Hand rehabilitation programmes for second to fifth metacarpal fractures: A systematic literature review.
Monique M Keller, Roline Barnes, Corlia Brandt and 1 others
PMID 34192208WHAT IT FOUND
One high-quality trial found a structured home exercise programme matched or beat traditional physiotherapy for hand movement and function after surgery.
Two observational studies suggested early self-managed mobilisation works for non-surgical fractures, but evidence remains limited.
Key findings
01A structured home exercise programme resulted in significantly better total active motion and lower disability scores than traditional physiotherapy after surgical fixation of metacarpal fractures.
02Conservative management with buddy strapping and a home exercise handout led to high satisfaction and good function in patients with fifth metacarpal fractures.
03Overall, the limited number of studies and heterogeneity in rehabilitation approaches prevent a definite conclusion on the single best hand rehabilitation programme.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only three studies were included in the review, limiting the strength of conclusions. A meta-analysis was not possible due to the small number of studies and heterogeneity. The observational studies had high attrition rates and lacked robust statistical analysis. The review excluded studies published before 2008, potentially missing earlier relevant evidence. The RCT did not have a controlled physiotherapy programme, making direct comparison difficult.
Declared interests
The study was approved by the Health Sciences Research Ethics Committee of the University of the Free State. No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that home exercises are universally superior to physiotherapy for all hand fractures. The positive findings for home programmes were specific to post-surgical management in one trial, and the overall evidence base is small and heterogeneous.