Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
Department of Orthopedic Surgery, Kagawa Prefectural Shirotori Hospital, Mastubara, Higashikagawa City, Kagawa, Japan.
Medicine (Baltimore). 2022 May 13;101(19):e29262. doi: 10.1097/MD.0000000000029262.
The use of volar locking plates (VLPs) for distal radius fractures has remarkably improved clinical outcomes; however, there are some reports of delayed recovery of grip strength. Since January 2019, we have been conducting an early and proactive grip strength training program (EGTP). In this program, 20 minutes of grip strength training-using a gripper with a load of 0.7 kg-was initiated from 2 weeks after surgery; the load was then gradually increased. From 6 weeks postsurgery, daily home grip strength training was performed using a gripper with a load of 5 kg, provided to the patient.We investigated whether the introduction of the EGTP could lead to earlier recovery of grip strength. We also examined whether the EGTP caused postoperative correction loss at the fractured site, or contributed to the early improvement of wrist function.Thirty-nine patients who underwent surgery using VLPs for distal radius fractures were included in this study; 20 followed the EGTP (EGTP group) and 19 patients did not (NGTP group). For these patients, grip strength and range of motion of the wrist joint were evaluated both 3 and 6 months postoperatively. The Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were also evaluated 6 months postoperatively. Additionally, corrective losses of radial inclination (RI), palmar tilt (PT), and ulnar variance (UV)-occurring from immediately postsurgery to 6 months after surgery-were evaluated.At both 3 and 6 months postoperatively, the grip strength of the EGTP group was significantly higher than that of the NGTP group. Regarding range of motion, only palmar flexion was significantly improved in the EGTP group at 3 months postoperatively. Conversely, no differences in corrective losses of RI, PT, and UV, or in qDASH scores, were observed between the two groups.The results of this study suggest that the EGTP can provide early recovery of grip strength and palmar flexion of the wrist without causing corrective loss at the fracture site.
掌侧锁定板（VLPs）治疗桡骨远端骨折可显著改善临床疗效，但有报道称握力恢复延迟。自 2019 年 1 月以来，我们一直在开展一项早期且积极的握力训练计划（EGTP）。在该计划中，术后 2 周开始进行 20 分钟的握力训练——使用 0.7kg 的握力器，然后逐渐增加负荷。术后 6 周开始，患者每天在家使用 5kg 的握力器进行握力训练。我们研究了引入 EGTP 是否能更早地恢复握力。我们还研究了 EGTP 是否会导致骨折部位的术后矫正丢失，或者是否有助于早期改善腕关节功能。本研究共纳入 39 例接受 VLPs 治疗的桡骨远端骨折患者，其中 20 例患者接受 EGTP（EGTP 组），19 例患者未接受 EGTP（NGTP 组）。对这些患者术后 3 个月和 6 个月时进行握力和腕关节活动度评估，并于术后 6 个月时进行 Quick Disabilities of the Arm, Shoulder, and Hand（qDASH）评分评估。此外，还评估了从术后即刻到术后 6 个月时桡侧倾斜角（RI）、掌倾角（PT）和尺侧偏移（UV）的矫正丢失。术后 3 个月和 6 个月时，EGTP 组的握力均显著高于 NGTP 组。在腕关节活动度方面，EGTP 组仅在术后 3 个月时掌屈显著改善。相反，两组 RI、PT 和 UV 的矫正丢失以及 qDASH 评分均无差异。本研究结果表明，EGTP 可在不导致骨折部位矫正丢失的情况下，提供握力和腕掌屈的早期恢复。
