Sandvall Brinkley K, Friedrich Jeffrey B
Division of Plastic Surgery, University of Washington, Seattle, WA.
Division of Plastic Surgery, University of Washington, Seattle, WA.
J Hand Surg Am. 2015 May;40(5):1042-7. doi: 10.1016/j.jhsa.2014.04.037. Epub 2014 Jun 6.
Driving with upper extremity immobilization can be potentially dangerous. The aim of this article is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization and appraise the available evidence. A literature search was conducted to identify citations related to driving with upper extremity immobilization and included a law literature search. Each state's Department of Motor Vehicle handbook was reviewed. Fourteen studies were reviewed and 5 provided subjective and/or objective assessments of upper limb immobilization. Of 2 studies that evaluated only below-elbow immobilization, 1 found driving in a wrist splint had no perceptible effect on driving ability, and the other supported safe driving under normal conditions. The studies that evaluated both below- and above-elbow immobilization recommended against driving with left arm above-elbow immobilization. Two of them found a trend toward worse driving performance in both below- and above-elbow splints. The following organizations' policies on driving are (1) The American Medical Association and National Highway Traffic Association have a joint recommendation for older drivers recommending referral to a rehabilitation specialist, (2) the U.S. Public Health Service recommends normal motor function and adequate mobility of both upper extremities and a performance examination when impaired, and (3) the U.S. Department of Transportation recommends a performance evaluation to determine fitness of commercial motor vehicle drivers. There are no state statutes or multijurisdictional surveys on the topic. This review finds that driving is hindered in some splints, there are substantial variations in physician practice patterns, there are no formal guidelines for physicians and patients to consider, and there is a paucity of published literature on this topic in the United States. Both physicians and patients would benefit from evidence-based recommendations or practice guidelines.
上肢固定时驾车可能存在潜在危险。本文旨在回顾当前关于上肢固定时驾车的医学文献、州法律和指南，并评估现有证据。进行了文献检索以识别与上肢固定时驾车相关的引用文献，包括法律文献检索。对每个州的机动车手册进行了审查。共审查了14项研究，其中5项提供了对上肢固定的主观和/或客观评估。在仅评估肘部以下固定的2项研究中，1项发现佩戴腕部夹板驾车对驾驶能力没有明显影响，另一项支持在正常情况下安全驾车。评估肘部以下和肘部以上固定的研究均建议不要在左臂肘部以上固定的情况下驾车。其中两项研究发现，无论是肘部以下还是肘部以上夹板，驾驶性能都有变差的趋势。以下是各组织关于驾车的政策：（1）美国医学协会和国家公路交通协会联合建议老年驾驶员转诊至康复专家处；（2）美国公共卫生服务局建议上肢具备正常运动功能和足够的活动能力，功能受损时进行性能检查；（3）美国运输部建议进行性能评估以确定商用机动车驾驶员的健康状况。关于这个主题没有州法规或多辖区调查。本综述发现，某些夹板会妨碍驾驶，医生的实践模式存在很大差异，没有供医生和患者参考的正式指南，并且在美国关于这个主题的已发表文献很少。医生和患者都将从基于证据的建议或实践指南中受益。
