ORIF of Distal Radius Fractures

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.