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Wrist Fracture
ORTHOPAEDIC UNIT: 01-293 8687 /01-293 6602
UPMC BEACON CENTRE FOR ORTHOPAEDICS: 01-2937575
PHYSIOTHERAPY DEPARTMENT: 01-2936692
GUIDELINES FOR PATIENTS FOLLOWING WRIST
FRACTURE
Please stick addressograph here
Last Revised May 2011
Wrist Fracture
Table of Contents
1.
Introduction
2. What is a wrist fracture?
3. Causes
4. Symptoms
5. Treatment
6. Risks
7. Pain management
8. Physiotherapy and Exercise program
9. Your Rehabilitation Goals
10. General recommendations
11. Discharge Instructions
12. Conclusion
13. Individual Patient Notes
Last Revised May 2011
Introduction
This information booklet has been written to give you and your
family a basic understanding of what is involved when you
fracture your wrist. Throughout your stay in UPMC Beacon
Hospital, you will receive continuous advice and support from all
members of the team.
What is a Wrist Fracture?
A wrist fracture is a break in one or more of the bones in the wrist.
The wrist is made up of the two bones in the forearm – the radius
and ulna, and eight carpal bones. The radius is the bone on the
thumb side of the forearm, and the ulna is the outer bone of the
forearm located on the side of the baby finger.
The carpal bones lie between the end of the forearm bones and the
bases of the fingers.
Wrist Fracture
The Colles' fracture is a specific type of wrist fracture. When a
patient sustains a Colles' fracture, there is displacement of the
bone such that the wrist joint rests behind its normal anatomic
position. A Colles' fracture is most commonly found after falling
on to an outstretched hand.
The Smith's fracture, also sometimes known as a reverse Colles'
fracture is also a fracture of the distal radius. In this injury there is
displacement of the bone such that the wrist joint rests in front of
its normal anatomic position. The injury is most commonly found
after falling on to the back of the hand.
What causes a wrist fracture?
Wrist fracture is caused by trauma to the bones in the wrist.
Trauma may be caused by:
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Falling on an outstretched arm
Direct blow to the wrist
Severe twist of the wrist
Some factors increase your chance of breaking your wrist. They
include:
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The most commonly fractured carpal bones is called the scaphoid
bone.
Last Revised May 2011
Osteoporosis
Poor nutrition
Conditions that increase risk of falling:
Snow
Ice
Loss of agility or muscle strength
If you are elderly
• Post menopause
• Decreased muscle mass
Wrist Fracture
Symptoms
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Arm or wrist pain
Bruising
Swelling
Tenderness
Severe pain with movement
Trouble moving wrist or arm
Wrist appears out of line
Treatment
It takes 6-10 weeks for a fracture of the radius at the wrist to heal.
The type of treatment you receive depends upon where you broke
your bone and how serious the break is.
Some fractures require what is called a reduction. This means the
doctor realigns the bones before healing begins. Reductions can
be done by the doctor moving your arm into position or through
surgery.
Your doctor may choose to treat the fracture using a cast. Your
cast may be removed after a few weeks and replaced if it loosens.
Most casts are removed at about six weeks.
In other cases, a splint or a soft bandage may be used instead of a
cast.
A fracture sometimes requires surgery. The surgeon first carries
out a reduction.
Then they may use any of the following to hold the bones
together as they heal:
Last Revised May 2011
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A plate and screws
Pins
An external device that holds the inside pins together
You may be given a splint to wear after surgery to keep your arm
from moving too much.
Risks
Surgery when carried out is performed under general anaesthetic.
There is a small risk (<1%) of damage to nerves or blood vessels
or infection. Infection is now a rare complication occurring in less
that 1% of patients. Strict protocols in the operating theatre, intraoperative antibiotics, special surgical gowns and meticulous
attention to surgical detail have helped achieve this low number.
As with any surgery, there are also a small proportion of patients
who fail to derive benefit from the surgery or who require further
procedures.
Manage Your Pain
Pain is a common occurrence following any fracture. The wrist
may be sore which can be well managed with medications. The
pain will naturally reduce as your fracture heals and with regular
use of analgesics (pain killers). It is imperative to keep your pain
well controlled so you can mobilise comfortably, perform your
physiotherapy exercises and resume normal activities. You will be
asked to rate or score your pain regularly after your surgery. The
score will depend on how your pain feels to you.
0= No Pain, 10= worst pain imaginable
Wrist Fracture
(Please point to the number that best describes your pain)
surgery. The exercises should not lead to excessive pain or
discomfort.
.
Exercise Program
Frequency: You will need to exercise at least three times a day
to ensure you reach your rehabilitation goals.
It is normal to have some swelling after your wrist fracture. Your
sensation may be also decreased after if surgery is carried out, so
use extra care. The swelling may last 2-3 months but can be
minimised by:
Elevating your wrist so it is above the level of your heart- if you
are sitting, prop your wrist up on several pillows
Ice: When cast is removed, Wrap ice in a towel and apply to the
wrist for 10minutes on then 10 minutes off for 30 minutes
duration. Repeat x 3-4 times daily. When a cast is in place, ice can
be used to assist with reducing swelling in the fingers and thumb.
Physiotherapy
The physiotherapist may commence gentle range of movement
exercises with you, depending on directions by your consultant.
You should ensure that you have had adequate pain medication
prior to seeing the physiotherapist.
The physiotherapist will teach you gentle neck and shoulder girdle
movements and will advise you regarding regular elbow and
finger/ hand / wrist movements as prescribed by your consultant.
It is important to ensure that these joints do not become stiff post
Last Revised May 2011
The following exercises start as soon as you are able. You may
feel uncomfortable at first, but these exercises will speed your
recovery. Additional exercises permitted by your consultant will
be provided by your physiotherapist when applicable.
1) Cervical Rotation
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Turn your head to one side until you feel a stretch
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Hold Approx. 20 seconds
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Repeat to other side x 3 repetitions
Wrist Fracture
2) Scapula setting/posture
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Relaxed your shoulders then gently squeeze your shoulder
blades together.
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Hold 10 seconds
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Repeat 5 times
3) Shoulder Rolls
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Roll your shoulders forwards- repeat x 10 repetitions then
roll backwards x 10 repetitions
4) Finger Flexion and Extension
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Curl down fingers towards palm then straighten fully
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Repeat 10 times
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Bend knuckles nearest wrist, keeping middle and end
knuckles straight then straighten fully
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Repeat 10 times
3) Elbow Range of Movement
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Keeping your arm close to your side, Bend and straighten
your elbow fully focussing on getting your elbow as
straight as possible.
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Repeat 10 times
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Wrist Fracture
5) Thumb Range of Movement
General Recommendations
Driving
In order to be safe driving a motor vehicle, you must be in control
of the wheel effectively. It is recommended that you do not drive
a motor vehicle until you are advised by your consultant.
Returning to Work
Plan to take time off work following your surgery. If your job
requires a lot of manual labour, contact your consultant for
appropriate work restrictions.
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Move thumb in a wide circular motion.
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Repeat 10 times
Your Rehabilitation Goals
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Independent in the correct use of any sling/support
provided
Independent in the completion of your exercise program
Ensure that you have adequate pain control.
Clear awareness of your follow up rehabilitation program.
Last Revised May 2011
Discharge Instructions
You will be discharged from hospital 0-1 days after your
operation. When you leave the hospital you will be asked to make
an appointment to see your consultant, usually 6 weeks after the
operation.
Follow up
Commencement of follow up physiotherapy is dependant on your
consultant’s advice, usually post removal of cast/ splint. Once
advised for same, please make a physiotherapy appointment. The
Beacon Physiotherapy department number is 01 2936692. It is
advisable to attend physiotherapy in the Beacon as the
Wrist Fracture
physiotherapists will have access to all of your medical notes. The
Physiotherapy team also are in direct contact with your surgeon
should a problem arise.
On discharge from hospital, your consultant will prescribe you
some medications. One of the medications prescribed will be pain
medications. Plan to take your pain medication 30 minutes before
exercises. Preventing pain is easier than chasing pain. If pain
control continues to be a problem, contact the orthopaedic centre
or your general practitioner.
Wound Care
Most people will have sutures that will need to be removed
approximately 10-14 days after surgery. This may be done by the
GP, Dressing clinic, consultant or in the convalescence centre.
Conclusion
We hope that you have found this booklet useful and that it has
helped to relieve some of your fears and anxieties regarding your
surgery.
During your hospital stay, your medical team will be available to
answer any other queries you may have.
You may leave the hospital with a simple surgical wound.
Infection may occur despite your very best efforts. If any of the
symptoms below occur then you will need to see your GP or liaise
with the orthopaedic link nurses re advice and possibly antibiotics.
Individual Patient Notes:
Signs of Infection
If you develop any of the following signs of infection, it is
important to report them to your doctor. The signs of infection
include:
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Redness around the wound site
Increased pain in the wound
Swelling around the wound
Heat at the wound site
Discharge of fluid – may be green or yellow
Odour or smell from the wound
Feeling of being generally unwell
Fever or temperature
Last Revised May 2011
Consultant Name: ________________________________
Date of Surgery: __________________________________
Surgery Note: ___________________________________
Date for removal of sutures __________________________