When the weather begins to get icy it gets less safe underfoot and people start to fall over and hurt themselves. A common injury is a fall on the outstretched hand (FOOSH) which often results in wrist fracture. When we say wrist fracture we are usually describing a fracture of the end of the radius and ulna, the two major bones of the forearm. Wrist fractures vary from very minor like a chip to major breaks which require operative fixation. Osteopaths work in fracture clinics and rehabilitate the hand, wrist and forearm after such injuries.
The wrist is the most commonly damaged part of the arm and three quarters of wrist injuries consists of radius and ulna fractures. Minor injuries may have just a crack and remain in position and as injuries become more serious they involve larger numbers of fragments and more marked displacement. As the person falls on the hand the results depend to some degree on age: children develop a greenstick fracture (a kink in the bone), adolescents separate the growth plate from the bone and adults fracture the radius and ulna in the last inch near the wrist.
Fractures of this type occur mostly in people from 60-69 years old and those from 6 to 10 years old. Fractures can occur without joint involvement (older people) or with fractures extending into the joint (younger people due to higher trauma forces) which complicates the picture. Diagnosis of a fracture is straightforward as the area is often very painful and swollen and the patient resists moving it. It may have a typical postural deformity called a dinner fork and feeling over this area will confirm the presence of a fracture.
Medical Treatment of Wrist Fractures
A fracture needs to be maintained as close to the original anatomical alignment as possible while it is healing, for a good functional result. A fracture with little or no displacement may just be plastered in its typical position for successful healing, but a badly displaced fracture may need manipulation and plastering to ensure correct alignment. If the fracture does not stay in the right position then operation such as using a k-wire or performing open reduction and internal fixation (ORIF) will be necessary to stabilise and realign the fracture. After such operations the fracture is plastered to maintain the position.
Osteopathy after Wrist Fracture
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 assessment shows only a stiff and uncomfortable wrist the osteopathy exercises will consist of range of movement for the shoulder, elbow, forearm rotation, wrist and hand. To ease the transition out of plaster and enable early functional ability without pain a velcro futura wrist splint can be used for a week or so. Referral to exercise hand class may be necessary and the osteos can mobilize the wrist and forearm joints by re-establishing the gliding movements between the joints. As the wrist improves the focus of osteo moves to strengthening exercises and the promotion of normal day-to-day activities.
The content of this page is informed by feedback from practices in Hertfordshire and also clinics in Worcester. Further input was received from osteopaths in the Edinburgh area and osteopathic practitioners in Covent Garden. Finally a contribution was made by a practitioner in Nottingham.