Distal radius fractures (DRFs) are fractures affecting the wrist and occurring in the distal portion of the radius bone. DRFs can also be classified as Colles, Barton, Smith, and Hutchinson/Chauffeur fractures according to the characteristics of the fracture. The incidence of these fractures shows a bimodal distribution. In young adults, distal radius fractures occur more often as a result of high-energy traumas (e.g., traffic accidents or impacts during contact sports), while in older adults, especially during winter months, low-energy falls from standing height (falling onto an outstretched hand) are a more common cause.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
active joint movements of the hand and wrist, passive, active-assisted and active stretching exercises
Neuromuscular stimulation will be applied to the m. flexor digitorum superficialis and m. flexor digitorum profundus muscles.
Visual analog scale
A visual analog scale will be used to evaluate the patients' current pain severity. This scale is one of the frequently preferred scales to evaluate the pain intensity of patients during rest, activity and night. The scale has a 10 cm long line where the patient can mark the intensity of pain. The patient will be asked to indicate the degree of pain intensity between no pain (left part) and unbearable pain (right part) of the line.
Time frame: Baseline
Visual analog scale
A visual analog scale will be used to evaluate the patients' current pain severity. This scale is one of the frequently preferred scales to evaluate the pain intensity of patients during rest, activity and night. The scale has a 10 cm long line where the patient can mark the intensity of pain. The patient will be asked to indicate the degree of pain intensity between no pain (left part) and unbearable pain (right part) of the line.
Time frame: 4th week
Visual analog scale
A visual analog scale will be used to evaluate the patients' current pain severity. This scale is one of the frequently preferred scales to evaluate the pain intensity of patients during rest, activity and night. The scale has a 10 cm long line where the patient can mark the intensity of pain. The patient will be asked to indicate the degree of pain intensity between no pain (left part) and unbearable pain (right part) of the line.
Time frame: 6th week
Edema
Edema measurement will be done using a thin measuring tape, measuring in figure-eight increments, and recorded in centimeters.
Time frame: Baseline
Edema
Edema measurement will be done using a thin measuring tape, measuring in figure-eight increments, and recorded in centimeters.
Time frame: 4th week
Edema
Edema measurement will be done using a thin measuring tape, measuring in figure-eight increments, and recorded in centimeters.
Time frame: 6th week
Grip Strength
The Jamar hand dynamometer, recommended by the American Association of Hand Therapists (AETD) and considered the gold standard due to its high validity and reliability in numerous studies, will be used to measure hand grip strength. Hand grip strength will be measured in the standard position recommended by the AETD: seated, with shoulder adduction and neutral rotation, elbow 90 degrees flexion, forearm mid-rotation and supported, and wrist in neutral position. According to the test procedure, three consecutive measurements of hand grip strength will be taken, and the averages will be recorded in kilograms.
Time frame: Baseline
Grip Strength
The Jamar hand dynamometer, recommended by the American Association of Hand Therapists (AETD) and considered the gold standard due to its high validity and reliability in numerous studies, will be used to measure hand grip strength. Hand grip strength will be measured in the standard position recommended by the AETD: seated, with shoulder adduction and neutral rotation, elbow 90 degrees flexion, forearm mid-rotation and supported, and wrist in neutral position. According to the test procedure, three consecutive measurements of hand grip strength will be taken, and the averages will be recorded in kilograms.
Time frame: 4th week
Grip Strength
The Jamar hand dynamometer, recommended by the American Association of Hand Therapists (AETD) and considered the gold standard due to its high validity and reliability in numerous studies, will be used to measure hand grip strength. Hand grip strength will be measured in the standard position recommended by the AETD: seated, with shoulder adduction and neutral rotation, elbow 90 degrees flexion, forearm mid-rotation and supported, and wrist in neutral position. According to the test procedure, three consecutive measurements of hand grip strength will be taken, and the averages will be recorded in kilograms.
Time frame: 6th week
Pinch Strength
Pinch strength measurement will be performed in the standard position recommended by AETD; sitting position, shoulder in adduction and neutral rotation, elbow 90 degrees flexion, forearm in mid-rotation and supported, wrist in neutral position. According to the test procedure, 3 consecutive measurements will be taken for pinch strength and the averages will be recorded in kg.
Time frame: Baseline
Pinch Strength
Pinch strength measurement will be performed in the standard position recommended by AETD; sitting position, shoulder in adduction and neutral rotation, elbow 90 degrees flexion, forearm in mid-rotation and supported, wrist in neutral position. According to the test procedure, 3 consecutive measurements will be taken for pinch strength and the averages will be recorded in kg.
Time frame: 4th week
Pinch Strength
Pinch strength measurement will be performed in the standard position recommended by AETD; sitting position, shoulder in adduction and neutral rotation, elbow 90 degrees flexion, forearm in mid-rotation and supported, wrist in neutral position. According to the test procedure, 3 consecutive measurements will be taken for pinch strength and the averages will be recorded in kg.
Time frame: 6th week
Patient-Reported Wrist Assessment Questionnaire
The Patient-Reported Wrist Assessment Questionnaire (PRWE) will be used to assess patients' activities of daily living, pain levels, and functional impairment (disability). On the pain subscale of the PRWE, the patient can score a maximum of 50 points, and on the function subscale, a maximum of 50 points. The total PRWE score assesses both pain and functional impairment. Higher scores indicate more severe pain and more significant functional impairment/disability.
Time frame: Baseline
Patient-Reported Wrist Assessment Questionnaire
The Patient-Reported Wrist Assessment Questionnaire (PRWE) will be used to assess patients' activities of daily living, pain levels, and functional impairment (disability). On the pain subscale of the PRWE, the patient can score a maximum of 50 points, and on the function subscale, a maximum of 50 points. The total PRWE score assesses both pain and functional impairment. Higher scores indicate more severe pain and more significant functional impairment/disability.
Time frame: 4th week
Patient-Reported Wrist Assessment Questionnaire
The Patient-Reported Wrist Assessment Questionnaire (PRWE) will be used to assess patients' activities of daily living, pain levels, and functional impairment (disability). On the pain subscale of the PRWE, the patient can score a maximum of 50 points, and on the function subscale, a maximum of 50 points. The total PRWE score assesses both pain and functional impairment. Higher scores indicate more severe pain and more significant functional impairment/disability.
Time frame: 6th week
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