Osteopathy and the Treatment of Wrist Fractures

Every winter the weather gets cold and icy at some time and we realise that the time has come when we are less safe out and about, that season when people start to slip and fall. Falls on an outstretched hand (FOOSH) are a very common injury and often cause a fracture of the end of the forearm bones, a fracture routinely known as a wrist or colles fracture. The fracture can be insignificant or very major requiring screws and plates to realign and fix it in position. Osteopaths assess and plan rehabilitation of the wrist, hand and forearm.



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.



The commonest age groups for colles fractures to occur in are the 6-10 and the 60-69 year olds, with older people more likely to suffer fractures in the forearm away from the joint and younger people, due to the higher violence of the injury, being more likely to get joint involvement in the fracture. Diagnostic features of a radius and ulna fracture are significant pain with increased pain on palpating the area, a dinner fork bony deformity, swelling over the area and a marked reluctance to use it.



Management of Colles Fracture



To allow the fracture to heal correctly a colles fracture needs to be fixed in a position that allows the fracture to be held in as close to the original shape as possible. A simple fracture which is undisplaced can just be plastered and left to heal, while a displaced fracture has to be returned to a better anatomical alignment. Manipulation and plastering might work, but if the fracture does not remain in a good position then operative fixation with k-wires or plates and screws might be required. After the operation plaster is applied to maintain the correction.



Osteopathy after Wrist Fracture



Five or six weeks is the normal time for the plaster to remain on, with the physio assessing the state of the wrist and hand as this can be very unpredictable once its out. An assessment from a physio skilled in fracture management is important to set the treatment programme and recommend any further treatment. The hands swelling and colour is a key indicator of the state of the area and how it should be treated. Strong colour changes, tight swelling and severe pain means the diagnosis of Complex Regional Pain Syndrome (CRPS) should be suspected, a severe pain condition which needs immediate intervention.



Initially the osteo assesses the movements of the shoulder as this can be damaged by a fall on the hand and cause a limitation. It is unusual for the elbow to have restricted movement after colles fracture unless the person has held their arm bent for a few weeks in a sling. The rotatory movements of the forearm (pronation and supination) are key functional movements and often limited as the lower joint between the ulna and the radius is close to the fracture line. The osteo records the ranges of wrist flexion, wrist extension, and finger and thumb movements.



If the osteopath determines that the wrist is uncomplicated after removal of plaster then they will prescribe mobilizing exercises for the wrist, forearm and hand and perhaps the elbow and shoulder. Coming straight out of plaster is a shock for the wrist and a strap on futura splint can rest the wrist and permit normal activity without too much discomfort. If the wrist is very stiff then attendance at a hand class may be useful and the accessory joint movements can be restored by using joint mobilization techniques on the many wrist joints. The physio will progress to strengthening the wrist as the movements improve and teach the patient to use the hand normally in daily activities.



Andrew Mitchell, editor of the Osteopath Network, writes articles about osteopathy, osteopaths, osteopath in Brighton, back pain, neck pain, injury management. Andrew is interested in many aspects of alternative medicine.