Limitations
upper extremity fractures, fracture, fractures, swelling
A major limitation of the study in the case of upper extremity fractures is that only a fraction of the targeted group size of 20 patients per fracture could be achieved. Thus, only a limited power could be achieved in these groups with regard to the statistical analysis. On the one hand, this was because patients with such fractures were often too old or comorbid. On the other hand, and more importantly, this was because these patients were in most cases not admitted as inpatients for soft-tissue conditioning but were immobilized in a plaster cast and treated as outpatients. However, even in these cases, significant effects could be detected. The second limitation is the lack of blinding and hence the risk of performance bias. However, blinding was not feasible for either the observer or the participant due to the obvious intervention. This limitation was countered by selecting independent observers to assess the operability. A correlation analysis carried out in a preliminary study (κ = 0.816) revealed almost complete agreement in their assessments. Another limitation is that the pure circumference measurement performed to objectify the swelling was rounded to 5 mm increments. However, a volumetric analysis was not possible when patients were immobilized in a cast or external fixator and a more precise measurement was not possible due to the duration and size of the study and the fact that it was carried out in the context of normal inpatient daily routine.