IN a landmark systematic review and meta-analysis, researchers have shed new light on the optimal timing for mobilization following open reduction and internal fixation (ORIF) of hand fractures. This insight is critical for orthopedic surgeons and rehabilitation specialists seeking to improve patient outcomes and reduce complications post-surgery.
The study reviewed 53 eligible publications out of 794 screened abstracts, collectively evaluating 1822 hand fractures treated with ORIF within two weeks of injury. The researchers aimed to determine whether the timing of post-operative mobilization influenced outcomes such as patient-reported function, bone healing time, and adverse events.
Notably, immediate mobilization within one day of ORIF led to the fastest mean bone healing time at 38.7 days (95% CI 34.3 to 42.3), outperforming early mobilization within seven days which had a healing time of 49.6 days (95% CI 42.8 to 56.5). However, delayed mobilization—defined as starting after seven days—was associated with the lowest rate of adverse events, just 9.3% (95% CI 5.6 to 15.2), compared to 25.0% (95% CI 17.1 to 35.0) in the early group.
The findings underscore a complex trade-off between rapid bone healing and the risk of complications. While early activity may promote faster union, it could potentially increase the risk of adverse outcomes. Despite these insights, the authors caution that inconsistencies in outcome reporting and diagnostic criteria limit definitive clinical guidance.
Given the heterogeneity across studies and overlapping confidence intervals, the authors call for a definitive multi-centre randomized controlled trial. Such a trial should integrate standardized outcome measures and evaluate cost-effectiveness to guide evidence-based rehabilitation protocols for hand fracture management in the future.
Reference:
Kynaston J et al. Systematic review and meta-analysis of mobilisation following open reduction and internal fixation of hand fractures. J Plast Reconstr Aesthet Surg. 2025;106:53-61.
