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.