Fixation (ORIF) of Distal Radius Fracture
Post Op Protocol
WEEK 1
- Patient will present with stitches intact. Steri-strips may be used for protection of suture line
- Fabrication of THERMOPLASTIC volar EXTENSION wrist splint to be worn at all times except during exercise
- Patient to perform wrist, digit and forearm AROM exercises for 10 repetitions 4-5 times per day
- Initiate edema management as needed, including edema gloves, tensogrip sleeves, ice and elevation
In hospital ICE / cryo-cuff every 2-3 hours
- Do not put up with pain
- If no contraindications use this pain relief regime
- PCA overnight then change to the following in am:
- Paracetamol 1gram four times a day
- Ibuprofen 400mg three times a day
- 10 to 20 mg of TARGIN (Oxycontin) twice a day
- 5-10 mg of Endone as required up to 3 hourly
- Ensure Fluid intake and bowel softening agents
- Prevent constipation from Endone/Targin by taking regular fibre +/- Coloxyl or Similar Bowel Softening agent
- Drink plenty of fluids
WEEK 2
- Sutures removed approximately day 10 if not dissolving (if no suture material visible stitch is dissolving)
- Initiate scar management including scar molds and scar massage with Bio-Oil or Vitamin E cream/oil
- Continue exercises above
- Wean off Targin and Endone after first week
- No sling required
- Continue AROM exercise to wrist and forearm; digits PRN
- Initiate AAROM (Assisted Active Range of Motion) exercises to wrist and forearm; digit ROM PRN
- Pending pain and edema, patient may remove splint and use affected upper extremity during gentle ADL’s
- Wean analgesia to regular Paracetamol only 2 tablets (1 gram) four times a day
- Stop ibuprofen as may retard bone healing
- Endone PRN or Tramadol PRN or Panadeine Forte in place of Paracetomol
- Use warmth or heat before exercises and cold therapy (ICE) after exercise
WEEK 3
- Initiate gentle strengthening with theraputty and a 1 kg weight for wrist extension/flexion
- Initiate isolated wrist extension exercises (digits in flexion, i.e. holding a pencil)
- Continue scar and edema management
- Continue A/AAROM exercises
- Progress to gentle PROM if needed
- Patient to continue wearing splint for protection during involved or strenuous activities and at night
- Use warmth or heat before exercises and cold therapy (ICE) after exercise
WEEK 4
- Progress wrist extension/ flexion strength and resistance work as tolerated up to 5 kg
- No axial loading
- Upgrade home program as needed
- Continue splint for protected activities and at night.
- May start hydro or gentle swimming
- Use warmth or heat before exercises and cold therapy (ICE) after exercise
WEEK 6
- Discontinue splint
- Progress wrist extension/ flexion strengthening with no restrictions
- Initiate gentle wrist loading
- Continue scar management, range of motion, and modalities as needed
- Use warmth or heat before exercises and cold therapy (ICE) after exercise
CONSIDERATIONS:
- Patient may resume normal activities as tolerated as early as 6 weeks post-op.
- Younger/athletic patients may progress at an even faster rate than stated above.
- Elderly patients may progress at a slower pace than stated above.
- Joint mobilizations may be utilized pending patient tolerance and fracture healing.