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Predictors of Splint Adherence and Outcomes Following Volar Plating of Distal Radius Fractures
Yehuda A. Masturov, B.S.
1, Sebastian D. Arango, M.D.
1, Jacob H. Zeitlin, M.D.
1, Jason C. Flynn, B.S.
2, Lauren DeTullio, OTR/L, CHT
1, Tristan B. Weir, M.D.
1; Andrew J. Miller, M.D.
1(1)Philadelphia Hand to Shoulder Center, Philadelphia, PA, (2)Sidney Kimmel Medical College, Philadelphia, PA
Introduction: Accurately measuring brace adherence with temperature sensors has been shown to positively correlate with outcomes. Temperature sensors have previously been used in shoulder slings to monitor adherence following rotator cuff repair, as well as other shoulder procedures. The aim of this study was to compare patient-reported and actual splint adherence using the validated temperature sensors for patients undergoing volar plating for distal radius fracture.
Materials & Methods: This prospective observational study was performed at a single tertiary referral upper extremity surgery practice. Patients who received elective ORIF with a volar plate requiring at least four weeks of immobilization in a thermoplastic splint postoperatively were invited to join the study. Patients were excluded if they were lost to follow-up, had non-elective surgery, complex injuries affecting the immobilization protocol, bilateral distal radius repair, revision for nonunion/malunion, required a dorsal approach, dorsal bridge plate, external fixator, or had a tumor/infection diagnosis. Eligible patients were given a temperature sensor fitted forearm volar splint at their first postoperative visit (as described by Weir et al.) and instructed to wear the splint as much as possible. Upon enrollment, participants provided information on demographics, circumstances surrounding injury, pre-existing hand conditions, previous surgeries/date (if applicable), and initial hand therapy treatment date. Upon sensor removal, patients were asked how many hours per day, on average, they believed they had worn their splints.
Results: Based on sensor measurements, overall compliance in subjects enrolled thus far (n=37) had a median of 88.3% [IQR: 59.8% - 94.9%]. Daytime compliance was 85.2% [56.3% - 93.2%] and nighttime compliance was 94.7% [77.2% - 99.7%] (
Figure 1). This difference was statistically significant according to a paired t-test (
P = 0.001). There was no statistically significant difference in overall compliance between dominant- and non-dominant-sided fractures (
P = 0.803). Patient-reported compliance was strongly correlated with actual compliance based on sensor data (
Figure 2). Pearson's correlation coefficient between actual compliance and reported compliance showed a strong positive correlation (r = 0.662 [95% CI: 0.438 - 0.887],
P = 0.014).
Conclusions: This data corroborates previous work, further validating the temperature sensors as reliable and reproducible means of measuring compliance with postoperative immobilization protocols. Patients do have some insight into their compliance with postoperative recommendations, as there was a statistically significant correlation between patient-reported and actual compliance with splint wear. Future analyses will be designed to evaluate key thresholds for postoperative immobilization in order to optimize patient outcomes.
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