A recent study reported that distal radius fractures represent 16.4% of all broken bones making it one of the most common fractures. Thankfully, many patients respond well to immobilization – using either a cast or splint depending on the severity of the injury.
This post will cover distal radius fracture treatment in healthy patients. We briefly covered wrist fractures as a larger group of fragility fractures that occur as we age in this previous blog post about osteoporosis.
The ongoing debate over casting versus surgery in distal radius fractures.
Being that so many distal radius fractures occur, there is a wide spectrum of treatments available. Our American Academy of Orthopaedic Surgeons recently explored treatment options in depth and you can find the full discussion here.
Currently there is moderate evidence supporting surgery as a way to improve outcomes in patients younger than 65 with appropriate radiographic criteria, including radial height loss, dorsal displacement, and intra-articular displacement. For these candidates, a surgeon can utilize many different surgical options to return the bone to its original anatomic position.
Patients who are lucky enough to not need surgery may be treated with a variety of splints and casts. The difference between a splint and a cast is largely that the splint allows for the swelling that occurs immediately after injury while a cast does not. Splints are used immediately after an injury, but once the swelling subsides, patients may transition to a cast during a follow up visit.
What can I expect while my distal radius fracture heals over the next few months?
Normal “healing” for adult bone occurs over the course of 6-8 weeks. The American Academy of Orthopaedic Surgeons explains the process of bone healing in this short article and video. Several factors determine whether “normal” healing occurs, things like the patient’s age, overall health, and using tobacco products, e.g. smoking cigarettes.
Assuming “normal” healing occurs, the best analogy for bone healing is painting a wall. The first “coat of paint” happens during the first few weeks after an injury while the bones are immobilized. The reality of bone healing is that your body continues to “add additional coats of paint” during the course of the first year post-injury. During that time, your surgeon will create an individual rehabilitation program for your distal radius fracture depending on many features. The next part of the rehabilitation process happens when the splint or cast can be safely removed. At this point we address the stiffness that has set in while waiting for the fracture to heal.
Home exercise programs versus formal therapy for distal radius fractures treated without surgery.
Researchers at the University of Nottingham, UK recently performed a randomized study of patients with isolated distal radius fractures who underwent immobilization alone. Patients were split into three groups:
- The first group of patients received a leaflet that explained appropriate wrist exercises.
- The second group of patients received access to four videos of a therapist who went over the exercises.
- The third group of patients received formal hand therapy with an occupational therapist who guided the specific range of motion exercises in person.
Patients in the study were evaluated once six weeks after treatment, and again one year after the initial treatment. They self-reported via questionnaire their wrist function, grip strength and range of motion. One year after treatment, there were no significantly different outcomes between the three groups. This may indicate that a well-designed home exercise/range of motion program can produce results equal to a dedicated in-person occupational therapy regimen.
So what should I do?
Your surgeon can help design the best program for you and your distal radius fracture. One important caveat to the study above is that the physicians carefully selected patients who received a home exercise program. When patients follow generic treatment plans without the guidance of a caring surgeon, poor outcomes are almost certainly guaranteed. Please do not try to figure out your own rehab program at home!
How Can Proliance Hand, Wrist and Elbow Physicians Help?
A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine if your distal radius fracture is appropriate for conservative management with a home exercise program. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices. This allows you to see both your hand surgeon and therapist in a single visit. Whether it is time for a cast, or a therapy program, or even a surgical correction, our staff can help. Contact us to make an appointment at any of our five convenient Eastside locations.
Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.