As the winter starts the weather gets cold and frosty mornings make pavements and roads slippery and dangerous, causing an epidemic of falls. A FOOSH, a fall on the outstretched hand, is a typical accident and commonly results in a fracture of the ulna and radius in the forearm, although it is often referred to as a wrist fracture. A wrist fracture can be small like an avulsion or a greenstick or major like multiple fractures requiring internal fixation. Osteopaths assess progress and rehabilitate wrist fractures in osteopathy departments and fracture clinics.

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.

The highest incidence of this fracture occurs in people from 6 to 10 years and from 60 to 69 years. In older people the fracture is usually away from the joint but in younger people the forces involved are often higher and this increases the likelihood of joint damage along with the fracture. On examination a fractured wrist is usually swollen and may have a typical bony deformity as the bones are out of line, referred to as a dinner fork deformity. The fracture will be very painful and palpation over the fractured area will confirm the likely diagnosis.

Medical Treatment of Wrist Fractures

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 Rehabilitation of Wrist Fractures

The plaster is usually in place for 5-6 weeks and then the osteopath can get a look at the wrist and hand to see what rehabilitation plan is required. When the hand is removed from plaster its condition varies greatly so a skilled osteo needs to assess the situation and recommend appropriate treatment. The swelling and colour of the hand will give the osteopath important information about how severe things are. High levels of pain, strong changes in colour and extreme swelling in the hand and wrist could indicate Complex Regional Pain Syndrome (CRPS), a severe pain condition needing vigorous management.

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.

If the osteopath determines that the wrist is uncomplicated after removal of plaster then they will prescribe mobilizing exercises for the wrist, forearm and hand and perhaps the elbow and shoulder. Coming straight out of plaster is a shock for the wrist and a strap on futura splint can rest the wrist and permit normal activity without too much discomfort. If the wrist is very stiff then attendance at a hand class may be useful and the accessory joint movements can be restored by using joint mobilization techniques on the many wrist joints. The physio will progress to strengthening the wrist as the movements improve and teach the patient to use the hand normally in daily activities.