Welcome back to The Hand-To-Shoulder Solution—Carl here, OT and board-certified hand therapist. In this video I dive into distal radius fractures, often caused by a fall on an outstretched hand. Let’s break down what these are, how they’re treated, and how rehab supports optimal recovery.
🔍 Understanding the Anatomy of a Distal Radius Fracture
- The distal radius is the end of the radius bone near your wrist—a common hit during a fall when the radius rotates over the ulna.
- A fracture is simply a broken bone. They can be:
- Non-displaced: broken but well-aligned
- Displaced: bone has shifted and needs realignment
🩹 Treatment Options
- Closed Reduction + Cast
- Realignment is done manually or via imaging (fluoroscopy/X-ray)
- If bone alignment is stable, a cast is used for ~6 weeks
- Rehab begins after cast removal to reduce swelling and restore strength
- Surgical Fixation (ORIF)
- Necessary for displaced or comminuted fractures
- Surgeons use plates and screws to align and compress fracture fragments
- Ideal when alignment can’t be achieved non-surgically
🛠️ Advanced Surgical Hardware
- Hardware often fits just inside the watershed line, avoiding tendon irritation
- Locking screws prevent backing out—crucial for tendon protection
- Plates may include hooks to hold articular fragments in place
- Advanced drill guides help position screws precisely for optimal fixation
🩺 Rehab: What a Hand Therapist Does
- At ~1 week post-op, cast is removed and a custom orthosis is fitted
- Customized gutter splints secure wrist, allowing early gentle motion
- Early rehab focuses on restoring forearm rotation (radius on ulna) with passive, gentle motion and light stretches—e.g., using knee as a fulcrum
- Motion also promotes lymphatic flow, essential for reducing swelling during the inflammatory phase
💪 Progressive Rehab Phases
| Phase | Weeks Post-Injury | Focus |
|---|---|---|
| 1–2 | Inflammatory | Gentle ROM, edema management, no compressive gloves |
| 3–6 | Mobility Building | More aggressive ROM with splint removal, light traction |
| 6+ | Strengthening | Begin lifting tools like a hammer, build strength |
- A hammer exercise (flexion/extension, pronation/supination with weight) engages multiple muscles together
- Early fixation with plates allows quicker progress and reduces stiffness from immobilization
✅ Why It Works
- Fixed hardware enables exact alignment
- Movement therapy enhances healing and vascular flow
- Custom orthoses support targeted motion without compromising fracture integrity
- Phase-based rehab ensures safety while maximizing gains
🔗 Watch the Full Episode
For in-depth explanations, demonstrations of the hardware, and live exercises, watch the full 16-minute video:
▶️ Watch “Wrist Trouble? A Deep Dive into Distal Radius Fractures” by Carl Petitto here
🎯 How This Helps
- Patients learn realistic recovery timelines, rationale behind immobilization vs. surgery, and how to support healing
- Therapists gain deeper understanding of fracture mechanics, hardware considerations, and rehab protocols—perfect for hands-on clinical cases