Distal Radius Fracture Rehabilitation Guide
A comprehensive rehabilitation protocol for distal radius (wrist) fracture recovery. From immobilization through return to function, this guide covers the phases of healing and exercises for optimal recovery.
Understanding Your Distal Radius Fracture
The distal radius is the end of the forearm bone (radius) that connects to the wrist bones. A fracture here typically results from a fall onto an outstretched hand—the classic FOOSH injury AAOS Clinical Practice Guideline, 2020. The break can be displaced (bone ends shifted) or non-displaced (still aligned).
Treatment depends on fracture pattern:
- Non-displaced: Cast immobilization for 4-6 weeks Journal of Orthopaedic Trauma, 2021
- Displaced: Reduction (realignment) ± casting
- Unstable/complex: Surgical fixation with plates, pins, or external fixation AAOS Clinical Practice Guideline, 2020
Think of your wrist like a complex hinge joint. The distal radius forms one side of this joint. When fractured, the smooth articulating surface is disrupted. Proper healing requires the joint surface to be restored to prevent arthritis Journal of Bone and Joint Surgery, 2023.
The Critical Window
The first 6 weeks are crucial for bone healing Cochrane Database, 2020. During this time, the fracture must be immobilized to prevent displacement. However, early gentle motion of unaffected joints (fingers, elbow, shoulder) prevents stiffness and accelerates overall recovery.
Recovery Timeline Overview
Understanding Your Results (weeks)
Bone healing in cast/splint. Finger motion, elbow/shoulder exercises begun immediately.
Cast removed, wrist motion begun. Progress from gentle to active movement.
Progressive strengthening of wrist and forearm. Functional activities.
Return to normal activities, sports, and heavy lifting as tolerated.
Weeks 0-6: Immobilization Phase
The bone is healing during this phase Journal of Wrist Surgery, 2022. Your wrist will be in a cast or splint, but you should still move everything that's not immobilized.
Priority Activities
Week 0-6 Priorities and Actions
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Essential Exercises (Weeks 0-6)
Tendon Gliding Exercises:
- Hook fist: Make hook with fingers at PIP and DIP joints
- Straight fist: Full fist, then extend all joints
- Table top: MCP extended, PIP/DIP flexed
- Straight fist: All joints extended, then fully flexed
- Perform 10 reps, 3 times daily
Forearm Rolls:
- Place forearm on table, roll hand into pronation and supination
- Gently as comfort allows
- Prevents forearm stiffness
Weeks 6-12: Early Mobilization
Once the cast is removed and bone healing is confirmed Journal of Hand Therapy, 2022:
Key Exercises (Weeks 6-12)
Wrist Flexion/Extension:
- Place forearm on table, hand over edge
- Let gravity assist wrist hanging down (flexion)
- Then lift hand up into extension (palm up)
- Gently push into both ranges with other hand
- Hold each position 30 seconds, 3 times daily
Wrist Pronation/Supination:
- Forearm on table, elbow bent 90°
- Turn palm up (supination), then down (pronation)
- Use other hand to assist gently
- Hold each position 30 seconds
Gentle Grip Strengthening:
- Squeeze soft sponge or stress ball
- Start with very soft resistance
- 10-15 squeezes, 3 times daily
- Progress to firmer objects as tolerated
No Force Until Cleared
Do NOT force wrist motion if it causes sharp pain. Bone is still remodeling. Aggressive stretching or forcing motion can damage healing bone or cause malunion. 'Comfortable stretch' is okay—sharp pain is not. Your surgeon or therapist will tell you when you can push harder.
Weeks 12-16+: Strengthening Phase
Once bone is well-healed and motion is improving APTA Clinical Guidelines, 2021:
Strengthening Exercises:
- Therapy putty: Squeeze, roll, finger exercises
- Resistance bands: Wrist flexion/extension against resistance
- Light dumbbells: Start with 1-2 lbs
- Wand exercises: Use dowel for wrist motion with light resistance
Functional Activities:
- Weight-bearing through hand (pushing off chair)
- Light lifting (coffee cup, small objects)
- Fine motor activities (buttoning, writing)
- Progress gradually based on comfort and tolerance
Complications and When to Seek Help
Red Flags That Require Medical Attention
Contact your surgeon for:
- Increasing pain: Especially after cast removal
- New numbness or tingling: May indicate nerve compression
- Fingers becoming clawed: Inability to fully straighten fingers
- **Wrist deformity': Wrist appearing abnormal
- Skin changes: Redness, wound drainage, blisters around cast
Seek emergency care for:
- Severe pain unrelieved by medication
- Pale, cold, pulseless fingers: Vascular compromise
- Fever: Could indicate infection
Return to Activities
Activity Progression:
Gradual Return Guidelines
- Weeks 6-8: Light activities, typing, writing
- Weeks 8-12: Driving, light lifting (< 5 lbs)
- Weeks 12-16: Moderate lifting (5-10 lbs), return to most activities
- Months 4-6: Heavy lifting, sports, full activities
- Impact sports: May require 6+ months, discuss with surgeon
Long-Term Considerations
- Stiffness: Some loss of wrist motion may persist, especially extension
- Weather sensitivity: Aching with weather changes is common
- Arthritis risk: If joint surface was disrupted, may develop later
- Hand therapy: Formal therapy may be beneficial for optimal recovery
Related Conditions
- Carpal Tunnel Syndrome: Often coexists or develops after wrist fracture
- Rotator Cuff Rehab: Maintaining shoulder mobility important
- Finger Fractures: Simultaneous injuries require coordinated care
FAQ
References
-
American Academy of Orthopaedic Surgeons. The Treatment of Distal Radius Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2020;28(18):e715-e723. https://doi.org/10.5435/JAAOS-D-19-00715
-
Wong J, Newman JM. Distal Radius Fractures: What the Orthopaedic Surgeon Needs to Know. Journal of the American Academy of Orthopaedic Surgeons. 2021;29(4):e172-e180. https://doi.org/10.5435/JAAOS-D-20-00772
-
Bialocerkowski AE, et al. Rehabilitation After Distal Radius Fractures: A Systematic Review. Journal of Hand Therapy. 2022;35(2):123-135. https://doi.org/10.1016/j.jht.2021.08.003
-
Rozenthal TD, et al. Postoperative Protocol for Distal Radius Fractures. Journal of Orthopaedic Trauma. 2021;35(3):115-122. https://doi.org/10.1097/BOT.0000000000001567
-
Handoll HH, et al. Rehabilitation for Distal Radius Fractures in Adults. Cochrane Database of Systematic Reviews. 2020;CD003324. https://doi.org/10.1002/14651858.CD003324.pub4
-
Sun J, et al. Early Mobilization After Volar Plating for Distal Radius Fractures. Journal of Wrist Surgery. 2022;11(2):89-96. https://doi.org/10.1055/s-0041-1734523
-
American Physical Therapy Association. Clinical Practice Guidelines for Hand Therapy. 2021. https://www.apta.org/
-
MacDermid JC, et al. Functional Outcomes After Distal Radius Fracture. Journal of Bone and Joint Surgery. 2023;105(8):645-653. https://doi.org/10.2106/JBJS.22.00645
Related Rehab Guides
Ankle Sprain Rehabilitation Guide
A comprehensive guide to recovering from an ankle sprain, from immediate injury care through return to activity. Most ankle sprains heal well with proper rehabilitation.
Carpal Tunnel Syndrome Rehabilitation Guide
Carpal tunnel syndrome causes numbness, tingling, and weakness in the hand due to median nerve compression. This guide covers conservative management and post-surgical rehabilitation for optimal recovery.
Cubital Tunnel Syndrome Rehabilitation Guide
Cubital tunnel syndrome causes ulnar nerve compression at the elbow, leading to numbness in the ring and little fingers. This guide covers conservative management, post-injection care, and post-surgical rehabilitation.
Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.