Physiotherapy Treatment of Wrist Fractures

When the weather begins to get icy it gets less safe underfoot and people start to fall over and hurt themselves. A common injury is a fall on the outstretched hand (FOOSH) which often results in wrist fracture. When we say wrist fracture we are usually describing a fracture of the end of the radius and ulna, the two major bones of the forearm. Wrist fractures vary from very minor like a chip to major breaks which require operative fixation. Physiotherapists work in fracture clinics and rehabilitate the hand, wrist and forearm after such injuries.

75 percent of wrist fractures involve the radius and ulna, with the wrist the most often injured part of the upper extremity. A fracture can be minor and be undisplaced or very severe with multiple fractures (comminuted) and badly displaced, which may need operation with plates and screws to fix the fracture securely. The type of fracture is related to the age of the sufferer: adolescents have wrist growth plate displacement, children bend their bones in a greenstick fracture and adults present with a fracture of the final inch of the forearm bones above the wrist.

The highest incidence of this fracture occurs in people from 6 to 10 years and from 60 to 69 years. In older people the fracture is usually away from the joint but in younger people the forces involved are often higher and this increases the likelihood of joint damage along with the fracture. On examination a fractured wrist is usually swollen and may have a typical bony deformity as the bones are out of line, referred to as a “dinner fork” deformity. The fracture will be very painful and palpation over the fractured area will confirm the likely diagnosis.

Medical Treatment of Wrist Fractures

The main principle of treatment is to immobilize the fracture in an anatomically correct position so it heals as closely as possible to the original shape. The fracture is assessed for its severity and whether it is displaced. Displacement can be manipulated and plastered to hold the position but if the displacement is too great or the plaster does not hold the position then operative intervention is pursued. Internal fixation can involve passing narrow wires into the bones to hold position (k wiring) or inserting a plate with screws to immobilize the fracture, after which plaster is again applied.

Physiotherapy after Wrist Fracture

Five or six weeks is the normal time for the plaster to remain on, with the physio assessing the state of the wrist and hand as this can be very unpredictable once it’s out. An assessment from a physio skilled in fracture management is important to set the treatment programme and recommend any further treatment. The hand’s swelling and colour is a key indicator of the state of the area and how it should be treated. Strong colour changes, tight swelling and severe pain means the diagnosis of Complex Regional Pain Syndrome (CRPS) should be suspected, a severe pain condition which needs immediate intervention.

Initially the physio assesses the movements of the shoulder as this can be damaged by a fall on the hand and cause a limitation. It is unusual for the elbow to have restricted movement after colles fracture unless the person has held their arm bent for a few weeks in a sling. The rotatory movements of the forearm (pronation and supination) are key functional movements and often limited as the lower joint between the ulna and the radius is close to the fracture line. The physio records the ranges of wrist flexion, wrist extension, and finger and thumb movements.

If the assessment shows only a stiff and uncomfortable wrist the physiotherapy exercises will consist of range of movement for the shoulder, elbow, forearm rotation, wrist and hand. To ease the transition out of plaster and enable early functional ability without pain a velcro futura wrist splint can be used for a week or so. Referral to exercise hand class may be necessary and the physios can mobilize the wrist and forearm joints by re-establishing the gliding movements between the joints. As the wrist improves the focus of physio moves to strengthening exercises and the promotion of normal day-to-day activities.