Unsupervised protocol twice daily for 12 weeks, starting 24 hours post-surgery

The intervention consists of an active photobiomodulation wrist brace equipped with 100 light-emitting diodes (LEDs), including 18 LEDs at 630 nm delivering 23 mW of power, 117 J/cm², and 8 J per LED; 18 LEDs at 680 nm delivering 20 mW of power, 102 J/cm², and 7 J per LED; 32 LEDs at 760 nm delivering 24 mW of power, 122 J/cm², and 9 J per LED; and 32 LEDs at 830 nm delivering 28 mW of power, 143 J/cm², and 10 J per LED. The device will be applied once daily for a total of 12 minutes, with six minutes directed to the dorsal aspect of the wrist and six minutes to the volar aspect, over a 12-week period.

The intervention consists of an inactive LED wrist plate that is identical in appearance and sound to the active device but contains no active LEDs. It will be applied once daily for 12 minutes, during which the device will emit only activation light and sound, without delivering therapeutic irradiation.

In this project, the disability/symptom component of the QuickDASH (Disabilities of the Arm, Shoulder and Hand) score, validated for Brazil and available online (https://dash.iwh.on.ca/sites/dash/public/translations/Scoring\_QuickDASH\_Portuguese\_Brazil.pdf

), will be used as presented in Appendix 2. The calculation of the Disability/Symptom Score will follow the official instructions provided by the developers. At least 10 of the 11 items must be answered, and each item has a maximum value of 5. The total score is then transformed to a 0-100 scale by subtracting 1 from the mean of the responses and multiplying the result by 25, a procedure that allows comparison with other scales standardized on a 0-100 range. In this context, higher scores indicate greater disability, and the QuickDASH score is therefore expressed according to the following formula: [(Sum of responses / n) -1] X 25, where n: number of questions answered

In this project, the disability/symptom component of the QuickDASH (Disabilities of the Arm, Shoulder and Hand) score, validated for Brazil and available online (https://dash.iwh.on.ca/sites/dash/public/translations/Scoring\_QuickDASH\_Portuguese\_Brazil.pdf

), will be used as presented in Appendix 2. The calculation of the Disability/Symptom Score will follow the official instructions provided by the developers. At least 10 of the 11 items must be answered, and each item has a maximum value of 5. The total score is then transformed to a 0-100 scale by subtracting 1 from the mean of the responses and multiplying the result by 25, a procedure that allows comparison with other scales standardized on a 0-100 range. In this context, higher scores indicate greater disability, and the QuickDASH score is therefore expressed according to the following formula: [(Sum of responses / n) -1] X 25, where n: number of questions answered

Spontaneous pain intensity will be assessed using a 10-cm visual analog scale (VAS) with numerical, color, and facial expression indicators (mild, moderate, severe) to facilitate participant understanding. Pain occurrence will also be recorded during daily monitoring and documented in the participant's control sheet.

Spontaneous pain intensity will be assessed using a 10-cm visual analog scale (VAS) with numerical, color, and facial expression indicators (mild, moderate, severe) to facilitate participant understanding. Pain occurrence will also be recorded during daily monitoring and documented in the participant's control sheet.

Spontaneous pain intensity will be assessed using a 10-cm visual analog scale (VAS) with numerical, color, and facial expression indicators (mild, moderate, severe) to facilitate participant understanding. Pain occurrence will also be recorded during daily monitoring and documented in the participant's control sheet.

Spontaneous pain intensity will be assessed using a 10-cm visual analog scale (VAS) with numerical, color, and facial expression indicators (mild, moderate, severe) to facilitate participant understanding. Pain occurrence will also be recorded during daily monitoring and documented in the participant's control sheet.

Spontaneous pain intensity will be assessed using a 10-cm visual analog scale (VAS) with numerical, color, and facial expression indicators (mild, moderate, severe) to facilitate participant understanding. Pain occurrence will also be recorded during daily monitoring and documented in the participant's control sheet.

Type and dosage of analgesics, as well as daily use or non-use, will be recorded in the participant's control sheet.

Type and dosage of analgesics, as well as daily use or non-use, will be recorded in the participant's control sheet.

Type and dosage of analgesics, as well as daily use or non-use, will be recorded in the participant's control sheet.

Type and dosage of analgesics, as well as daily use or non-use, will be recorded in the participant's control sheet.

In the PRWE-BR questionnaire, the 15 items are scored from 0 to 10, covering two domains: pain and disability. The pain domain score is obtained by summing the responses to the five corresponding items, whereas the functional domain score is calculated by summing the responses to the ten corresponding items and subsequently dividing the result by two. The total score ranges from 0 to 100, with each domain having a maximum of 50 points. Higher scores indicate greater levels of dysfunction and pain reported by the participant.

In the PRWE-BR questionnaire, the 15 items are scored from 0 to 10, covering two domains: pain and disability. The pain domain score is obtained by summing the responses to the five corresponding items, whereas the functional domain score is calculated by summing the responses to the ten corresponding items and subsequently dividing the result by two. The total score ranges from 0 to 100, with each domain having a maximum of 50 points. Higher scores indicate greater levels of dysfunction and pain reported by the participant.

In the PRWE-BR questionnaire, the 15 items are scored from 0 to 10, covering two domains: pain and disability. The pain domain score is obtained by summing the responses to the five corresponding items, whereas the functional domain score is calculated by summing the responses to the ten corresponding items and subsequently dividing the result by two. The total score ranges from 0 to 100, with each domain having a maximum of 50 points. Higher scores indicate greater levels of dysfunction and pain reported by the participant.

In the PRWE-BR questionnaire, the 15 items are scored from 0 to 10, covering two domains: pain and disability. The pain domain score is obtained by summing the responses to the five corresponding items, whereas the functional domain score is calculated by summing the responses to the ten corresponding items and subsequently dividing the result by two. The total score ranges from 0 to 100, with each domain having a maximum of 50 points. Higher scores indicate greater levels of dysfunction and pain reported by the participant.

Passive wrist range of motion will be assessed bilaterally using a fleximeter (Sanny, model FL 6010, SBC, São Paulo, Brazil). The evaluator will record the maximum tolerated position for flexion, extension, radial and ulnar deviation, pronation, and supination. For each movement, three measurements will be performed and the mean value will be calculated.

Passive wrist range of motion will be assessed bilaterally using a fleximeter (Sanny, model FL 6010, SBC, São Paulo, Brazil). The evaluator will record the maximum tolerated position for flexion, extension, radial and ulnar deviation, pronation, and supination. For each movement, three measurements will be performed and the mean value will be calculated.

Passive wrist range of motion will be assessed bilaterally using a fleximeter (Sanny, model FL 6010, SBC, São Paulo, Brazil). The evaluator will record the maximum tolerated position for flexion, extension, radial and ulnar deviation, pronation, and supination. For each movement, three measurements will be performed and the mean value will be calculated..

Passive wrist range of motion will be assessed bilaterally using a fleximeter (Sanny, model FL 6010, SBC, São Paulo, Brazil). The evaluator will record the maximum tolerated position for flexion, extension, radial and ulnar deviation, pronation, and supination. For each movement, three measurements will be performed and the mean value will be calculated..

Passive wrist range of motion will be assessed bilaterally using a fleximeter (Sanny, model FL 6010, SBC, São Paulo, Brazil). The evaluator will record the maximum tolerated position for flexion, extension, radial and ulnar deviation, pronation, and supination. For each movement, three measurements will be performed and the mean value will be calculated.

Grip strength will be assessed using a digital dynamometer (Instrutherm, model DM-90, São Paulo, Brazil). Participants will be seated with elbows flexed at 90°, forearms neutral, and wrists in slight extension. Three measurements will be performed per limb at each session, alternating between injured and uninjured sides, with a 30-second rest. If the third attempt is the highest, further trials will be added until values decrease. The mean of the three highest values per limb will be recorded as grip strength. For right-dominant limbs, a 10% adjustment will be applied.

Grip strength will be assessed using a digital dynamometer (Instrutherm, model DM-90, São Paulo, Brazil). Participants will be seated with elbows flexed at 90°, forearms neutral, and wrists in slight extension. Three measurements will be performed per limb at each session, alternating between injured and uninjured sides, with a 30-second rest. If the third attempt is the highest, further trials will be added until values decrease. The mean of the three highest values per limb will be recorded as grip strength. For right-dominant limbs, a 10% adjustment will be applied.

Grip strength will be assessed using a digital dynamometer (Instrutherm, model DM-90, São Paulo, Brazil). Participants will be seated with elbows flexed at 90°, forearms neutral, and wrists in slight extension. Three measurements will be performed per limb at each session, alternating between injured and uninjured sides, with a 30-second rest. If the third attempt is the highest, further trials will be added until values decrease. The mean of the three highest values per limb will be recorded as grip strength. For right-dominant limbs, a 10% adjustment will be applied.

Grip strength will be assessed using a digital dynamometer (Instrutherm, model DM-90, São Paulo, Brazil). Participants will be seated with elbows flexed at 90°, forearms neutral, and wrists in slight extension. Three measurements will be performed per limb at each session, alternating between injured and uninjured sides, with a 30-second rest. If the third attempt is the highest, further trials will be added until values decrease. The mean of the three highest values per limb will be recorded as grip strength. For right-dominant limbs, a 10% adjustment will be applied.

Wrist radiographs in posteroanterior, lateral, and oblique views will be obtained at 4, 6, and 12 weeks to assess bone healing, defined as the presence of callus formation bridging three of the four cortices and uniting the main fracture fragments, compared with the immediate postoperative radiograph. At the end of each follow-up visit, participants will receive written instructions regarding the care to be taken in each phase of treatment, along with the date of the next appointment.

Wrist radiographs in posteroanterior, lateral, and oblique views will be obtained at 4, 6, and 12 weeks to assess bone healing, defined as the presence of callus formation bridging three of the four cortices and uniting the main fracture fragments, compared with the immediate postoperative radiograph. At the end of each follow-up visit, participants will receive written instructions regarding the care to be taken in each phase of treatment, along with the date of the next appointment.

Wrist radiographs in posteroanterior, lateral, and oblique views will be obtained at 4, 6, and 12 weeks to assess bone healing, defined as the presence of callus formation bridging three of the four cortices and uniting the main fracture fragments, compared with the immediate postoperative radiograph. At the end of each follow-up visit, participants will receive written instructions regarding the care to be taken in each phase of treatment, along with the date of the next appointment.

The costs will be assessed from the perspective of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) as the purchaser of services. Direct costs of the procedures performed during the study period will be considered, including the value of materials used, professional fees, hospital costs, and costs associated with productivity loss due to time away from work. The sources of cost data in Brazilian currency (Real) will include the ComprasNet database, SIGTAP, and the Price Bank of the Ministry of Health.

The final analysis of cost-effectiveness and incremental cost will follow the Methodological Guidelines: Economic Evaluation Studies of Health Technologies and the National Policy on Health Technology Management.