Every winter the weather gets cold and icy at some time and we realise that the time has come when we are less safe out and about, that season when people start to slip and fall. Falls on an outstretched hand (FOOSH) are a very common injury and often cause a fracture of the end of the forearm bones, a fracture routinely known as a wrist or colles fracture. The fracture can be insignificant or very major requiring screws and plates to realign and fix it in position. Physiotherapists assess and plan rehabilitation of the wrist, hand and forearm.
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.
Fractures of this type occur mostly in people from 60-69 years old and those from 6 to 10 years old. Fractures can occur without joint involvement (older people) or with fractures extending into the joint (younger people due to higher trauma forces) which complicates the picture. Diagnosis of a fracture is straightforward as the area is often very painful and swollen and the patient resists moving it. It may have a typical postural deformity called a "dinner fork" and feeling over this area will confirm the presence of a fracture.
Medical Treatment of Wrist Fractures
The main principle of treatment is to immobilize the fracture in an anatomically correct position so it heals as closely as possible to the original shape. The fracture is assessed for its severity and whether it is displaced. Displacement can be manipulated and plastered to hold the position but if the displacement is too great or the plaster does not hold the position then operative intervention is pursued. Internal fixation can involve passing narrow wires into the bones to hold position (k wiring) or inserting a plate with screws to immobilize the fracture, after which plaster is again applied.
Physiotherapy Rehabilitation of Wrist Fractures
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.
Initially the physio assesses the movements of the shoulder as this can be damaged by a fall on the hand and cause a limitation. It is unusual for the elbow to have restricted movement after colles fracture unless the person has held their arm bent for a few weeks in a sling. The rotatory movements of the forearm (pronation and supination) are key functional movements and often limited as the lower joint between the ulna and the radius is close to the fracture line. The physio records the ranges of wrist flexion, wrist extension, and finger and thumb movements.
If the assessment shows only a stiff and uncomfortable wrist the physiotherapy exercises will consist of range of movement for the shoulder, elbow, forearm rotation, wrist and hand. To ease the transition out of plaster and enable early functional ability without pain a velcro futura wrist splint can be used for a week or so. Referral to exercise hand class may be necessary and the physios can mobilize the wrist and forearm joints by re-establishing the gliding movements between the joints. As the wrist improves the focus of physio moves to strengthening exercises and the promotion of normal day-to-day activities.
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.
Fractures of this type occur mostly in people from 60-69 years old and those from 6 to 10 years old. Fractures can occur without joint involvement (older people) or with fractures extending into the joint (younger people due to higher trauma forces) which complicates the picture. Diagnosis of a fracture is straightforward as the area is often very painful and swollen and the patient resists moving it. It may have a typical postural deformity called a "dinner fork" and feeling over this area will confirm the presence of a fracture.
Medical Treatment of Wrist Fractures
The main principle of treatment is to immobilize the fracture in an anatomically correct position so it heals as closely as possible to the original shape. The fracture is assessed for its severity and whether it is displaced. Displacement can be manipulated and plastered to hold the position but if the displacement is too great or the plaster does not hold the position then operative intervention is pursued. Internal fixation can involve passing narrow wires into the bones to hold position (k wiring) or inserting a plate with screws to immobilize the fracture, after which plaster is again applied.
Physiotherapy Rehabilitation of Wrist Fractures
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.
Initially the physio assesses the movements of the shoulder as this can be damaged by a fall on the hand and cause a limitation. It is unusual for the elbow to have restricted movement after colles fracture unless the person has held their arm bent for a few weeks in a sling. The rotatory movements of the forearm (pronation and supination) are key functional movements and often limited as the lower joint between the ulna and the radius is close to the fracture line. The physio records the ranges of wrist flexion, wrist extension, and finger and thumb movements.
If the assessment shows only a stiff and uncomfortable wrist the physiotherapy exercises will consist of range of movement for the shoulder, elbow, forearm rotation, wrist and hand. To ease the transition out of plaster and enable early functional ability without pain a velcro futura wrist splint can be used for a week or so. Referral to exercise hand class may be necessary and the physios can mobilize the wrist and forearm joints by re-establishing the gliding movements between the joints. As the wrist improves the focus of physio moves to strengthening exercises and the promotion of normal day-to-day activities.
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Glasgow.
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