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
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 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. 10. General recommendations 11. Discharge Instructions 12. Conclusion 13. Individual Patient Notes
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? The most commonly fractured carpal bones is called the scaphoid bone. Wrist fracture is caused by trauma to the bones in the wrist. Trauma may be caused by: 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: 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
Symptoms 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: 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 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 Turn your head to one side until you feel a stretch Hold Approx. 20 seconds Repeat to other side x 3 repetitions
Wrist Fracture 2) Scapula setting/posture Relaxed your shoulders then gently squeeze your shoulder blades together. Hold 10 seconds Repeat 5 times 3) Shoulder Rolls Roll your shoulders forwards- repeat x 10 repetitions then roll backwards x 10 repetitions 4) Finger Flexion and Extension Curl down fingers towards palm then straighten fully Repeat 10 times Bend knuckles nearest wrist, keeping middle and end knuckles straight then straighten fully Repeat 10 times 3) Elbow Range of Movement Keeping your arm close to your side, Bend and straighten your elbow fully focussing on getting your elbow as straight as possible. Repeat 10 times
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. Move thumb in a wide circular motion. Repeat 10 times Your Rehabilitation Goals 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. 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
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: 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 Consultant Name: Date of Surgery: Surgery Note: Date for removal of sutures