As the winter starts the weather gets cold and frosty mornings make pavements and roads slippery and dangerous, causing an epidemic of falls. A FOOSH, a fall on the outstretched hand, is a typical accident and commonly results in a fracture of the ulna and radius in the forearm, although it is often referred to as a “wrist fracture”. A wrist fracture can be small like an avulsion or a greenstick or major like multiple fractures requiring internal fixation. Physiotherapists assess progress and rehabilitate wrist fractures in physiotherapy departments and fracture clinics.

The wrist is the most commonly damaged part of the arm and three quarters of wrist injuries consists of radius and ulna fractures. Minor injuries may have just a crack and remain in position and as injuries become more serious they involve larger numbers of fragments and more marked displacement. As the person falls on the hand the results depend to some degree on age: children develop a greenstick fracture (a kink in the bone), adolescents separate the growth plate from the bone and adults fracture the radius and ulna in the last inch near 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.

Orthopaedic Management of Wrist Fracture

To allow the fracture to heal correctly a colles fracture needs to be fixed in a position that allows the fracture to be held in as close to the original shape as possible. A simple fracture which is undisplaced can just be plastered and left to heal, while a displaced fracture has to be returned to a better anatomical alignment. Manipulation and plastering might work, but if the fracture does not remain in a good position then operative fixation with k-wires or plates and screws might be required. After the operation plaster is applied to maintain the correction.

Physiotherapy after Wrist Fracture

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 shoulder ranges are assessed initially by the physiotherapist as the shoulder can be injured in the fall and suffer loss of movement. Loss of movement at the elbow can occur if the patient holds their arm stiff for the first few weeks but the rotatory forearm movements (supination & pronation) are much more commonly restricted and functionally important. The fracture is close to the lower rotatory forearm joint and restricts this and the wrist ranges of motion. The hand function, finger and thumb movements are also assessed by the physio.

If the physiotherapist determines that the wrist is uncomplicated after removal of plaster then they will prescribe mobilizing exercises for the wrist, forearm and hand and perhaps the elbow and shoulder. Coming straight out of plaster is a shock for the wrist and a strap on futura splint can rest the wrist and permit normal activity without too much discomfort. If the wrist is very stiff then attendance at a hand class may be useful and the accessory joint movements can be restored by using joint mobilization techniques on the many wrist joints. The physio will progress to strengthening the wrist as the movements improve and teach the patient to use the hand normally in daily activities.