Neuromuscular Stimulation in the Distal Radius Fractures

Distal radius fractures (DRFs) can be treated surgically, or conservatively with closed reduction followed by immobilization with a cast. Fractures with minimal displacement are treated conservatively in approximately one-third of cases. The standard immobilization period for DRFs is six weeks to allow for callus formation and healing of the bone and soft tissues. During plaster cast application, the standard practice is to ensure the preservation of the range of motion of the upper extremity joints above and below the cast.

Recent studies have investigated shorter immobilization periods to allow for earlier mobilization. In studies comparing plaster cast applications that can be as short as 10 days with the standard duration (approximately 6 weeks), no significant difference was found between the groups in terms of patient-reported functional outcomes, pain levels, development of Complex Regional Pain Syndrome (CRPS), secondary displacement or complications in follow-ups up to nine months after the fracture. In DRF, regardless of the treatment method, the recovery of motor functions, strength and mobility generally takes three to six months. In a small percentage of patients, mild disability and pain may persist even years after a distal radius fracture (DRF). As a result of DRF, individuals experience a decrease in wrist joint range of motion (ROM), a decrease in grip strength, impairment of hand skills (hand agility/dexterity), and an increase in pain. The main aim of rehabilitation is to eliminate these disorders using physical agents (modalities), manual therapy and exercise programs. Exercise programs include exercises aimed at improving range of motion, hand skills and muscle strength. Rehabilitation makes significant contributions to reducing functional losses, accelerating the recovery process and shortening the time individuals are away from work .Neuromuscular Electrical Stimulation (NMES) is a useful treatment method for preserving, maintaining, and restoring neuromuscular function losses resulting from disuse. One of the significant advantages of NMES is that the devices are easily purchased for individual use and can be applied at home. NMES is used in the treatment of paresis, contractures, and spasticity in the upper extremities after stroke. Studies on the upper extremities have shown that NMES application provides improvements in muscle strength, range of motion (ROM), functional performance, and cortical activation. Reduction in upper extremity spasticity and pain has also been reported. In knee osteoarthritis (OA), NMES applications have resulted in improved muscle strength and function along with reduced pain and stiffness. Furthermore, NMES applied after knee and hip replacement surgeries has been shown to increase muscle strength and functional capacity, reduce muscle atrophy, and decrease pain. Due to the positive effects of NMES on muscle strength, blood circulation, and hand edema in the early stages, this study will investigate the effects of neuromuscular stimulation on pain, grip strength, edema, range of motion, and functionality in the rehabilitation of operated distal radius fractures. This approach is expected to provide an innovative contribution to the classical rehabilitation protocols used in distal radius fractures.

Inclusion criteria

• Patients who underwent open reduction and volar plate surgery due to distal radius fracture (DRF) evaluated with plain radiography and CT scans.

Exclusion criteria

• Polytrauma
• Surgical intervention other than volar plate
• History of surgery on the affected extremity
• Injury to multiple anatomical sites in the affected extremity
• Hemiplegia or contracture in the affected extremity
• Major complications such as postoperative neurovascular injury and hematoma