ORIF of Distal Radius Fractures

Fixation (ORIF) of Distal Radius Fracture

Post Op Protocol


-  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


- 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


- 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



- 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



- 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




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. 


© Maguire Upper Limb Pty Ltd 2014 Ph: 07 5531 2222