Effects of early finger mobilization on functional outcomes of the hand after distal radius fracture

• Main Authors: Ying-YaHsu, 徐瑛雅
• Other Authors: Li-Chieh Kuo
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/55089484865364871048

碩士 === 國立成功大學 === 職能治療學系碩博士班 === 98 === Abstract Background and purpose: Some clinical evidences have indicated that the uninjured joint stiffness and contracture is one of the complications of patients after distal radius fracture (DRF). The finger joints are reported to have a higher incidence of joint stiffness and contracture than the rates of other joints. Although the finger exercise has been advocated in the discharge plan, few clinical evidences present the realistic practice of the execution of the finger exercise of the patients, the change of range of motion (ROM) of fingers over a period of time after the external fixation of the wrist joint, and the effect of early finger intervention on the finger mobility and functional performance. From our clinical observations, it is not difficult to discover that joint stiffness or contracture is easily detected during fractural healing, even after completely bony recovery, so that the functional outcomes of the hand are usually not satisfied owing to the limitation of joint mobility. Hence, the purpose of this study is to investigate the effect of early intervention, which consists of finger joint mobilization and edema control, on the functional outcome performances of patients after receiving external fixation of DRF based on objective biomechanical and clinical assessments. Methods: This study recruited 22 patients suffering from DRF and receiving wrist external fixation surgically. 11of them were randomly assigned to the early intervention group and the other 11 were allocated to the controlled group. Patients in the early intervention group received early finger intervention and designated home program immediately after surgically external fixation until 12 weeks after surgery. The controlled group only received hand rehabilitation after removing the external fixation (around 6-8 weeks) until 12 weeks after surgery. The assessments for the outcome measures include the evaluations of edema (measuring tape), pain (10 points VAS), strength (lateral pinch, three-jaw pinch, and grip power, measured by JAMAR? Hydraulic Pinch Gauge and JAMAR? Grip Hand Dynamometer respectively), ROM and maximal working space of finger and thumb (miniBird (a electromagnetic field motion monitor), Innovative Sports Training, Inc.), hand functional performance (Manual Ability Measure, MAM), and radiograph in accordance with the following timetable: 1) at the first week and 2) the third week after surgery, 3) at the first week after removing the external fixation, and 4) at the twelfth week after surgery. After data collection, the demography, the level of Frykman classification, and the parameters of kinematics were analyzed by descriptive statistics. The investigation of the measured parameters between these two groups was examined by the Mann-Whitney U test and tested the intervention effect by eddect size. Results: About the demography, the mean age of the early intervention group and the controlled group were 59.27 ± 5.26 and 64.91 ± 7.57 years old respectively. All subjects were right handed. The level of Frykman classification and radiographic factors had no significant difference between the two groups. The bone healing status which including radial shortening, radial tilt, and volar tilt were no significant difference between the early intervention and controlled groups. There was a significant difference of the distal middle finger at the 3rd assessment (p=.033 ＆ p=.011) between the two groups of edema improving status, and the mean edema improving status in the early intervention group was better than the controlled group.The mean finger motion area in the early intervention group was better than the controlled group . The dexterity improving status had a significant difference (p= .038, Effect Size=0.40) between the two groups. The strength which including lateral pinch, three-jaw pinch, grip power except the grip power, there were significant differences of the three-jaw pinch and later pinch at the 3rd assessment (p=.039 ＆ .045). Finally, the mean pain score of the early intervention group was less than the controlled group. Discussion: The results demonstrate that the early finger intervention might not be able to affect bone healing status since no significant difference between the intervention and controlled groups. This report also shows that the early finger intervention is effective, because the mean scores of the early intervention group were better than the performances of the controlled group in the edema improving status, pain status, the maximal working space of finger and thumb, strength, and the hand functional performance. The reasons for few significant differences of the above parameters maybe be the number of subjects. It may recruit more subjects with distal radius fracture by different surgery ways, and attend to compliance of the subjects in the future. Conclusion: The outcomes of this study provide detailed and objective evidence-based knowledge for further intervention and the hand status progress of the patients with distal radius fracture. Therefore, it might suggest that the orthopedists could refer the patients with distal radius fracture to occupational therapists or hand therapists for early finger mobilization after surgery immediately.