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.
75 percent of wrist fractures involve the radius and ulna, with the wrist the most often injured part of the upper extremity. A fracture can be minor and be undisplaced or very severe with multiple fractures (comminuted) and badly displaced, which may need operation with plates and screws to fix the fracture securely. The type of fracture is related to the age of the sufferer: adolescents have wrist growth plate displacement, children bend their bones in a greenstick fracture and adults present with a fracture of the final inch of the forearm bones above 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.
Orthopaedic Management of Wrist Fracture
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.
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 shoulder ranges are assessed initially by the osteopath as the shoulder can be injured in the fall and suffer loss of movement. Loss of movement at the elbow can occur if the patient holds their arm stiff for the first few weeks but the rotatory forearm movements (supination & pronation) are much more commonly restricted and functionally important. The fracture is close to the lower rotatory forearm joint and restricts this and the wrist ranges of motion. The hand function, finger and thumb movements are also assessed by the physio.
The osteo will decide if the patients hand is normal for coming out of plaster and give range of motion exercises for the elbow, forearm, wrist and hand and perhaps the shoulder. A futura splint, a velcro fastening wrist splint, is useful to reduce the shock of coming out of plaster and allow patients to do functional activities without aggravating the pain too greatly. Attending a hand class for repeated exercise can be useful and osteos can use mobilizing techniques to restore the accessory movement between the joints. Once the wrist is settled and moving better the osteopath will work on strengthening exercise and encourage functional normality.