Radiuskop fractuur: meteen mobiliseren!

In de Journal of Orthopaedic Trauma verschijnt binnenkort onderstaand artikel dat vergelijkt of vroege mobilisatie na een eenvoudige radiuskopfractuur schadelijk is of juist beter voor de patient.

Het bleek dat een versnelde mobilisatie geen schadelijke gevolgen met zich mee bracht en dat er juist voordeel behaald werd met een snelle mobilisatie afgezet tegen een week gips.

Comparison of early mobilization protocols in radial head fractures. A prospective randomized controlled study. The effect of fracture characteristics on outcome

Paschos, Nikolaos K.; Mitsionis, Grigorios I. ; Haris, Vasiliadis S. ; Georgoulis, Anastasios D. 

Objectives: We compared two different protocols of early mobilization with a protocol of delayed mobilization in patients with simple radial head fractures (B2.1 type of Orthopaedic Trauma Association Classification). An attempt to correlate certain characteristics of the radial head fractures with outcome was made.

Design: Prospective randomized comparative study.

Setting: Level I trauma center.

Patients/Participants: 180 consecutive patients were randomly allocated into three different protocols.

Intervention: In the first group, immediate mobilization of the elbow joint was applied. In the second, a sling was used for 2 days and then active mobilization was introduced. The third protocol represented the control group where immobilization in a cast for 7 days prior the mobilization was applied.

Main Outcome Measurements: Broberg-Morrey score, ASES-E score, visual analogue scale, grip and pinch strength were evaluated.

Results: The two protocols introducing early mobilization resulted in better outcome compared to immobilization. The first protocol resulted in worse pain in the first 3 days. Range of motion, strength and functional outcome was better in patients allocated to the second protocol. These differences were more evident in displaced fractures. A fragment displacement of more than 4 mm and an anglulation of more than 30 degrees proved to impair outcome.

Conclusions: Early mobilization of simple radial head fractures appeared to be a safe and effective treatment option. It seems that a delay of 48 hours prior early mobilization could be advantageous. Individualization of treatment in accordance to the fracture's characteristics could be a decisive factor for outcome.