This handout explains your follow-up care after the surgery to repair your distal radius fracture. Because of the anesthesia block and the local anesthetics, you may notice numbness and tingling in your hand and fingers for up to 24 hours. There is a drain in place to remove excess fluid and avoid the possibility of infection. Please check with our office that you have a follow-up appointment within 48 hours after surgery to remove the drain. Alternatively, you may remove the drain at home, if you feel comfortable with the nursing instructions from the Surgery Center. The splint is there for your protection. If the Ace bandage is tight, you may unwrap and rewrap it as necessary. It is important to keep moving your fingers to avoid stiffness, but please avoid any heavy lifting with the hand. If the incision is red or if there is drainage coming out of it, please call us right away. The phone number is listed on the bottom of this page. Go to the emergency room if this occurs outside business hours (at night or on a weekend).

WOUND CARE:

  • A metal plate with screws or pins (hardware) is often used to repair the distal radius fracture. These keep the bones in place while they are healing. The surgical approach may involve either the front of the hand or the back of the hand, or both, depending on complexity of the fracture.
  • Right after surgery, most patients will have their arm wrapped in a bulky dressing (bandage) and a plastic splint that goes above the elbow. The splint cannot be removed and you must keep it cleaned and dry. Cover the splint with a plastic bag when you shower.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take this with your medication as directed. It is important to “stay ahead” of your pain medication and avoid having to play “catch up” for significant increases in pain. Medication for nausea will also be provided. Please make sure to take this as directed.
  • Please make sure to check with the postoperative nurses and the office staff at Bellevue Bone & Joint Physicians about how to manage your pain medication. To best manage your pain, you must take the pain medication the way it was prescribed. Taking the correct dose at the right time is very important.
  • If you have uncomfortable side effects from the pain medication, please call us at 425-462-9800.
  • Please see “medications after surgery” information form for more instructions.
  • It is normal to have some pain off and on for approximately one year after surgery, particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medications, as it is not safe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.

  • Once you are no longer taking narcotic medication, you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • Move your fingers throughout the day to help prevent stiffness. Try to completely bend and straighten your fingers five to six times a day.

  • Exercise your shoulder by lifting your arm over your head several times a day to avoid stiffness because you will not be using your arm and hand normally for everyday activities.
  • Elevate your arm to help lessen swelling, pain and joint stiffness.
  • You may use an ice pack for up to 20 minutes at a time over the surgical dressing to help reduce swelling in the hand. Place a thin cloth between the ice pack and your skin or dressing to protect your skin. The initial splint is very bulky and requires a large amount of ice positioned around the wrist in order to provide substantial relief.
  • Do not lift any object heavier than a pencil until your sutures have been removed and until you have been advised to progress by your physician or therapist.
  • You may be able to do some typing or writing right after surgery. However, swelling or stiffness may make it difficult to do these types of activities for three to four weeks after surgery.
  • Please let us know if you need any letters and documentation regarding your disability to help with your work or school. Particularly for students, this type of documentation will make you eligible for help with certain writing or typing activities.

Follow-Up:

  • 10-14 days after surgery, your dressing will be removed, along with some or all of your sutures. You will be placed in a cast or splint that covers the wrist and forearm, but does not include the elbow.
  • You will be referred to a hand therapist. You will start exercises for rotation of the forearm as well as finger motion. For your convenience, you can be referred to a therapist closer to your home, although typically the first one to two sessions start with the therapist at our Hand Institute.
  • When the cast or splint is removed, usually six weeks after surgery, most patients are given a brace for continued support. At this point, we recommend a vigorous hand therapy program that includes bending the wrist and strengthening the hand.
  • Therapy after distal radius fracture can last as long as three months. Therefore, you may need therapy two to three times a week. As your fracture heals and become more familiar with your home exercises program, you will be able to have therapy one time a week and then once every two weeks until you regain good range of motion and strength.
  • Do not use any weightlifting or strengthening exercises without talking with your surgeon or physical therapist.

Results:

Most patients take approximately three months to get most of the strength and motion back, and many need therapy during this time.

Most patients recover well after the treatment of the distal radius fractures. Most are able to return to their work and recreational activities after the fracture is healed. Patients often lose some motion, especially in flexion and extension of the wrist. Patients often choose to have their hardware removed 6 to 12 months after surgery because the metal pins or screws can become irritating, particularly to the tendons that glide over them. The surgery is typically elective and can be scheduled at your convenience.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD