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Wrist fractures are common in the elderly, especially in postmenopausal women, when the bones are weakened by osteoporosis. The rehabilitation of the hand is very important in order to avoid deformations and complications after the fracture.
A fall or strenuous dorsal flexion of the wrist is enough and we have a wrist fracture (in fact – a forearm fracture). The most common is the Coles fracture, i.e. the fracture of the distal epiphysis of the radius approximately 2,5 cm from the wrist joint. It occurs when you fall and lean on the ground with your outstretched hand. Doctors diagnose Smith’s fracture less frequently – when we fall on the back of the hand, i.e. the limb is bent in the opposite way than in the Coles fracture. Carpal fractures are less serious and less frequent.
From X-ray to plaster
The typical symptoms of a wrist fracture are visible deformation of the wrist, as well as swelling and hematoma at the site of the injury and pain. The wrist mobility may or may not be preserved. Sometimes symptoms are mild, especially in women with osteoporosis. Then there is a doubt as to whether it is a fracture. Therefore, it is recommended to take an X-ray image.
When it is known that there is a fracture, the adjacent joints must be immobilized, which means that the hand is inserted into the plaster from the wrist to the elbow. Depending on the type of fracture, it lasts for 3 to 6 weeks. A hand sling is necessary – otherwise it will become swollen. Thanks to this, the shoulder joint is also relieved.
Pay attention to whether the plaster is too tight and whether the fingers are swollen. Circulation is weaker under the plaster, so hypoxia and cardiovascular stasis may occur. If in doubt, consult a doctor and remember about follow-up visits.
The disadvantage of gypsum is undoubtedly its weight, so you can opt for lighter materials made of plastic. But beware – they are not refundable.
Exercise until you feel tired
The rehabilitation process is of great importance for the future dexterity of the hand. Even with a cast on, you can try to move your fingers. It is also worth practicing shoulder movements, e.g. placing a cast arm (holding it with your healthy hand) over your head. About a year after removing the plaster, the hand usually functions normally, although it sometimes happens that we will not be fully functional.
The rehabilitation itself takes a long time. Therefore, the help of a specialist is necessary, who will indicate the order and intensity of active exercises, i.e. those during which the patient exercises alone, and the therapist only demonstrates them. Such systematic gymnastics is very important in therapy! If we do not take it, contractures, distortions, serious limitations in hand mobility may arise, making it impossible, for example, to dress.
Manual activities are also useful in rehabilitation – knitting, embroidering, kneading the dough (they can be done several weeks after removing the plaster). In case of pain, reach for the Visiomed KINECARE VM-GB8 compress for ankle, wrist, elbows.
For wrist problems, it is worth using the OS1st WS6 compression wristband, available in black or flesh-colored.
Procedures in the clinic
In patients with wrist fractures, rehabilitation (reimbursed) treatments are also performed at the clinic. A rehabilitation specialist or a rehabilitation master will issue a referral. The most frequently ordered treatments include:
• Magnetotherapy – involves the use of a low-frequency magnetic field, which includes facilitates ossification and healing processes.
• Laser therapy – stimulates metabolic changes, improves blood circulation in the skin.
• Iontophoresis – consists in administering and introducing the right drug through the skin with the use of direct current (galvanic). The applied medicine works for 24 to 48 hours, reaching the sick and damaged tissues. The treatment is recommended for inflammation and chronic pain.
• Cryotherapy – is the application of a very low negative temperature in a specific place. It consists in “blowing” the diseased area with vapors of liquid nitrogen or liquefied carbon dioxide. The treatment has an analgesic and anti-swelling effect. Makes exercise easier.
Possible complications
As with any fracture, complications do occur in the wrist area. One of them is carpal tunnel syndrome. It is characterized by numbness (at night and in the morning) of the thumb, index and middle fingers. If these symptoms persist, consult a neurologist or physiotherapist. Relief is provided by painkillers and by placing the wrist in a splint at night. Sometimes corticosteroid injections or even surgery are necessary.
Another complication is Sudeck’s syndrome (reflex sympathetic neuropathy). Symptoms appear after removing the plaster or while wearing it. The hand hurts a lot, it is excessively sweating, it can grow over thick black hair. Sudeck’s syndrome is evidenced by the X-ray image of macular osteoporosis. Treatment should be comprehensive, with intensive rehabilitation. The patients are given painkillers and salmon calcitonin preparations.
Comfrey root can be used to mitigate fractures.
Consultation: Anna Raczkiewicz, MD, PhD, specialist in internal diseases, rheumatology and rehabilitation, Department of Internal Medicine and Rheumatology, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defense, Warsaw