What is the next step in management for a patient with a closed distal radius fracture (distal radius fracture) who has 30 degrees of extension and 40 degrees of flexion, and is able to extend fingers and make a fist?

Management of Closed Distal Radius Fracture with Limited Range of Motion

For a patient with a closed distal radius fracture showing 30 degrees of extension and 40 degrees of flexion who can extend fingers and make a fist, the recommended management is to begin weaning from the brace, implement a home exercise program focusing on active and passive range of motion exercises with a stress ball, and schedule follow-up with new x-rays in 3 months. 1, 2

Current Status Assessment

• Patient demonstrates:
  • Ability to extend fingers and make a fist
  • Approximately 30° of wrist extension
  • Approximately 40° of wrist flexion
  • Stable fracture (implied by current management plan)

Management Plan

Immediate Steps

1. Begin weaning from brace

   • Gradual reduction in brace usage is appropriate at this stage of healing 2
   • Complete removal is not recommended until adequate strength and range of motion are achieved

2. Implement range of motion exercises

   • Active and passive range of motion exercises
     • Use of stress ball as recommended is appropriate 2
     • Focus on both wrist and finger movements
   • Early finger motion is essential to prevent edema and stiffness 1
   • When immobilization is discontinued, aggressive finger and hand motion becomes necessary for optimal outcomes 1

Home Exercise Program

A directed home exercise program is recommended by the American Academy of Orthopaedic Surgeons for patients after distal radius fracture 1, 2. This approach has shown comparable outcomes to supervised therapy for uncomplicated fractures.

Components should include:

• Finger flexion and extension exercises
• Wrist flexion, extension, pronation, and supination exercises
• Grip strengthening with stress ball
• Gradual increase in resistance as tolerated

Follow-up Plan

• Schedule follow-up with new x-rays in 3 months
• If any concerns arise before scheduled follow-up, patient should be referred to hand surgery

Important Considerations

Monitoring for Complications

1. Range of motion limitations

   • Current measurements (30° extension, 40° flexion) indicate limited motion
   • Normal wrist ROM: 60-75° extension, 60-80° flexion
   • Continued exercises are crucial for improvement

2. Potential complications to watch for:

   • Joint stiffness
   • Chronic pain
   • Post-traumatic arthritis
   • Tendon complications 3
   • Malunion 4

When to Refer to Hand Surgery

Immediate referral to hand surgery is warranted if:

• Significant loss of motion despite exercise program
• Increasing pain
• Signs of tendon irritation or rupture
• Evidence of malunion on follow-up imaging
• Development of complex regional pain syndrome

Prognosis

With appropriate home exercises and gradual return to activities, most patients with stable distal radius fractures can expect continued improvement in range of motion over 3-6 months. Complete recovery may take 6-12 months, with some patients experiencing residual stiffness or mild discomfort with certain activities.

The current management approach aligns with evidence showing that a home exercise program can be as effective as supervised therapy for uncomplicated distal radius fractures 1, 2, while ensuring appropriate monitoring through scheduled follow-up imaging.