Wrist Fracture Treatment By Osteopaths
When the weather begins to get icy it gets less safe underfoot and people start to fall over and hurt themselves. A common injury is a fall on the outstretched hand (FOOSH) which often results in wrist fracture. When we say wrist fracture we are usually describing a fracture of the end of the radius and ulna, the two major bones of the forearm. Wrist fractures vary from very minor like a chip to major breaks which require operative fixation. Osteopaths work in fracture clinics and rehabilitate the hand, wrist and forearm after such injuries.
In the arm the wrist is the most commonly injured area and radius and ulna fractures make up 75% of all wrist fractures. Injuries vary from a single fracture which remains in place without displacement to severe injuries with many fragments (comminuted) and with the bones out of position. The age of the person dictates to some degree the type of fracture experienced: adults suffer radius and ulna fractures in the last inch of the forearm, adolescents displace the wrist growth plate and children suffer from a bend in the cortex of the bone called a greenstick fracture.
The commonest age groups for colles fractures to occur in are the 6-10 and the 60-69 year olds, with older people more likely to suffer fractures in the forearm away from the joint and younger people, due to the higher violence of the injury, being more likely to get joint involvement in the fracture. Diagnostic features of a radius and ulna fracture are significant pain with increased pain on palpating the area, a dinner fork bony deformity, swelling over the area and a marked reluctance to use it.
Orthopaedic Management of Wrist Fracture
To allow the fracture to heal correctly a colles fracture needs to be fixed in a position that allows the fracture to be held in as close to the original shape as possible. A simple fracture which is undisplaced can just be plastered and left to heal, while a displaced fracture has to be returned to a better anatomical alignment. Manipulation and plastering might work, but if the fracture does not remain in a good position then operative fixation with k-wires or plates and screws might be required. After the operation plaster is applied to maintain the correction.
Osteopathy after Wrist Fracture
The typical time in plaster is five to six weeks and once it comes off the osteopath 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 osteo 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.
The osteo will look at the ranges of movement of the upper limb, checking the shoulder ranges first to make sure the shoulder was not damaged in the fall. The elbow range is usually unaffected except in some cases where the patient has kept their elbow bent in a sling for weeks, making the joint stiff. Supination and pronation are very important movements functionally and often restricted due to the proximity of the inferior radio-ulnar joint to the fracture site. Wrist flexion and extension, finger movement and thumb ranges are all assessed and recorded.
If the osteopath determines that the wrist is uncomplicated after removal of plaster then they will prescribe mobilizing exercises for the wrist, forearm and hand and perhaps the elbow and shoulder. Coming straight out of plaster is a shock for the wrist and a strap on futura splint can rest the wrist and permit normal activity without too much discomfort. If the wrist is very stiff then attendance at a hand class may be useful and the accessory joint movements can be restored by using joint mobilization techniques on the many wrist joints. The physio will progress to strengthening the wrist as the movements improve and teach the patient to use the hand normally in daily activities.
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Written by Andrew Mitchell on November 16th, 2009 with
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