What is the follow-up plan for a 75-year-old female with a distal radius fracture who has been wearing a wrist splint (orthotic device) continuously since the injury?

From the Guidelines

For a 75-year-old female with a distal radius fracture who has been wearing a wrist splint continuously since the injury, I recommend beginning gentle range of motion exercises while continuing to use the splint for protection during high-risk activities. At this stage of recovery, you should start removing the splint for periods during the day to perform gentle wrist flexion, extension, and rotation exercises 3-4 times daily for 5-10 minutes each session 1. Continue using the splint at night and during activities that might stress the wrist for another 1-2 weeks. Apply ice for 15-20 minutes after exercises if you experience discomfort. Gradually increase activity as tolerated, but avoid heavy lifting (more than 5 pounds) for at least 6 weeks from the initial injury. This approach promotes healing while preventing stiffness and muscle atrophy. The bone typically takes 6-8 weeks to heal substantially, but regaining full strength and function may take 3-6 months, especially at your age when bone healing can be slower 1. If you experience increased pain, swelling, or any new symptoms, contact your healthcare provider promptly.

Some key points to consider in the management of distal radius fractures include:

• Early finger motion is essential to prevent edema and stiffness after casting or surgery 1
• Aggressive finger and hand motion is necessary to facilitate the best possible outcomes after immobilization is discontinued 1
• Range-of-motion exercises should begin within the first postoperative days after surgical treatment of a fracture 1
• Overly aggressive physical therapy and exercises may increase the risk of fixation failure in the postoperative period 1

It's also important to note that the American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed an evidence-based clinical practice guideline for the management of distal radius fractures, which provides recommendations for treatment and care 1. However, the specific details of this guideline are not directly applicable to this patient's situation, and a more individualized approach is necessary.

In terms of specific exercises, you can try the following:

• Wrist flexion: Hold your arm straight out in front of you and bend your wrist down, then back up to the starting position
• Wrist extension: Hold your arm straight out in front of you and bend your wrist up, then back down to the starting position
• Wrist rotation: Hold your arm straight out in front of you and rotate your wrist in a circular motion, first clockwise and then counterclockwise

Remember to start slowly and gently, and gradually increase the intensity and duration of your exercises as tolerated. It's also important to listen to your body and stop if you experience any pain or discomfort.

From the Research

Distal Radius Fracture Management

• Distal radius fractures are common, especially in elderly females, with a peak incidence in the 65 years and older age group 2.
• The first line of treatment for distal radius fractures is to reduce the fracture and stabilize the bone alignment, even if surgical intervention is expected 2.
• Non-operative management, including immobilization with or without reduction, can give good results, especially in older adults 3.
• Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation 3.

Treatment Outcomes

• A study on unstable distal radius fractures in elderly patients found that volar fixed-angle plate osteosynthesis prevented secondary loss of reduction and resulted in good functional outcomes 4.
• Another study compared the outcomes of operative distal radius fracture treatment in patients over 75 with those aged 65 to 74 and found no significant difference in outcomes between the two age groups 5.
• The use of a wrist splint, as in the case of the 75-year-old female, is a common aspect of postoperative management, with the splint typically used for 4 weeks 4.

Complications and Considerations

• Common complications of distal radius fractures include median nerve compression, tendon rupture, arthrosis, and malunion 3.
• The management of distal radius fractures should consider the severity of the fracture, desired functional outcome, and patient comorbidities 3.
• Patient factors, including activity level and independence, can influence treatment outcomes, but age alone may not be a determining factor 5.