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The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis

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Abstract

Purpose of Review

Fractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials support non-surgical treatment. Evidence behind the best non-surgical treatment strategy has been sparse and raises questions as to when and how to initiate exercises. The purpose of this systematic review and meta-analysis was to assess the benefits and harms of early mobilization versus late mobilization and supervised versus non-supervised exercises therapy after PHF and DRF.

Recent Findings

15 published and 5 unpublished trials were included. Early mobilization after PHF resulted in better function with a mean difference (MD) of 4.55 (95% CI 0.00–9.10) on the Constant Shoulder Score. However, the MD was not found to be clinically relevant. No clear evidence showed that early mobilization after PHF had a positive effect on range of motion or pain. Neither did it lead to more complications. Furthermore, no eligible evidence was found supporting early mobilization to be superior to late mobilization after DRF, or that supervised exercise therapy was superior to non-supervised exercise therapy after PHF and DRF. The quality of evidence on all outcomes was found to be low or very low.

Summary

Early mobilization after PHF may have a beneficial effect on function. Due to the lack of clear evidence, there is an urgent need for future studies to determine the effect of early mobilization and supervised exercise therapy after PHF and DRF.

Prospero ID number: CRD42020167656, date of registration 28.04.2020

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Acknowledgments

We wish to thank Jaana Isojärvi for her assistance with the literature search. Furthermore, we wish to thank Carlos Torrens for sharing his unpublished data.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Viborg Regional Hospital, Heiberg Allé 4, 8800, Viborg, Denmark

    Helle K. Østergaard & Marianne T. Vestermark

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Helle K. Østergaard & Inger Mechlenburg

  3. Department of Public Health, Aarhus University, Aarhus, Denmark

    Inger Mechlenburg

  4. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark

    Inger Mechlenburg

  5. Department of Orthopaedics, Tampere University Hospital, Tampere, Finland

    Antti P. Launonen & Ville M. Mattila

  6. Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland

    Ville T. Ponkilainen

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Contributions

Conception and design of the work: H.K.Ø., I.M., A.P.L., V.M.M., and V.T.P. Data collection, selection, evaluation, and analysis: H.K.Ø. and V.T.P. Drafting the article: H.K.Ø. Guidance and critical revision of the manuscript: H.K.Ø., I.M., A.P.L., M.T.V., V.M.M., and V.T.P.

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Correspondence to Helle K. Østergaard.

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H.K.Ø., I.M.,, A.P.L., M.T.V., V.M.M., and V.T.P. declare that they have no conflicts of interest.

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Østergaard, H.K., Mechlenburg, I., Launonen, A.P. et al. The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis. Curr Rev Musculoskelet Med 14, 107–129 (2021). https://doi.org/10.1007/s12178-021-09697-5

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