Østergaard Helle K, Mechlenburg Inger, Launonen Antti P, Vestermark Marianne T, Mattila Ville M, Ponkilainen Ville T
Department of Orthopaedic Surgery, Viborg Regional Hospital, Heiberg Allé 4, 8800, Viborg, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Curr Rev Musculoskelet Med. 2021 Apr;14(2):107-129. doi: 10.1007/s12178-021-09697-5. Epub 2021 Mar 10.
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.
15 published and 5 unpublished trials were included.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. 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.
肱骨近端骨折（PHF）和桡骨远端骨折（DRF）是老年人中最常见的上肢骨折。近期的随机对照试验支持非手术治疗。最佳非手术治疗策略背后的证据一直很少，这引发了关于何时以及如何开始锻炼的问题。本系统评价和荟萃分析的目的是评估PHF和DRF后早期活动与晚期活动以及监督与非监督运动疗法的益处和危害。
纳入了15项已发表和5项未发表的试验。PHF后早期活动在Constant肩关节评分上功能更好，平均差（MD）为4.55（95%可信区间0.00 - 9.10）。然而，未发现该MD具有临床相关性。没有明确证据表明PHF后早期活动对活动范围或疼痛有积极影响。也未导致更多并发症。此外，未找到符合条件的证据支持DRF后早期活动优于晚期活动，或PHF和DRF后监督运动疗法优于非监督运动疗法。所有结局的证据质量均为低或极低。PHF后早期活动可能对功能有有益影响。由于缺乏明确证据，迫切需要未来的研究来确定PHF和DRF后早期活动和监督运动疗法的效果。Prospero注册号：CRD42020167656，注册日期2020年4月28日。
