DOS 2020

DOS Kongressen 2020 · 233 Rehabilitation after non-operatively treated proximal humerus and distal radius fractures. A systematic review and meta-analysis assessing the benefits and harms of early mobilisation Helle K. Østergaard, Inger Mechlenburg, Antti Launonen, Ville Ponkilainen Department of Orthopaedic Surgery, Viborg Regional Hospital; Department of Orthopaedics , Aarhus University Hospital; Department of Orthopaedics, Tampere University Hospital Background: Proximal humerus fractures (PHF) and distal radius fractures (DRF) are common among the elderly. Recent randomised controlled trials (RCTs) support non-surgical treatment. However, the evidence on the most optimal rehabilitation strategy is sparse and does not support clinical guidelines describing when to initiate the post-fracture mobilisation. Purpose / Aim of Study: To conduct a systematic review and meta-analysis to assess the benefits and harms of early mobilisation compared to late mobilisa- tion after PHF and DRF. Materials and Methods: A systematic search was performed in 8 electronic databases. The study population consisted of adults (>= 18 years) sustaining a PHF or DRF. The intervention and comparison were defined as early mobilisa- tion (<2 weeks post fracture) vs. late mobilisation. The outcome measures of interest were function, pain and health-related quality of life (HRQoL). Two in- dependent reviewers conducted the screening, eligibility assessment, inclusion and data extraction. The overall quality of evidence of the included studies was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted when possible. Findings / Results: Six RCTs with a total number of 348 participants were included. A significant difference in favour of early mobilisation after PHF was found in function (standardized mean difference 0.73 (0.35;1.11) at 3 months follow-up. HRQoL was presented only in one study reporting that two dimen- sions of the Short-Form-36 were significantly higher after early mobilisation at 3 months follow-up No nonunions were reported. Meta-analysis could not be conducted on early mobilisation after DRF. Overall, none of the included studies presented significant differences in function or pain between early and late mo- bilisation after DRF. One study reported a higher proportion of algoneurodys- trophy (19% vs. 4%) after late mobilisation. The quality of the studies was low. Conclusions: Early mobilisation after PHF resulted in a moderate effect on function, whereas there was insufficient evidence after DRF. The included stud- ies show, that it is safe to start the mobilisation within two weeks after the fracture. To support the non-surgical treatment strategy, there is a need for more high quality RCTs. 212.