Wrist Fracture Treatment by Physiotherapists

November 22nd, 2008

by Jonathan Blood Smyth

Every winter the weather gets cold and icy at some time and we realise that the time has come when we are less safe out and about, that season when people start to slip and fall. Falls on an outstretched hand (FOOSH) are a very common injury and often cause a fracture of the end of the forearm bones, a fracture routinely known as a wrist or colles fracture. The fracture can be insignificant or very major requiring screws and plates to realign and fix it in position. Physiotherapists assess and plan rehabilitation of the wrist, hand and forearm.

In the arm the wrist is the most commonly injured area and radius and ulna fractures make up 75% of all wrist fractures. Injuries vary from a single fracture which remains in place without displacement to severe injuries with many fragments (comminuted) and with the bones out of position. The age of the person dictates to some degree the type of fracture experienced: adults suffer radius and ulna fractures in the last inch of the forearm, adolescents displace the wrist growth plate and children suffer from a bend in the cortex of the bone called a greenstick fracture.

Fractures of this type occur mostly in people from 60-69 years old and those from 6 to 10 years old. Fractures can occur without joint involvement (older people) or with fractures extending into the joint (younger people due to higher trauma forces) which complicates the picture. Diagnosis of a fracture is straightforward as the area is often very painful and swollen and the patient resists moving it. It may have a typical postural deformity called a “dinner fork” and feeling over this area will confirm the presence of a fracture.

Medical Treatment of Wrist Fractures

A fracture needs to be maintained as close to the original anatomical alignment as possible while it is healing, for a good functional result. A fracture with little or no displacement may just be plastered in its typical position for successful healing, but a badly displaced fracture may need manipulation and plastering to ensure correct alignment. If the fracture does not stay in the right position then operation such as using a k-wire or performing open reduction and internal fixation (ORIF) will be necessary to stabilise and realign the fracture. After such operations the fracture is plastered to maintain the position.

Physiotherapy Rehabilitation of Wrist Fractures

The typical time in plaster is five to six weeks and once it comes off the physiotherapist can assess and rehabilitate the wrist and hand. The condition of the wrist and hand is very variable on coming out of plaster and a skilled assessment of the problems and potential for improvement is vital. The physio will look initially at the colour or swelling of the hand to get an indication of the severity of the problem. Excessive swelling, significant colour change or extreme reported pain might point to Complex Regional Pain Syndrome (CRPS), a severe and important condition which needs prompt treatment.

The physio will look at the ranges of movement of the upper limb, checking the shoulder ranges first to make sure the shoulder was not damaged in the fall. The elbow range is usually unaffected except in some cases where the patient has kept their elbow bent in a sling for weeks, making the joint stiff. Supination and pronation are very important movements functionally and often restricted due to the proximity of the inferior radio-ulnar joint to the fracture site. Wrist flexion and extension, finger movement and thumb ranges are all assessed and recorded.

The physio will decide if the patient’s hand is normal for coming out of plaster and give range of motion exercises for the elbow, forearm, wrist and hand and perhaps the shoulder. A futura splint, a velcro fastening wrist splint, is useful to reduce the shock of coming out of plaster and allow patients to do functional activities without aggravating the pain too greatly. Attending a hand class for repeated exercise can be useful and physios can use mobilizing techniques to restore the accessory movement between the joints. Once the wrist is settled and moving better the physiotherapist will work on strengthening exercise and encourage functional normality.

About the Author:
Jonathan Blood Smyth is Superintendent of a large team ofPhysiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Edinburgh or elsewhere in the UK.

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