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DISTAL RADIUS FRACTURES
What is the Radius?
The radius is the bone in your forearm that is on the same side as
your thumb. The second long bone in the forearm, the ulna, also can be
fractured.
What are the Implications of this Condition?
Besides pain and swelling, a distal radius fracture may result in
the inability to move the wrist. The
thumb, fingers, forearm, shoulder and elbow also can become stiff and
swollen due to disuse of the affected hand. Not having full motion at one
or more joints can cause inability to perform self-care, work, and leisure
activities.
What are the Risk Factors If There is No Treatment?
If untreated or unrecognized, the fracture may not heal in a normal
position (malunion) or may not heal at all
(nonunion). Other risks include wrist deformity, post-traumatic arthritis,
grip and pinch weakness, nerve compression/irritation at the wrist, CRPS
(Complex Regional Pain Syndrome), tendon ruptures, or permanent wrist pain
due to changes in joint gliding and/or bone length(1,2,3). Ultimately a person's ability to move
correctly may be permanently affected.
Self-care activities that require reaching behind the back, leaning
on the arm, holding change, brushing teeth, or self feeding may be
extremely difficult or absent. However,
if the distal radius fracture is given immediate and appropriate care, the
chances of returning to full use are dramatically increased.
Options for Treatment?
The type of fracture determines how it is treated by the physician. Fractures can be stable (stay in place) or
unstable, displaced (not lined up) or nondisplaced,
or in more than two pieces (comminuted). Also, treatment can be affected by whether
the fracture involves the wrist joint. These fracture characteristics can lead
the surgeon to use some of the below surgical procedures:
Closed reduction with cast and/or percutaneous
(external) pins for stable, displaced, non-articular
(not in joint) fractures - pins are inserted through the skin to hold the
bone in place
External fixation for unstable, displaced, intra-articular (in joint) fractures or fractures with
several bone fragments (comminuted) - a device that pulls the bones apart
is used to keep the bones in the right place
Open reduction and internal fixation for displaced, intra-articular fractures the skin is cut and wires, plates
and/or screws are placed on the bone to hold it in place. The period of immobilization (wrist
cannot be moved) while the bone heals can last 2-8 weeks and is often
followed by the use of a soft brace or thermoplastic splint made by a hand
therapist. The surgeon will
determine how long the bone needs to be immobilized based on how it is
healing. It's important to
understand that just because the surgeon is able to repair the fracture,
this does not mean that there will be full wrist motion(3). Sometimes the severity of
the fracture may lead to some long-term limitations in motion. The goal of surgery, if done, is to
restore the correct, natural position of the bone ends and the wrist
joint. This helps prevent arthritis
and provides the best chance for re-establishing motion.
Hand Therapists Role
Treatment by a hand therapist may be needed even when the wrist is
immobilized in a cast or from the surgery.
The hand therapist will teach the patient how to control swelling
and pain, how to move thumb, fingers, elbow and shoulder to prevent
stiffness, and how to complete daily self-care and home activities with one
hand. After the cast or splint comes
off, the hand therapist will instruct the patient in exercises to move the
wrist and forearm. A very important
part of therapy is teaching the patient a home exercise program so that
exercises are done regularly and frequently. Therapy also will include techniques to
improve the appearance and mobility of any scars from the surgery, and
retraining the injured arm for use with dressing, eating, driving, and work
activities. The ultimate goal is to increase strength and flexibility in
the involved wrist so that the patient can return to their prior level of
activity.
Anything Else That Should Be Known
Anyone who suffers a fracture after age 40, especially
postmenopausal women, should be screened for
osteoporosis. Having a distal radius fracture can be the first sign that
bones are weakened by osteoporosis(1).
References
1. Fedorczyk J: Rehabilitation of distal
radius and ulna fractures. Lecture given at APTA 2004 combined sections
meeting, Nashville,TN.
2. Laseter GF:Therapist's management fo
distal radius fractures. In: Mackin EJ, Callahan
AD, Skirven TM, Schneider LH, Osterman
AL, Hunter
JM (eds): Hunter-Mackin-Callahan
Rehabilitation of the Hand and Upper Extremity, 5th ed. St Louis,MO: Mosby, 2002.
3. Rettig ME, Raskin
KB, Melone, Jr CP:
Fractures of the distal radius. In: Lichtman DM,
Alexander AH (eds):The
Wrist and Its Disorders, 2nd ed. Philadelphia, PA:WB Saunders, 1997.
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