Abstract
Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that
enables patients to increase strength at a fraction of the weight typically necessary
in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes
with a BFR therapy program for closed management after a distal radius fracture compared
to a traditional rehabilitation protocol.
Literature review A randomized-controlled study was conducted comparing a standardized hand therapy
rehabilitation protocol alone to a combined protocol with the use of BFR therapy in
patients who were initially treated with closed reduction and short arm cast immobilization
for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR
therapy was performed with a restrictive tourniquet applied to the upper brachium,
performing the same strengthening exercises as the control group but with the restrictive
tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from
the date of initial cast immobilization. Outcome measures collected included wrist
range of motion; grip strength; pinch strength; visual analogue scale for pain with
activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities
of the arm, shoulder, and hand scores.
Results Thirteen patients were enrolled and randomized between the BFR (n = 6) and control (n = 7) groups. The BFR group noted significantly greater reduction in pain with activity
compared to the control group after 8 weeks of therapy (Δ −4.0 vs. −2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE
scores compared to the control group after 8 weeks of BFR therapy (Δ −57.9 vs. 30.8,
p = 0.01). The two groups did not demonstrate any significant difference in radiographic
outcomes at any time point or throughout the course of the study. All patients tolerated
the BFR therapy program and there were no complications.
Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management
of a distal radius fracture is safe, well tolerated by patients, without any deleterious
effects on radiographic outcomes. This pilot study noted that BFR therapy in patients
with nonoperative distal radius fractures may result in a larger reduction in pain
with activity and greater improvement in overall self-perceived function.
Keywords distal radius fracture - blood flow restriction therapy - fracture rehabilitation
