Functional Electrical Stimulation Combined with Therapeutic Exercise in the Strengthening Phase of Rehabilitation of Distal Forearm Fractures Following Open Reduction Internal Fixation Surgery: a Randomized Controlled Trial

Abstract

Background: Distal forearm fractures (DFF) are among the most common orthopedic lesions in adults, often significantly impairing upper limb function and reducing quality of life. Open reduction and internal fixation (ORIF) of DFF is the most widely used approach due to more favorable outcomes, underscoring the need for effective post-surgical rehabilitation. While standardized rehabilitation protocols exist, more effective approaches remain to be developed. The impact of functional electrical stimulation (FES) in rehabilitation management after ORIF surgery to improve muscle strength and prevent atrophy has not been sufficiently investigated. Objectives: The objective of this study was to assess the impact of combining functional electrical stimulation with therapeutic exercise on the strengthening phase of rehabilitation of distal forearm fractures following open reduction internal fixation surgery. Methods: 45 patients with DFFs that underwent ORIF participated in the study, which took place during weeks 6-8post-surgery (strengthening phase). Patients were first divided into two groups based on whether they used continuous passive motion (CPM) in the prior phase of rehabilitation (A-CPM group; B–no-CPM group). Consequently, the groups were further divided into two subgroups each: A1 and B1, receiving FES treatment focusing on grip strength and therapeutic exercise (TE), and A2 and B2, which underwent solely TE for the study period (3 weeks). All patients were assessed at the inception and end of the study for grip strength (GS), active range of motion of the wrist (AROM), and wrist function during activities of daily living (ADLs) using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: Statistical analysis of data revealed that even though all four groups demonstrated significant increase across all three measures at 3 weeks (p<0.05), the participants of A1 and B1groups experienced notably higher level of improvement with regards to GS and DASH scores (p<0.05), while the improvement in AROM was very similar in both pairings (A1 vs A2 and B1 vs B2, all p>0.05). Additionally, the comparison between the A1 and B1 groups showed that although the differences in GS changes were insignificant (p>0.05), the opposite was observed for AROM and DASH (p<0.05), with progress clearly greater in group A, which is directly linked to prior CPM use. Conclusions: Using FES as an additional intervention during the strengthening phase of rehabilitation after ORIF in patients with DFFs may lead to increased muscle strength, improved wrist/hand function, and, therefore, improved activities of daily living. Further implementation of FES into various exercise programs may yield better outcomes in muscle strength, joint mobility, and function.