WRIST FRACTURES

2016/04/07 Home Education and advice

Wrist fractures are the most common type of fracture of the upper limb across all age groups. The wrist is composed of many bones including the radius, the ulna and the carpal bones. As a result, a fracture can affect one or more of these bones. The most prevalent damage involves a fracture of the radius with distal displacement on the dorsal side, commonly known as a Colles’ fracture.

Groups most affected by Colles’ fractures¹

Postmenopausal women with osteoporosis, people falling on one hand with an extended wrist
Young people experiencing trauma at high speeds (sports, motor vehicle accident)

Signs and symptoms²

Pain in the wrist and fingers
Acute edema
Palpable and/or visible wrist deformation
Loss of active and passive joint motion
Loss of muscular strength in the wrist, fingers and hand grip

Numerous structures are located in the wrist region, including several tendons, ligaments and nerves. Thus, these structures can also be affected and create complications. Depending on the severity of the fracture and bone displacement, immobilization with or without surgical intervention may be necessary.

Most common potential complications³:

Peripheral neuropathy (especially median nerve damage)
Wrist osteoarthritis
Complex regional pain syndrome or shoulder-hand syndrome
Tendon rupture
Stiffness in the fingers
Adhesive capsulitis of the shoulder (secondary to arm immobilization)
Persistent reduction in the range of motion, limiting the return to normal functions of the wrist

Physiotherapy interventions⁵

Reduction of pain and edema	Increase in the range of motion of the wrist
Electro-therapeutic modalities (TENS) Contrast bath (hot-cold) Ice Paraffin bath Advice on pain and edema management	Articular mobilizations Soft tissue techniques Prescription of active, assisted and passive exercises
Strengthening of the wrist	Return to normal functions
Prescription of exercises for gradual strengthening	Functional exercises (e.g. unscrewing lids, attaching buttons) Advice on upper limb usage

Scientific studies demonstrate that early intervention by a physiotherapist following the healing of a fracture is very effective and allows for a faster return to normal functions while preventing complications.⁴

References

1. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001;219(1):11-28.

2. Brogren E, Hofer M, Petranek M, Dahlin LB, Atroshi I. Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2–4 years after fracture. Journal of Hand Surgery (European Volume). 2011;36(7):568-76.

3. Cooney WP, Doybins JH, Linscheid RL. Complications of Colles’ Fracture. The Journal of Bone and Joint Surgery. 1980;62(4):613-617.

4. Watt CF, Taylor NF, Baskus K. Do Colles’ fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg. 2000;120:413-415.

5. Bruder AM, Taylor NF, Dodd KJ, Shields N. Physiotherapy intervention practice patterns used in rehabilitation after distal radial fracture. Physiotherapy. 2013;99(3):233-40.

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