Distal Radius Fractures

Chapter 11 Distal Radius Fractures



Coleen T. Gately, PT, DPT, MS


Epidemiologic studies indicate that distal radius fractures are the most common fractures of the forearm. The mechanism of injury usually involves a fall on an outstretched hand (FOOSH). Distal radius fractures resulting from this type of low-energy injury are more common than those sustained secondary to high-energy trauma, such as a motor vehicle accident. The incidence of distal radius fractures in the 35- to 64-year-old population is greater in women than men.



Surgical Overview



• The distal radius articulates with the ulna and proximal row of carpal bones. The radius, ulna, and carpal bones make up the wrist complex.

• The medical management of distal radius fractures varies depending on the extent of the injury.
1 Common procedures include closed reduction with casting, closed reduction with external fixation (CREF), percutaneous pinning, open reduction with internal fixation (ORIF), or any combination of these techniques.

2 Reduction may be combined with a graft, depending on the level of comminution or defect. The goal of reduction is to maintain the bone in alignment so that the fracture may heal properly.


Rehabilitation Overview



• As the fracture progresses through the phases of healing, the focus of rehabilitation is to help the patient regain functional use of the hand and upper extremity.

• The stability of the fracture, strength of fixation, and extent of soft tissue trauma will determine the progression of therapy in each phase of healing.

• Direct communication with the doctor is essential to define precautions and set realistic goals.

• Treatment is tailored to the specific needs of the patient and the type of fixation used.


Postoperative Phase I: Protective (Weeks 0 to 6)



GOALS



• Maintain correct protective immobilization

• Minimize edema and pain

• Maintain full range of motion (ROM) of uninvolved joints


PRECAUTIONS



• Obtain physician approval before beginning gentle forearm active ROM (AROM)

• Early motion of the shoulder is critical to prevent adhesive capsulitis

• Report early symptoms of complex regional pain syndrome to physician for early intervention


TREATMENT STRATEGIES



Protection Options



• Custom thermoplastic volar or bivalve wrist splint: 0- to 20-degree wrist extension; thenar crease and distal palmar crease are cleared to prevent thumb web space and metacarpophalangeal joint stiffness


Pin and Wound Care (for CREF, ORIF)



• Pin care regimens may vary: follow physician’s specific protocol, for some may not request pin care at all (50% H2O2 and sterile water two times per day)

• Standard wound care procedures are followed for ORIF


Edema/Pain Management



• Elevation, rest, ice/cold, compression

• Light, compressive garment or wrap, that is, Isotoner gloves, Coban, Tubigrip stockinette
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Jun 22, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Distal Radius Fractures

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