American Association for Hand Surgery
Theme: Beyond Innovation

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Blood Flow Restriction Therapy after Non-Operative Management of Distal Radius Fractures: A Randomized Controlled Pilot Study
Jill M Cancio, OTD, OTR, CHT1; Nicole M Sgromolo, MD2; Peter C. Rhee, DO, MS3
1Center for the Intrepid, Fort Sam Houston, TX; 2San Antonio Military Medical Center, Fort Sam Houston, TX; 3Orthopaedic Surgery, Mayo Clinic, Rochester, MN

Blood Flow Restriction Therapy after Non-Operative Management of Distal Radius Fractures: A Randomized Controlled Pilot Study
Introduction:
Blood flow restriction therapy (BFR) is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol.
Materials and Methods:
A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between 01 May 2015 and 01 August 2016. Blood flow restriction therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial injury. Outcome measures collected included wrist range of motion, grip strength, pinch strength, visual analogue scale (VAS) for pain with activity and at rest, Patient Rated Wrist Evaluation Scores (PRWE), and Disabilities of the Arm, Shoulder and Hand Scores (DASH).
Results:
Thirteen patients were enrolled and randomized between the BFR (n = 6) and control (n = 7) groups. The BFR group noted significantly less pain with activity compared to the control group after 8 weeks of therapy (1.5 versus 2.1, p = 0.03). Similarly, patients in the BFR group reported significantly lower PRWE scores compared to the control group after 8 weeks of blood flow restriction therapy (8.9 versus 17.0, p = 0.01). The two groups did not demonstrate any difference in radiographic outcomes at any time point. All patients tolerated the BFR therapy program and there were no complications.
Conclusions:
The addition of blood flow restriction therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a faster reduction in pain with activity and rapid improvement in overall function.


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