2019-10-31

Management of Distal Radius Incidence

Fractures
•  Occurs in all age
group
•  Greater in persons
over 40
•  Females > Males
•  Commonest of all
upper extremity

Mechanism of Injury Mechanism of Injury

l Fallon an
Fall on outstretched hand outstretched hand –
Colles #
l Fall
on flexed hand –
Smith’s #
•  Axial load – volar/
dorsal – Barton’s #

1
 2019-10-31

Associated soft tissue trauma is Primary complications

often underestimated making
diagnosis difficult Injury to:

•  Median nerve & vessels

•  Flexor & extensor
tendons
•  Rupture of EPL

Primary complications Primary complications

•  Fracture &/or Fracture &/or

dislocation of dislocation of radial
DRUJ head
•  Ligamentous
structures
Tear/trauma to
•  Carpal & radio-
rotator cuff
carpal joints

2

Reduction of fractures
•  Closed - casting
•  Open reduction & internal
fixation
-Volar, dorsal plating
•  Kapandji pinning
•  External fixation
Associated procedures
•  Compartment release
•  EPL repair
•  EIP transfer to EPL
•  Ligamentous repair
2019-10-31
Reduction of Fracture
Complications in Distal Radius
Fractures
•  Highest 31-50%
complication rate
•  20% - residual
symptoms
•  10% - Significant
functional impairment
•  60% - prevalence of
RSD
3
 2019-10-31

Factors Affecting Rehabilitation with Factors Affecting Rehabilitation with

Casting Plating
•  Secondary Compartment •  Adhesion of Flexors
Syndrome and Extensors
•  Shortened Flexors •  Extension of Lag
•  Lengthened Extensors •  Secondary Intrinsic
•  Reduced Composite Tightness
Flexion •  Reduced Digital
•  Collateral Ligament ROM
Tightness •  Contractures

Factors Affecting Rehabilitation with Ex-

Factors Affecting Rehabilitation -
Fix
General
•  Pain
•  Reduced Flexor/Extensor
Glide •  Swelling
•  1st Web Space Tightness •  Fear/Phobia
•  Collateral Ligament •  Contractures
Tightness
•  Secondary Intrinsic/ •  Weakness
Extrinsic Tightness •  Postural Changes
•  Muscle Contractures
•  RSD

4
 2019-10-31

Hand Therapy Consideration Evaluation of Upper Extremity

Stage 1 Stage 1
Fracture Immobilization Stage

•  Mechanism of Injury •  Posture of Upper

•  Surgical/Non Extremity
Surgical •  Edema
•  Details •  Range of Motion
•  X-Rays •  Intrinsic/Extrinsic
Function

Shoulder ROM Shoulder ROM

5
 2019-10-31

Evaluation of Upper Extremity

Role of Therapy in Stage 1
Stage 1

•  Patient & Family

•  Capsular/Ligamentous Education
Tightness •  Edema Control
•  Web Space •  Passive/Active ROM
•  Pain and Sensation Digits
•  General Mental Status

Mobilization of Digits Mobilization of Digits

6
 2019-10-31

Intrinsic Extrinsic Stretches AROM - Digits

Increasing Joint Motion &

Role of Therapy in Stage 1
Tendon Glide
•  AROM/AAROM
Elbow Forearm &
Shoulder
•  Contracture Control
•  Splinting
•  Light ADL

7
 2019-10-31

Activities of Daily Living Activities of Daily Living

Activities of Daily Living Distal Radius Fractures - ORIF

8
 2019-10-31

ORIF Complications

•  Persistent Swelling and

Pain
•  Sensory Disturbances
•  Tendon Adhesions
•  Periarticular Tightness
•  Joint Space Narrowing
•  1st Web Space
Contracture

Management Results of Early Mobilization

9
 2019-10-31

Hand Therapy Consideration Complications Affecting

Stage 2 Rehabilitation in Stage 2
•  Persistent Swelling and
Pain
l MobilizaFon Stage
•  Sensory Disturbances
Following Ex-Fix/Cast
removal •  Tendon Adhesions
•  Periarticular Tightness
•  Joint Space Narrowing
•  1st Web Space
Contracture

Complications Affecting
Rehabilitation in Stage 2
•  Reduced Range of
Motion
(wrist, forearm, elbow, &
shoulder)
•  Muscle Weakness
•  Shortened Stretch Reflex
•  Co-contraction of
Agonists & Antagonists

10
 2019-10-31

Complications Affecting Evaluation of Upper Extremity

Rehabilitation in Stage 2
•  Postural Changes
•  Depression/Withdrawal
•  Reflex Sympathetic
Dystrophy
Stage 2
•  Edema
•  Pain
•  A/P ROM Upper Extremity
•  Flexor/Extensor Function
•  Ligamentous Tightness
•  Muscle Strength
•  RSD Signs & Symptoms

Role of Therapy in Stage 2 Joint Mobilization

•  Edema Control
•  Joint Mobilization
•  Muscle Re-Education
•  Muscle Strengthening
•  Splinting
•  Pain Control
•  Continuous Passive Motion
Program

11
 2019-10-31

Modalities & Strengthening Shoulder Strengthening

Role of Therapy in Stage 2 Splinting

•  Splinting
-Static
-Dynamic
-Static Progressive
-Serial

12
 2019-10-31

Splinting Monitor Signs of RSD

Diagnosis
•  Pain
•  Swelling
•  Fluctuation in
Vascularity
•  Discoloration
•  Hyperhydrosis
•  X-Rays
•  Guarding Posture

Management of RSD in Distal

Radius Fractures Stress Loading
•  Edema Control
•  Gate Control for Pain
•  Contrast Baths
•  Retrograde Massage
•  Joint Mobilization
•  Ultrasound
•  Stress Loading
•  Splinting
•  Controlled Passive Motion

13
 2019-10-31

Indications for Using CPM Gains with Traditional Hand

in Therapy
Distal Radius Fractures
•  Minimal Progression
•  Slow & Short Lived
•  Unidirectional
•  Loss of Motion in Opposite
Direction

Effect of CPM & Hand

Therapy Conclusion

•  Regain Periarticular
Length •  Early mobilization
•  Restore Joint program for distal
Hydrodynamics radius fractures
•  Reduce Contractures & predictably produces
Stiffness
better results
•  Reduce Pain
•  Increase Musculo-
Tendinous Excursion

14