Distal Radius Fractures: Rehabilitative Treatment and Care

• Introduction: Open Reduction and Internal Fixation to Heal a Distal Radius Fracture
• The First Visit with the Therapist
• Caring for a Distal Radius Fracture After Surgery
• Keeping the Swelling Down and the Pain at a Minimum
• Avoiding Stiffness in the Arm
• Restoring the Range of Motion in the Wrist
• Conclusion: Restoring Strength and Function After a Distal Radius Fracture
• Resource

Introduction: Open Reduction and Internal Fixation to Heal a Distal Radius Fracture

This article focuses on the first six weeks of rehabilitation following a distal radius fracture that has been treated with open reduction and internal fixation (ORIF).

The primary goal of rehabilitation following a distal radius fracture is to help the patient regain functional use of the hand, wrist, and upper extremity. The therapist should have direct communication with the surgeon in order to determine precautions and attainable goals. The therapist will also consult with the patient to learn about the goals they wish to achieve.

The First Visit with the Therapist

During the first visit, the therapist performs an evaluation and develops a rehabilitation plan tailored to the patient's specific injury, lifestyle, and goals. The therapist will then create a home program for each patient.

In the first six weeks following a distal radius fracture with ORIF, rehabilitation serves to:

• protect the fracture while it heals;
• keep pain and swelling to a minimum;
• ensure that the uninvolved joints (such as the fingers, thumb, elbow, and shoulder) maintain their full range of motion; and
• restore wrist and forearm range of motion.

Caring for a Distal Radius Fracture After Surgery

In the first 1- 2 weeks following surgery, the patient will be wearing a bulky postoperative dressing. Once this dressing is removed, a therapist will replace it with a removable thermoplastic wrist splint. During this time, rehabilitation treatment will include making sure that the wound is healing properly. If there are any signs of problems with wound healing, including infection, the patient is promptly referred back to the surgeon for evaluation.

Keeping the Swelling Down and the Pain at a Minimum

To keep pain and swelling at a minimum, the therapist will introduce the principles of R.I.C.E.:

• Rest: The wrist splint rests and protects the wrist while the fracture is healing.
  
• Ice: Icing the wrist can help relieve pain and inflammation. The therapist will provide advice specific to the injury, but general guidelines are that ice or cold gel packs may be used 3-5 times a day for about ten minutes at a time. Cold gel packs can be found at most local drugstores.
  
• Compression: Compression dressings, like an elastic bandage or a compression glove, can help keep swelling down. However, because it's important to use compression garments the right way and monitor them closely, patients should only use them as instructed to do so by their therapist or surgeon. The compression dressings should be removed and checked every 2-3 hours. If there are any symptoms of reduced circulation (such as bluish fingertips, altered sensation, or increased swelling) the compression bandage or glove should be removed. Using compression incorrectly can cause too much pressure on the injury and actually result in more swelling, so patients should always follow their therapist's instructions and advice.
  
• Elevation: Elevation is key to reducing swelling. Therefore, it is critical that an elevated position is maintained throughout the day and at night. Patients should NEVER keep their hand down by their side for a prolonged period of time. The hand needs to be above the level of the heart so that gravity can help move fluid back toward the heart. Use 2-3 pillows to support the arm in the lap when seated, and keep it above the heart level on a pillow or two during sleep. Patients may be instructed to use a sling for elevation, particularly when out in public. However, be aware that over-reliance on a sling may lead to unnecessary elbow and shoulder stiffness.

Another technique to help control swelling is retrograde massage, which manually pushes fluid back towards the heart as well as stimulating the superficial lymphatic system. Retrograde massage involves positioning the arm so that the fingertips are higher than the elbow, gently massaging each fingertip towards the forearm in one continuous motion. NEVER massage from the forearm to the fingertips. Therapists can exhibit the proper technique.

Avoiding Stiffness in the Arm

Don't forget about the rest of the arm! Maintaining the full range of elbow and shoulder motion is very important, but patients will want to be gentle and use the right techniques. A therapist can provide a set of exercises specific to each injury, depending on how it was treated.

Restoring the Range of Motion in the Wrist

Patients with stable internal fixation (ORIF) may begin active motion of the wrist once cleared by their surgeons. A therapist can guide patients as they perform these exercises in the clinic as well as part of their home exercise program.

Conclusion: Restoring Strength and Function After a Distal Radius Fracture

After the first six weeks of therapy, once bone healing is determined to be firm and secure, rehabilitation will focus on the full restoration of strength and function. While types of wrist fractures and their surgical treatments vary, the core principles of fracture rehabilitation are consistent. Following these basic guidelines, a therapist will customize each treatment plan according to the patient’s specific needs.

Resource

Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician. Chapter 11: Distal Radius Fractures (Coleen T. Gately, PT, DPT, MS). ed. JeMe Cioppa-Mosca, PT, MBA; Janet B. Cahill, PT, CSCS; John T. Cavanaugh, PT, ATC; Deborah Corradi-Scalise, PT, DPT; Holly Rudnick, PT, Cert MDT; Aviva L. Wolff, CHT. St. Louis: Elsevier, 2006. Designed to help therapists provide post-surgical rehabilitation based on best practices and evidence-based research, this comprehensive reference presents effective guidelines for post-surgical rehabilitation interventions. More information on this book, including how to order a copy, can be found here.