Efficacy of the A-V Impulse System versus cryotherapy in the reduction of postoperative oedema of the hand: a prospective randomised trial

In a prospective randomised trial, the effects of an intermittent compression hand pump vs. cryotherapy were compared on reduction of postoperative hand swelling and gain in finger movement after distal radius fractures. Although intermittent compression as a physical method for thromboprophylaxis and swelling reduction in orthopaedic and trauma patients of the lower leg are established, a prospective randomised trial for an objective evaluation of the effects of intermittent compression in the upper extremity has not been previously performed. Forty-three subjects (63±33 years, 32 women, 11 men) with a unilateral distal radius fracture treated with transarticular external fixation were randomised into two treatment groups. In group A 21 patients were treated with cryotherapy. In group B 22 patients were treated with an intermittent compression hand pump. Reduction in swelling of the treated hand and MP and PIP joint movement were recorded with computerised assessment software (EVAL Hand Evaluation System) in comparison to the uninjured contralateral side. Reduction of swelling in group A was not statistically significant (28.5% of total swelling or 0.61 cm, SD 0.39, p=0.42), but in group B it was significant (92% of total swelling, 3.62 cm, SD 1.48, p<0.001). Comparison of increases in MP and PIP joint movement (p<0.0016) showed statistically significant differences in favour of the intermittent compression pump. This study demonstrates that intermittent compression is more effective in the reduction of postoperative oedema and gain of finger movement of the hand than cryotherapy.