Radial fracture Radial Fracture patient is a 65-year-old female. She was getting

Question

Radial fracture

Radial Fracture

patient is a 65-year-old female. She was getting up to walk to the bathroom in the middle of the night when she tripped over a throw rug and fell onto an outstretched hand. In the ER the doctors noted that she sustained a distal radius fracture. She was placed into a sugar tong plaster splint that included the elbow joint. At her next follow up 1 week later, she was then transitioned to a short arm cast. She was followed up weekly by her physician for repeat radiographs, which demonstrated acceptable healing without secondary displacement or collapse of the fracture.

Now 8 weeks have passed and she is referred to your outpatient hand clinic with orders to “Evaluate and Treat”. You notice that Norma is generally stiff but has a marked loss of passive extension of her radiocarpal joint. Motor, sensory, and pulses are intact.  

1)      Norma has a lot of questions for you about her non-surgical management. How does management of her injury non-surgically compare to surgically in term of: cosmetics, grip strength, and functionality?

2)      Distal radius fractures are often referred to as a “sentinel event” in older adults—why?

3)      Describe the normal arthokinetmatics of the radiocarpal joint for extension. To restore normal wrist extension using manual techniques to restore normal arthokinetmatics, which direction would you apply a gliding/sliding technique (Anterior to posterior? Posterior to Anterior? Medial to lateral? Lateral to medial?)

4)  Why is restoring extension of the wrist important functionally? There could be a couple of “right” answers here.

Explanation / Answer

1) The surgical management offers better cosmetic, grip strength and functionality in treating fractures than non surgical procedures. But, considering her age (65 years and female), osteoporotic changes would have occurred in the bones and therefore surgery is not the treatment of choice in this individual.

2) Distal radial fractures are often referred to as sentinel events in older adults because of the poor vasculature of the area and any bone injury is prone to last longer.

3) To restore normal wrist extension, the gliding or sliding technique has to be applied from anterior to posterior direction.

4) Restoring extension of wrist is important for the action of hands to hold any objects. It us also necessary for fine movements of fingers such as writing.

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