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.
75 percent of wrist fractures involve the radius and ulna, with the
wrist the most often injured part of the upper extremity. A fracture
can be minor and be undisplaced or very severe with multiple fractures
(comminuted) and badly displaced, which may need operation with plates
and screws to fix the fracture securely. The type of fracture is
related to the age of the sufferer: adolescents have wrist growth plate
displacement, children bend their bones in a greenstick fracture and
adults present with a fracture of the final inch of the forearm bones
above 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.
Orthopaedic Management of Wrist Fracture
The main principle of treatment is to immobilize the fracture in an
anatomically correct position so it heals as closely as possible to the
original shape. The fracture is assessed for its severity and whether
it is displaced. Displacement can be manipulated and plastered to hold
the position but if the displacement is too great or the plaster does
not hold the position then operative intervention is pursued. Internal
fixation can involve passing narrow wires into the bones to hold
position (k wiring) or inserting a plate with screws to immobilize the
fracture, after which plaster is again applied.
Osteopathy after Wrist Fracture
The typical time in plaster is five to six weeks and once it comes off
the osteopath can assess and rehabilitate the wrist and hand. The
condition of the wrist and hand is very variable on coming out of
plaster and a skilled assessment of the problems and potential for
improvement is vital. The osteo will look initially at the colour or
swelling of the hand to get an indication of the severity of the
problem. Excessive swelling, significant colour change or extreme
reported pain might point to Complex Regional Pain Syndrome (CRPS), a
severe and important condition which needs prompt treatment.
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.
The osteo will decide if the patients hand is normal for coming out of
plaster and give range of motion exercises for the elbow, forearm,
wrist and hand and perhaps the shoulder. A futura splint, a velcro
fastening wrist splint, is useful to reduce the shock of coming out of
plaster and allow patients to do functional activities without
aggravating the pain too greatly. Attending a hand class for repeated
exercise can be useful and osteos can use mobilizing techniques to
restore the accessory movement between the joints. Once the wrist is
settled and moving better the osteopath will work on strengthening
exercise and encourage functional normality.
Article Source:
http://www.articlesbase.com/health-articles/the-treatment-of-
wrist-fractures-by-osteopaths-1060095.html About the Author
Andrew Mitchell, clinical editor at the Osteopath Network,
writes papers about musculo-skeletal conditions, drug-free treatment,
pain management and how to find a
Osteopath in Coventry. He is interested in the treatment of
back pain, neck pain and injury and pain management. |
