Distal radius fractures can be reset either with surgery (open reduction) or without it (closed reduction). This article discusses the recovery process for both approaches, plus the pain management tactics that can be used for all patients.
Managing Pain During Recovery
During recovery, these pain management techniques can be used for patients:
- Physicians may prescribe a short course of opioid pain medications after a reduction. The prescription period will usually be brief, since opioids can cause troubling side effects and addiction.
- Patients can use non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) or naproxen (Alieve) to manage pain and inflammation. NSAIDs may cause mild side effects and should be taken as directed.
- Ice therapy is a simple, low-risk way to manage pain and inflammation. Icing sessions can be done for 5 to 10 minutes every hour. Patients should avoid placing ice directly onto the skin, which can cause damage.
Closed Reduction Recovery
After a closed (nonsurgical) resetting, the cast will be kept on for about 6 weeks. Patients will need to keep casts and splints dry by avoiding baths or swimming, and showering with a plastic bag covering it. If the fracture has been reset, patients may need to return for periodic X-rays to make sure the bone is healing correctly.
After the cast is removed, it’s normal for the wrist to be stiff for 1 to 2 months. For some patients—such as those who are older, have osteoarthritis, or were victims of a high energy break such as from a car accident— this stiffness may last up to 2 years.
Patients may still be advised to wear a soft wrist splint at night for 1 to 2 weeks after the cast is removed to stabilize the wrist and help patients sleep better.
Regardless of the approach used to treat a distal radius fracture, physical therapy is essential to the recovery process. Some of the goals of physical therapy include:
- Learning range of motion exercises for the fingers, wrist, and forearm
- Decreasing swelling and/or scarring with gentle manipulation
- Strengthening the hand and wrist to restore pinch and grip motion
The wrist and arm should be functional for most activity by 8 to 10 weeks after surgery. After about 3 to 6 months, most patients can resume heavier wrist or arm activity and sports.
Open Reduction Recovery
After a surgical procedure such as external fixation or internal plate fixation, a cast will not be necessary. Dressing will be applied until wounds heal and a splint is worn to stabilize the wrist.
For an external fixation, the wrist will be in a splint for 10 days to allow pain and swelling to subside. The external fixator is usually removed at 6 weeks, and any additional Kirschner wire pins can be removed 2 weeks later.
In the case of an internal plate procedure, the wound is dressed in a bandage and patients wear a splint for 6 weeks. The wrist should remain immobile for 1 week until the sutures are removed, but after that patients can begin mobility exercises.
A course of physical therapy will be prescribed to help patients restore range of motion, decrease swelling, and rebuild strength.
Possible Complications of Distal Radius Fractures
As with all procedures to treat an injury, there are some potential complications that can occur. The chances for the following complications vary based on the condition of the patient and the treatment approach used. Patients should ask their physicians for specific information about their own risk for certain complications.
Possible complications of a distal radius fracture can include, but are not limited to:
- Malunion of the bone and continued deformity
- Residual pain and stiffness
- Compromised function or strength in the hand or wrist
- Post-traumatic arthritis in the wrist (particularly with intra-articular fractures)
- Injuries to nerves, tendons, other soft tissues
- Pin-site or incision infections
In some cases—such as when the bone heals out of alignment (malunion) or there is tendon damage from an internal plate—a second surgery may be needed to correct the problem.
Most people who experience a distal radius fracture are able to recover well and return to the full scope of their former activities.