Influence of postoperative immobilization on pain control of patients with distal radius fracture treated with volar locked plating: A prospective, randomized clinical trial

Objectives: The purpose of this study was to compare the pain scores and the rates and doses of opioid use in patients undergoing volar locked plate fixation of intra-articular distal radius fractures using or not postoperative immobilization. Methods: This was a prospective randomized controlled trial. Thirty-nine patients with distal radius fractures scheduled to receive volar plate fixation were randomly assigned to receive a short forearm splint for two weeks postoperatively or conventional bandage with early wrist mobilization. Thirty-six patients completed the follow-up. The outcome measurements included pain scores (0-10 points); rates and doses of tramadol use; DASH score; wrist range of motion; patient satisfaction; and complication rates. The last follow-up assessment was performed at 6 months. Results: The pain scores were similar between the groups during hospital stay, as well as after hospital discharge within the first week and in subsequent assessments up to six months. The rates of tramadol use were greater in the No splint group during hospital stay, but this difference was not statistically significant (No splint = 65%; Splint = 47%; p = 0.296). Likewise, the doses of tramadol intake were higher in the No splint group during hospital stay (No splint = 218 mg; Splint = 167 mg; p = 0.273) and after discharge (2nd day: No splint = 112 mg; Splint = 75 mg; p = 0.286), with no statistically significant differences. The functional results and complication rates were similar between the groups. Conclusions: In this study, there was a trend to a greater use of tramadol in patients who did not use immobilization and started early wrist mobilization after volar locked plating of distal radius fracture, compared with patients who were immobilized for two weeks. The pain scores were similar but may have been influenced by the unbalanced use of opioids between the groups. The functional results and complication rates were not influenced by the use of immobilization.

Palavras-chave

Distal radius, Fracture, Volar plate, Analgesia, Immobilization, Pain score, Opioids

URI

https://observatorio.fm.usp.br/handle/OPI/31296

Referências

Arora R, 2011, J BONE JOINT SURG AM, V93A, P2146, DOI 10.2106/JBJS.J.01597
Bot AGJ, 2014, CLIN ORTHOP RELAT R, V472, P2542, DOI 10.1007/s11999-014-3660-4
Brehmer JL, 2014, J BONE JOINT SURG AM, V96A, P1621, DOI 10.2106/JBJS.M.00860
Brennan SA, 2016, INJURY, V47, P372, DOI 10.1016/j.injury.2015.08.040
Driessens S, 2013, J HAND THER, V26, P225, DOI 10.1016/j.jht.2013.05.002
Figl M, 2009, ARCH ORTHOP TRAUM SU, V129, P661, DOI 10.1007/s00402-009-0830-z
Fowler JR, 2013, J HAND SURG-AM, V38A, P2198, DOI 10.1016/j.jhsa.2013.08.116
Handoll HHG, 2015, COCHRANE DB SYST REV, DOI 10.1002/14651858.CD003324.pub3
Horst TA, 2016, INJURY, V47, P313, DOI 10.1016/j.injury.2015.09.030
Jakubietz MG, 2012, J ORTHOP SURG RES, V7, DOI 10.1186/1749-799X-7-8
Jupiter JB, 2010, J BONE JOINT SURG AM, V92A, P96, DOI 10.2106/JBJS.I.01340
Karantana A, 2013, J BONE JOINT SURG AM, V95A, P1737, DOI 10.2106/JBJS.L.00232
Koval K, 2014, J AM ACAD ORTHOP SUR, V22, P566, DOI 10.5435/JAAOS-22-09-566
Lozano-Calderon SA, 2008, J BONE JOINT SURG AM, V90A, P1297, DOI 10.2106/JBJS.G.01368
Marsh JL, 2007, J ORTHOP TRAUMA, V21, pS1, DOI 10.1097/00005131-200711101-00001
Nielsen S, 2016, PHARMACOEPIDEM DR S, V25, P733, DOI 10.1002/pds.3945
Osti M, 2012, ORTHOPEDICS, V35, pE1613, DOI 10.3928/01477447-20121023-18
Quadlbauer S, 2017, J WRIST SURG, V6, P102, DOI 10.1055/s-0036-1587317
Smith Dean W, 2004, J Hand Ther, V17, P43, DOI 10.1197/j.jht.2003.10.006

Coleções

Artigos e Materiais de Revistas Científicas - HC/IOT
Artigos e Materiais de Revistas Científicas - LIM/41

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