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