Dr. Kirkpatrick Distal Radius Fracture ORIF: Goals For Phase 1 Splint

Dr.
Kirkpatrick
Distal Radius Fracture ORIF
Phase 1- Early Protective Phase (0 - 4 weeks post-op)
Goals for phase 1 Splint

• Protect and immobilize • Patient is usually casted until 4 weeks post-op
fracture repair • At 4 weeks or at the first therapy visit, a volar thermoplastic wrist hand orthosis
• Edema and pain control (WHO) is fabricated with wrist in neutral position or the same as the post-
• Promote scar tissue mobility operative mold.
to decrease scar adherence
after incision healing Modalities
• Icing to reduce pain and swelling
• Heat modalities to promote flexibility of tissues
• Ultrasound as needed for scar (beginning 3 weeks post op)
Manual Therapy
• Manual Edema Mobilization (MEM) to promote edema reduction
Other considerations • Issue Compressive stocking and/or glove for edema management
Care should be taken to position • Begin scar massage no sooner than 2 days after suture removal and after scar
the wrist in neutral for volar is fully closed with no scabbing present. Begin with light massage using lotion.
displaced fractures and 20-30 Apply scar remodeling products as needed.
degrees of extension for dorsally
displaced traditional Colle’s Wound Care
fractures to prevent stress over the • Sterile dressing changes as needed. Apply non-adherent dressings keeping
fracture site during the healing the suture site clean and dry. If there is drainage from the wound, Xeroform
phase. If unsure, splint in neutral may be applied until resolved. Do not apply Bacitracin or any other anti-biotic
to be safe. ointments.
ROM
• Initiate gentle active motion to wrist and forearm gradually advancing to AAROM
as tolerated. The MD may delay motion if bone quality and/or fixation was not
good. Always check MD orders and notes for deviations in plan of care.
• A/PROM to uninvolved joints: shoulder, elbow, digits/thumb
HEP
• Edema control
• Scar Management when appropriate
• Gentle active wrist and forearm motion in all planes of motion 5-6x/day
• A/PROM to uninvolved joints as needed
1160 Kepler Drive 1|Page

Green Bay, WI 54311
920-288-5555
Phase 2 – Progressive Range of Motion (4-6 weeks post-op)
• Restore flexibility • Continue splint at all times between exercise sessions
• AROM improving
• Improvement in functional Modalities
abilities • Icing to reduce pain and swelling
• Heat modalities to promote flexibility of tissues
• Other modalities as needed
Manual Therapy
• Continue MEM to promote edema reduction
• Continue Edema garments as needed
• Kinesiotaping for edema as needed
• Continue scar management
Criteria for progression to
Phase 3 ROM
• AROM is pain free • Continue A/AAROM to wrist & forearm including active wrist extension
with simultaneous finger flexion to isolate wrist extensors & prevent
substitution of finger extensors and composite wrist and digit flexion to
prevent extrinsic extensor tightness
• 5-6 weeks: gradually advance to gentle pain-free PROM to wrist &
forearm
• A/PROM to uninvolved joints as needed

Green Bay, WI 54311
920-288-5555
Phase 3 – Progressive Stretching & Strengthening (6-12+ weeks post-op)
• Maximum ROM pain free • Begin to wean from wrist hand orthosis
wrist and forearm; full motion • After splint is discontinued, the patient may continue to wear it for activities
uninvolved joints involving resistance; discontinue after 12 weeks unless wrist support needed
• Increase strength while not for heavy activities & sports activities
increasing pain level
• Full use of extremity by 3 Modalities
months, depending on work • Ice as needed to reduce pain/inflammation
demands or sports • Heat modalities as needed to promote flexibility of tissues
Manual Therapy
• MEM as needed
• Scar massage/mobilization as needed
• 10+ weeks post-op: joint mobilizations to wrist and forearm to promote
maximal motion if needed
ROM
Criteria for return to work,
• Continue A/AA/PROM to wrist, forearm, digits progressing to end range
function, sport
stretching to promote maximum end range motion
• Return to heavy work or
sports as per MD approval Strengthening (7-8 weeks post-op)
• Grip and pinch strengthening with putty
• Progressive strengthening to wrist, forearm, elbow & shoulder
o Begin with isometrics and progress to isotonics
• Wrist stabilization and proprioception activities: flexbar for wrist strength and
oscillations, weighted alphabet, gyroball, smart phone games, tilt maze game,
progress to rebounder ball throwing
Work Conditioning (12+ weeks post-op)

• Initiate a comprehensive work conditioning program for patients with high-
demand, heavy manual labor occupations

Green Bay, WI 54311
920-288-5555
References
Brou, KE, Henry, MH, Smith, DW. Early active rehabilitation for operatively stabilized distal radius fractures.
Journal of Hand Therapy (2004); 17:43-49.
Bruder, AM, Dodd, KJ, Shields N, Taylor, NF. Physiotherapy intervention practice patterns used in rehabilitation
after distal radius fracture. Physiotherapy 99 (2013); 233-240.
Valdes, K. A retrospective pilot study comparing the number of therapy visits required to regain functional wrist
and forearm range of motion following volar plating of a distal radius fracture. Journal of Hand Therapy (2009);
22:312-318.
This protocol was reviewed and updated by Misty Carriveau, OTR, CHT, Mitchell Voss, OTR, and Andrew Kirkpatrick, MD
January 2019.

Green Bay, WI 54311
920-288-5555

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Dr.

Phase 1- Early Protective Phase (0 - 4 weeks post-op)

Goals for phase 1 Splint

1160 Kepler Drive 1|Page

1160 Kepler Drive 2|Page

Work Conditioning (12+ weeks post-op)

1160 Kepler Drive 3|Page

1160 Kepler Drive 4|Page

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