From the Guidelines
Rehabilitation for conservatively managed distal radius fractures should begin after 4-6 weeks of immobilization in a cast or splint, with a progressive approach to restore function and prevent complications. The rehabilitation process can be divided into three phases, with the initial phase (weeks 1-3 post-cast removal) focusing on gentle active and passive wrist range of motion exercises, light grip strengthening with therapy putty, and edema control through elevation and compression if needed 1.
Key Components of Rehabilitation
- Gentle range of motion exercises for the fingers, elbow, and shoulder to prevent stiffness while the wrist remains immobilized
- Progressive resistance training, proprioceptive exercises using unstable surfaces, and activity-specific rehabilitation in the later phases (weeks 6-12)
- Pain should guide activity intensity, with exercises causing mild discomfort but not severe pain
- Heat can be applied before exercises to improve tissue extensibility, while ice afterward helps manage inflammation
Phases of Rehabilitation
- Phase one (weeks 1-3 post-cast removal): gentle active and passive wrist range of motion exercises, light grip strengthening with therapy putty, and edema control
- Phase two (weeks 3-6): more active strengthening with light resistance bands, wrist curls with light weights, and functional activities
- Phase three (weeks 6-12): progressive resistance training, proprioceptive exercises, and activity-specific rehabilitation
According to the American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) clinical practice guideline summary management of distal radius fractures, a home exercise program is an option for patients prescribed therapy after distal radius fracture 1. The guideline also emphasizes the importance of a patient-centered discussion to inform appropriate decision-making and ensure that the treatment aligns with the patient's values, preferences, and rights 1.
Most patients regain functional use within 8-12 weeks, though complete strength recovery may take 6 months 1. It is essential to note that the rehabilitation process should be tailored to the individual patient's needs and progress, with regular monitoring and adjustments as necessary to ensure optimal outcomes.
From the Research
Rehabilitation of Conservative Management Distal End Radius Fracture
- The rehabilitation of conservative management distal end radius fracture involves careful consideration of individual indications and contraindications, with conservative treatment having significant advantages over surgical approaches, particularly in older patients 2.
- Immobilization after closed reduction enables satisfactory wrist function to be achieved according to individual patient expectations, with the duration of cast wearing planned at 5 weeks 2.
- General procedures to reduce swelling and sufficient analgesics should be prescribed, with the circular plaster cast applied once swelling has subsided sufficiently, generally after 2-3 days 2.
- Early mobilization may be beneficial for distal radius fractures treated with open reduction and internal fixation, with a systematic review and meta-analysis showing that early mobilization yields better clinical outcomes than late mobilization at 6 weeks postoperatively 3.
- However, early mobilization also shows a potentially higher rate of implant loosening and/or fracture re-displacement complication, highlighting the need for careful consideration of the optimal rehabilitation protocol 3.
- A proposed paradigm shift in the management of distal radius fractures suggests that most distal radius fractures can be treated conservatively with closed reduction and immobilization, with operative management reserved for displaced fractures or younger active patients with defined radiographic inclusion parameters 4.
- Non-surgical treatment for fractures of the distal radius tends to yield satisfactory functional results, and these favorable outcomes do not necessarily align with normal radiological parameters, with corrective osteotomy a good option to improve function in cases of symptomatic malunion 4.
- An evidence-based approach to assessment and management of distal radius fractures emphasizes the importance of considering the severity of the fracture, desired functional outcome, and patient comorbidities in determining the preferred management, with non-operative management giving good results in select patients, especially in older adults 5.
- Rehabilitation after distal radius fractures should focus on early mobilization and physiotherapy, with the need for immobilization and physiotherapy depending on the individual case and the type of fixation used, such as palmar locking plate fixation 6.