Distal radius fracture (wrist fracture)

A 40-year-old gentleman fell off a ladder backwards onto his right wrist and fractured his distal radius. He is right-handed and works as a carpenter. After a period of immobilisation in a cast, his wrist and hand were very stiff and weak. He was unable to do his job and was concerned as he was self-employed.

He presented with very limited movement in his fingers, thumb and wrist and with persistent sub-acute swelling.

The first aim was to reduce the swelling – he was advised on manual oedema mobilisation technique, compression and following an active exercise programme to reduce his swelling.

As wrist extension and finger flexion work together, the second aim was to improve the extension in his wrist. This was done by manual joint mobilisation, serial splinting and exercise.

The range of movement in his finger joints improved by using exercise splints made for him, to block his mobilise joints and direct the force to his stiff joints. As the flexibility in these joints improved, a proprioception and strengthening programme followed. This was tailored specifically to his job as a carpenter – an activity analysis was done to see what are the demands on his hand function.

He regained good functional range of movement and was able to return to his work in carpentry.