020.

21.

Davis TR, Buchanan JM. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis. Injury. 1987;18(4):283–5. https://doi.org/10.1016/0020-1383(87)90015-5.CrossRefPubMed

22.

Dias JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilisation in the treatment of Colles' fractures. J Bone Joint Surg (Br). 1987;69(3):463–7.CrossRef

23.

Stoffelen D, Broos P. Minimally displaced distal radius fractures: do they need plaster treatment? J Trauma. 1998;44(3):503–5. https://doi.org/10.1097/00005373-199803000-00014.CrossRefPubMed

24.

Jensen MR, Andersen KH, Jensen CH. Management of undisplaced or minimally displaced Colles' fracture: one or three weeks of immobilisation. J Orthop Sci. 1997;2(6):424–7.CrossRef

25.

Christersson A, Larsson S, Sandén B. Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomized study. Scand J Surg. 2018;107(1):82–90. https://doi.org/10.1177/1457496917731184.CrossRefPubMed

26.

Lungberg BJ, Svenungson-Hartwig E, Wikmark R. Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures. Scand J Rehabil Med. 1979;11(3):133–6.PubMed

27.

Bertoft ES, Lundh I, Ringqvist I. Physiotherapy after fracture of the proximal end of the humerus. Comparison between two methods. Scand J Rehabil Med. 1984;16(1):11–6.PubMed

28.

•• Gutierrez-Espinoza H, Rubio-Oyarzun D, Olguin-Huerta C, Gutierrez-Monclus R, Pinto-Concha S, Gana-Hervias G. Supervised physical therapy vs home exercise program for patients with distal radius fracture: a single-blind randomized clinical study. J Hand Ther. 2017;30(3):242–52. https://doi.org/10.1016/j.jht.2017.02.001This trial is the most recent trial comparing a supervised versus a non-supervised exercise program after distal radius fracture. They reported that a supervised exercise program is more effective for improving function compared to a non-supervised program. This was found on the PRWE score at 6 weeks and 6 months of follow-up.CrossRefPubMed

29.

Krischak G, Krasteva A, Pandorf-Frediani S, Dehner C, Schneider F, Gebhard F, et al. Effect of a home exercise program in rehabilitation of non operatively treated wrist fractures a prospectively randomized study. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin. 2009;19(4):185–92. https://doi.org/10.1055/s-0029-1225336.CrossRef

30.

Christensen OM, Kunov A, Hansen FF, Christiansen TC, Krasheninnikoff M. Occupational therapy and Colles' fractures. Int Orthop. 2001;25(1):43–5.CrossRefPubMed

31.

Wakefield AE, McQueen MM. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg Br Vol. 2000;82(7):972–6.CrossRef

32.

Watt CF, Taylor NF, Baskus K. Do Colles' fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg. 2000;120(7-8):413–5. https://doi.org/10.1007/pl00013772.CrossRefPubMed

33.

Bache S. Two different approaches to the physiotherapeutic management of patients with distal radial fractures. Physiotherapy. 2000;86(7):383.CrossRef

34.

Dabija DI, Jain NB. Minimal clinically important difference of shoulder outcome measures and diagnoses: a systematic review. Am J Phys Med Rehabil. 2019;98(8):671–6. https://doi.org/10.1097/phm.0000000000001169.CrossRefPubMedPubMedCentral

35.

Bruder AM, Taylor NF, Dodd KJ, Shields N. Physiotherapy intervention practice patterns used in rehabilitation after distal radial fracture. Physiotherapy. 2013;99(3):233–40. https://doi.org/10.1016/j.physio.2012.09.003.CrossRefPubMed

36.

Cunningham C, O’Sullivan R, Caserotti P, Tully MA. Consequences of physical inactivity in older adults: a systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020;30(5):816–27. https://doi.org/10.1111/sms.13616.CrossRefPubMed

37.

Non-operative Treatment in Sweden of Proximal Humeral Fractures, a Randomised Multicenter Trial. [database on the Internet]. National Library of Medicine (US). 2000 Feb 29 (cited July 2 2020), Available at: https://clinicaltrials.gov/ct2/show/NCT03786679. Accessed 30 May 2020.

38.

Johnson NA, Dias JJ. The effect of social deprivation on fragility fracture of the distal radius. Injury. 2019;50(6):1232–6. https://doi.org/10.1016/j.injury.2019.04.025.CrossRefPubMed

39.

Jayakumar P, Teunis T, Williams M, Lamb SE, Ring D, Gwilym S. Factors associated with the magnitude of limitations during recovery from a fracture of the proximal humerus: predictors of limitations after proximal humerus fracture. Bone Joint J. 2019;101-b(6):715–23. https://doi.org/10.1302/0301-620x.101b6.Bjj-2018-0857.R1.CrossRefPubMed

Titel: 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
verfasst von: Helle K. Østergaard
Inger Mechlenburg
Antti P. Launonen
Marianne T. Vestermark
Ville M. Mattila
Ville T. Ponkilainen
Publikationsdatum: 10.03.2021
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 2/2021
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-021-09697-5

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