title: Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.
abstract: BACKGROUND
  There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol.
  
  
  METHODS
  From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch.
  
  
  RESULTS
  The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant.
  
  
  CONCLUSIONS
  Patients who follow an accelerated rehabilitation protocol that emphasizes motion immediately postoperatively and initiates strengthening at two weeks after volar ORIF of a distal radial fracture have an earlier return to function than patients who follow a more standard rehabilitation protocol.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55454. E-mail address: breh0019@umn.edu.
authors.forename: Jess L
authors.initials: JL
authors.lastname: Brehmer
authors.affiliation: TRIA Orthopaedic Center, University of Minnesota, 8100 Northland Drive, Bloomington, MN 55431. E-mail address: jeffrey.husband@tria.com.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Husband
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D011885:Radius Fractures / Q000534:rehabilitation* / Q000601:surgery*; D016059:Range of Motion, Articular