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Return of Range of Motion Following Volar Plating for Distal Radius Fracture
Marci Jones, MD; Erika Lewis, PT, EdD, CHT; Ryan Strzepa; Patricia Franklin, MD, MBA
University of Massachusetts, Worcester, MA

Introduction: Distal radius fractures are a common upper extremity injury, and frequently result in decreased range of motion and functional status. The course of return of wrist range of motion after surgery is variable, and the optimal course of post-operative care is yet to be clearly determined. We sought to determine the course of return of range of motion in adults who underwent operative treatment with volar plating for distal radius fractures.
Materials and Methods: Following IRB approval, we reviewed 50 consecutive adult patients who underwent operative fixation of the distal radius with a volar plate and had wrist range of motion (ROM) measurements taken on at least 2 separate dates at our institution's hand therapy department between March 2011 and December 2012. We determined trends in return of ROM, and also evaluated ROM (wrist flexion, wrist extension, radial deviation, ulnar deviation, supination and pronation) over 2 week intervals up to 90 post-operative days (POD) to determine median, 25th and 75th percentile.
Results: Average ROM increased in all patients and in all directions over 90 days. The greatest gains in ROM were seen in supination, which increased from an average of 33° at 0-21POD, to an average of 67°at 77-90 POD. The rate of increase in supination was also greater than the rate of increase of the other ROM directions measured. Representative graphs of the median, 25th and 75th percentile are below.

Conclusions: The return of range of motion following operative treatment of distal radius fractures with volar plating predictably increases over the 90 days following surgery. The greatest gains are seen in supination. We were able to establish median, 25th and 75th percentile measurements for common wrist ROM measurements in an adult population. Establishment of this normative data will allow surgeons and hand therapists to better identify patients who are failing to regain ROM and potentially target these patients for further intervention.

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