Protection following a radius fracture

What possibilities does the ManuLoc long offer for post-operative treatment of distal radius fractures? This question was explored in an observational study conducted from October 2015 to March 2016 at the MVZ medical treatment center in Oberstdorf, Germany.

Does the long hand orthosis cover the area that needs to be protected in all cases? Does it offer sufficient flexibility for therapeutic measures? Distal radius fractures are breaks on the radial bone near the wrist. These fractures are typically caused when a hand is extended to protect the rest of the body during a fall. Distal radius fractures are the most common fractures suffered by adults – they account for around 25 percent of all such fractures. Elderly osteoporosis patients are particularly at risk, and women with osteoporosis are more likely to suffer such a fracture than men with the same condition. Sports-related accidents also account for a large share of radius fractures.

Six weeks of data collection

Contrary to what might be expected, it wasn’t visiting skiers but instead residents of the Oberstdorf winter sports town in the Allgäu region of Germany who served as the test subjects for the case study. That’s because the study needed subjects who would remain in the town for a relatively long period of time. In the end, a total of 13 test subjects between the ages of 30 and 70 took part in the observational study. None of the patients with a distal forearm or radius fracture experienced high-speed impact trauma and all of them underwent an angle-stable plate osteosynthesis on the flexor side. The patients were given a ManuLoc long orthosis on the first day after surgery. Examinations were then conducted at three different points in time: on the second day after surgery (inpatient discharge), on the 12th day after surgery (sutures removal), and after six weeks. Wrists were x-rayed in the first and third examinations. The study protocol called for a functional exercising of the hand using the orthosis to be permitted after two weeks of immobilization and for the patients to then start getting used to not using the orthosis up until the sixth week. Data was collected with the help of, among other things, the DASH and MAYO Wrist scores. VAS and wearing performance were documented and patients were queried on factors such as orthosis fit , their own ability to work, subjective stabilization sensation, and the perceived pain reduction resulting from the orthosis.

Extended period of wrist stabilization

Among other things, the study determined that most patients found the ManuLoc long orthosis to be “very easy” or “easy” to put on. ManuLoc long, which is the long version of the ManuLoc, stabilizes the wrist and forearm in cases of excessive strain or injury, and the orthosis is also used in post-operative treatment. Three pre-shaped aluminum stays immobilize the wrist and relieve strain. The ManuLoc long stays extend from the forearm to near the elbow joint and stab ilize this area against the stretching, bending and, in some cases, turning movements of the hand. The large thumb opening of the orthosis and the free movement of the fingers allow for controlled grasping movements, even as the wrist is kept securely immobilized. This makes it possible to begin functional therapy sooner. The ManuLoc long can be opened completely with four large Velcro fastenings. The orthosis supports the course of treatment from the first inspection of the wound to bone reconstruction.

“Voting with their hands”

As was stipulated in the study protocol , the orthosis was worn for two weeks by all test subjects. During this time, many patients assessed their subjective pain reduction as “good” to “very good.” This was to be hoped for – but then something really astonishing occurred: The test subjects “voted with their hands,” so to speak, as nine of 13 decided to keep wearing the ManuLoc long after the two-week period. This decision was based solely on their own feeling and desire, and some test subjects even kept wearing the orthosis until the end of the observation period – i.e. up until the sixth week. Ten patients also decided to keep wearing the orthosis at night. “That surprised me,” says Dr. Peter Katzmaier, Medical Managing Director of MVZ Oberstdorf, who also served as the director of the study. Katzmaier, a hand surgeon and orthopedic surgeon, is used to seeing patients quickly toss away medical aids that limit movement as soon as a physician tells them they no longer need to use them. This was not the case with the ManuLoc long. “The patients obviously grew to trust the orthosis,” Katzmaier explains.

More specifically, they developed trust in the protective effect and stability offered by the ManuLoc long. One should also not forget that despite all of the artificial instruments we’ve developed, up to and including digital robots and grippers, the hand remains our most important tool. This will also remain the case, which is why regaining the use of an injured hand is always a top priority. Katzmaier, who also treats athletes from the German National Ski Team, believes this explains why several patients reported less pain reduction in the third examination than in the second: “Some patients probably put some heavy strain on their hand while wearing the ManuLoc long – but that wasn’t a problem because the orthosis offers sufficient protection at all times.” Katzmaier also now trusts the security offered by the ManuLoc long. “After looking at the results of the observational study, I can see that patients benefit from continuing to use the orthosis after the first change of bandage,” the hand specialist explains. “I simply have a good feeling here.” Katzmaier can imagine using the conservative therapy approach with the long hand orthosis from the very beginning in the case of stable distal radius fractures.
In addition, depending on the injury at hand and the type of stabilization required, the shorter ManuLoc standard orthosis can also be used for conservative treatment of wrist injuries.

Pictures: Conny Kurz