Duration of Immobilization to Be Factored in
The authors’ results show the continued need for a critical evaluation by means of randomized controlled trials of the use of volar locking plate fixation, even though today this technique has been widely adopted in clinical practice (1).
In our letter, we like to highlight an important aspect which has only been briefly touched in the study. We think that the type of aftercare provided was among the key factor influencing the treatment outcomes achieved. In the Methods section of the article, the aftercare is described as consisting of two weeks of postoperative physiotherapy according to local standards (1). However, we would have been interested in information about how long the periods of immobilization were in the various centers. While some hospitals altogether avoid postoperative immobilization after volar locking plate fixation, other centers prescribe postoperative immobilization periods of several weeks (2). Likewise, there are several distinct immobilization regimes used together with the standard casting techniques for this injury (3). Prolonged periods of immobilization frequently increase the need for physiotherapy after cast removal to such an extent that two weeks, the time limit stated in the article, are not enough (4). Thus, different periods of immobilization within and between the treatment arms could act as a confounder for the level of recovery, at least at the follow-up study visits at 3 and 6 months (3).
These differences between aftercare regimes are of interest from the perspective of resource utilization and against the background of the epidemiological trend described by the authors.
Prof. Dr. med. Lukas Prantl
Dr. med. Silvan Klein
Dr. med. Sebastian Geis
PD Dr. med. Jürgen Dolderer
Zentrum für Plastische-, Hand- und
Prof. Dr. phil. Michael Koller
Zentrum für klinische Studien
Prof. Dr. med. Michael Nerlich
Dr. med. Markus Loibl
Klinik für Unfallchirurgie
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Bartl C, Stengel D, Bruckner T, Gebhard F and the ORCHID Study Group: The treatment of displaced intra-articular distal radius fractures in elderly patients—a randomized multi-center study (ORCHID) of open reduction and volar locking plate fixation versus closed reduction and cast immobilization. Dtsch Arztebl Int 2014; 111: 779–87 VOLLTEXT|
|2.||Klein SM, Prantl L, Koller M, et al.: Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation. Acta Chir Orthop Traumatol Cech 2015; 82: 33–40 MEDLINE|
|3.||Millet PJ, Rushton N: Early mobilization in the treatment of Colles’ fracture: a 3 year prospective study. Injury 1995; 26: 671–5 CrossRef|
|4.||Cyr LM, Ross RG: How controlled stress affects healing tissues. J Hand Ther 1998; 11: 125–30 CrossRef|