> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Systematic Review and Meta-Analysis of Mobilisation Following Open Reduction and Internal Fixation of Hand Fractures - URL: https://www.theplasticsfella.com/journal-hand-fractures/ - Published: 2025-06-27T19:26:53.000Z - Updated: 2025-06-27T19:28:02.000Z - Description: A systematic review (53 studies, 1,822 hand fractures) examined the timing of mobilisation post-ORIF. Immediate mobilisation showed faster healing but higher adverse events. Delayed mobilisation had fewer complications. Heterogeneity and lack of standardised PROMs limit conclusions. - Author: PlasticsFella - Tags: Journal Club #### In this Journal Club A systematic review (53 studies, 1,822 hand fractures) examined the timing of mobilisation post-ORIF. Immediate mobilisation showed faster healing but higher adverse events. Delayed mobilisation had fewer complications. Heterogeneity and lack of standardised PROMs limit conclusions. [****5-Point Summary**](https://www.theplasticsfella.com/journal-hand-fractures/#5-point-summary) A systematic review (53 studies) assessed when to start moving post-ORIF. Immediate mobilisation sped up healing; delayed reduced adverse events. PROMs varied. Heterogeneity limits conclusions. [****4-Key Findings**](https://www.theplasticsfella.com/journal-hand-fractures/#4-key-findings) Immediate mobilisation healed in 38.7 days. Early mobilisation had 25% adverse events; delayed had 9.3%. PROMs were inconsistent, limiting data synthesis. [****3-Critiques**](https://www.theplasticsfella.com/journal-hand-fractures/#3-critiques) Most studies were retrospective and biased. PROMs and adverse events were inconsistently defined and reported across studies. [****2-Practical Takeaways** ](https://www.theplasticsfella.com/journal-hand-fractures/#2-practical-takeaways) Delayed mobilisation may lower complications. Earlier movement may boost early function. RCTs needed for clarity. [****1-Recommended Reading**](https://www.theplasticsfella.com/journal-hand-fractures/#1-recommended-reading) Feehan & Bassett (2004) found early motion (<21 days) improved recovery and return to work without loss of alignment. [Read Full Article ](https://www.sciencedirect.com/science/article/pii/S1748681525003109?ref=theplasticsfella.com) ✍️ ****Note from the Editor** --- ## 5 Point Summary This systematic review and meta-analysis synthesises 53 studies on hand fracture ORIF, assessing how timing of postoperative mobilisation influences healing, function, and complications. 1️⃣ ****Hypothesis** Earlier mobilisation after ORIF of hand fractures leads to improved functional outcomes without increasing complication rates. ![Isolated metacarpal shaft fracture](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/5-2.png) Isolated metacarpal shaft fracture 2️⃣ ****Method** A systematic review and meta-analysis of 53 studies (1,822 fractures) evaluating mobilisation timing post-ORIF: immediate (≤1 day), early (≤7 days), and delayed (>7 days). Outcomes included PROMs, bone healing time, and adverse events. 3️⃣ ****Results** Immediate mobilisation had the fastest mean healing time (38.7 days), but early mobilisation showed the highest adverse events (25%). Delayed mobilisation had the lowest complications (9.3%). PROMs were inconsistently reported across studies. ![Breakdown of adverse events](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/3.png) Breakdown of adverse events 4️⃣ ****Conclusion** Timing of mobilisation post-ORIF affects healing and complication profiles. Immediate mobilisation may accelerate recovery, but variability in study design limits strong recommendations. 5️⃣ ****Implication** There is no definitive evidence to guide mobilisation timing after hand fracture ORIF. A multicentre RCT with standardised outcomes is needed to inform best practice. ![Immobilisation following hand fracture](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/6-1.png) Immobilisation following hand fracture --- ## 4 Key Findings This meta-analysis highlights the impact of mobilisation timing on bone healing, complications, and functional recovery following hand fracture ORIF. 1️⃣ ****Bone Healing** Immediate mobilisation (≤1 day) was associated with the shortest mean healing time (38.7 days), compared to early (49.6 days) and delayed (48.8 days) mobilisation. Confidence intervals overlapped, and statistical significance was not established. ![Mean bone healing time by group](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/2.png) Mean bone healing time by group 2️⃣ ****Adverse Events** Delayed mobilisation (>7 days) had the lowest adverse event rate (9.3%), while early mobilisation (≤7 days) had the highest (25%). Most reported events were stiffness, return to theatre, and wound issues. ![Adverse event rates by mobilisation timing](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/1.png) Adverse event rates by mobilisation timing 3️⃣ ****Patient-Reported Outcomes** PROMs such as QuickDASH, DASH, and VAS were inconsistently reported and measured at varied follow-up points, making comparisons difficult. QuickDASH scores tended to improve with earlier mobilisation but lacked standardisation. 4️⃣ ****Study Variability** There was marked heterogeneity in study design, mobilisation protocols, and outcome reporting. Most studies were retrospective and at high risk of bias, limiting the strength of pooled conclusions. --- ## 3 Critiques Although comprehensive, the review is limited by heterogeneity in study quality, outcome reporting, and rehabilitation protocols. 1️⃣ ****Study Quality** Most included studies were retrospective and rated high risk of bias. Only one randomised controlled trial was identified, reducing the reliability of pooled results. 2️⃣ ****Outcome Inconsistency** PROMs were not uniformly applied, and follow-up durations varied widely. This limited the ability to compare functional outcomes across mobilisation groups. 3️⃣ ****Rehabilitation Reporting** Few studies clearly described the type, frequency, or compliance with therapy regimens, making it difficult to assess the true impact of mobilisation timing. --- ## 2 Practical Takeaways This review supports clinical caution and individualised rehabilitation planning following hand fracture ORIF, with key implications for patient safety and recovery. 1️⃣ ****Rehabilitation Strategy** While early mobilisation may speed up functional recovery, the increased risk of complications — particularly with early movement — calls for tailored approaches based on fracture stability and patient factors. 2️⃣ ****Shared Decision-Making** Clinicians should counsel patients on the trade-offs between faster recovery and potential complications, ensuring realistic expectations and encouraging early engagement with hand therapy services. ![Risk–benefit spectrum of mobilisation timing post-ORIF](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/06/4.png) Risk–benefit spectrum of mobilisation timing post-ORIF --- ## 1 Recommended Reading **Feehan & Bassett’s systematic review (2004)* analysed early mobilisation (<21 days) in extraarticular hand fractures. Among 459 patients, early motion improved mobility and return to work without affecting fracture alignment. Despite low-quality evidence, the study highlights the potential benefits and supports the need for high-quality RCTs in hand fracture rehabilitation. [Read the Article](https://pubmed.ncbi.nlm.nih.gov/15162112/link?ref=theplasticsfella.com)