Etiology

Most common mechanism of injury is a fall on an outstretched hand. The wrist usually
lands in extension and the forearm in pronation.

Facts

  • Most common injury to the wrist
  • May result in limited wrist flexion, extension, forearm pronation & supination
  • External fixation may be used vs internal fixation
  • Educate patient in active ROM and proper care of pin sites while fixator is in place

Non-operative vs. Operative

Non-operative:

  • Patients with stable, non-displaced or minimally displaced fractures.
  • Patients with poor wound healing and/or medical illnesses that preclude them from surgery.
  • Patients with sedentary lifestyles and low functional demands.

Prevent

  • Loss of ROM
  • Pain and deformities
  • Loss of grip strength

Follow Up Care

 

Non-operative

Acute Stage:

  • Protection with cast (short-arm), remove at 6-8 weeks if healed
  • Control pain & edema (elevation, retrograde massage, compressive wraps along hand & digits)
  • Maintain range and exercise in uninvolved joints
  • Incorporate ADLs

Sub-Acute Stage:

  • Protect with splint as needed
  • Continue to control pain & edema
  • Increase ROM (AROM wrist extension/flexion, forearm supination/pronation)
  • Incorporate ADLs

Settled Stage:

  • Continue exercises from acute stage
  • Full ROM
  • Begin strengthening (including grip strength)
  • Return to all ADLs (except contact sports & heavy labor)
  • Advance, as tolerated, to progressive resistive exercises for all joints

Post-Operative with External-Fixation Immobilization

Acute Stage (Week 1-6):

  • Control pain & edema
  • Protect surgical fixation
  • Maintain ROM in uninvolved joints
  • Prevent dystrophic changes
  • Splint for pin protection
  • Elevate
  • ROM: forearm supination & pronation
  • Desensitize if necessary

Sub-Acute Stage (Week 7-10):

  • Continue to protect fracture healing site
  • Continue to control pain & edema
  • Restore ROM with active, active-assisted, and passive ROM to wrist and forearm

Settled Stage (Week 10+):

  • Full ROM
  • Begin strengthening (including grip)
  • ADLs

 

Post-Operative with ORIF

Acute Stage (Week 1-3):

  • Protect surgical fixation from outside forces
  • Control pain & edema
  • Resting wrist splint in 30 degrees extension
  • Maintain range in uninvolved joints
  • Maintain wrist ROM
  • Incorporate Basic ADLs (Less than 2# lifting)

Sub-Acute Stage (Week 4-7):

  • Continue to protect
  • Continue to control pain & edema
  • Increase ROM
  • Incorporate all ADLs
  • Gradually discontinue use of protective static wrist splint

Settled Stage (Week 8+):

  • Full ROM
  • Begin strengthening program, including grip strengthening (isometric progressing to resisted, e.g. dumbbells or theraband)
  • Return to all activities (except contact sports & heavy labor)

 


References:

Donatelli R, Wooden M. Orthopaedic Physical Therapy. Philadelphia, USA: Churchill Livingstone, 2001.

Smith D, Brow K, Henry M. Early active rehabilitation for operatively stabilized distal radius
fractures. J Hand Ther. 2004;17:43-49.

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.