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Fractura del radio distal (reparación quirúrgica abierta)

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Staged rehabilitation after plate fixation of a distal radius fracture, from the first days to return to full activity.

Updated Jun 2026
Ilustración de los huesos de la muñeca, con una placa metálica y tornillos que fijan el radio.
Una placa y tornillos que fijan el radio tras una fractura de muñeca. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Este protocolo le servirá de guía para su recuperación tras la fijación quirúrgica de una fractura del radio distal (muñeca) (reducción abierta y fijación interna, RAFI) realizada por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. Comienza con un programa de ejercicios para realizar en casa; posteriormente, siga el protocolo clínico estructurado redactado para su fisioterapeuta o terapeuta de la mano: lleve esta página o su versión en PDF a su primera sesión de terapia, a fin de garantizar una rehabilitación coordinada. Su terapeuta podrá modificar el plan según el progreso de su recuperación.

Si tiene alguna duda respecto a su herida postoperatoria, no dude en contactar con el consultorio. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su evaluación.

Qué esperar

Para el manejo de heridas, hinchazón y cicatrices, consulte la guía de cuidado de heridas del consultorio.

Después de la cirugía, es posible que le remitan a un terapeuta de mano para la confección de una férula de termoplástico. En ese caso, la férula se usará temporalmente para mayor comodidad y protección; no obstante, deberá quitársela para realizar su programa de ejercicios en casa. Si le indican que use una férula, recibirá información adicional sobre su uso y cuidado.

Los ejercicios que se detallan a continuación son esenciales para recuperar la amplitud de movimiento de los dedos, la muñeca y el antebrazo. El calor y el frío son métodos muy útiles para recuperar el movimiento, restaurar la función y mejorar la comodidad. Una vez que la herida haya cicatrizado, puede aplicar calor antes de hacer los ejercicios; posteriormente, un paquete de hielo ayudará a prevenir o reducir la inflamación.

El manejo de las cicatrices (en especial el masaje) es sumamente importante tras una cirugía de radio distal, a fin de que los tendones situados bajo la incisión sigan deslizándose libremente y no se adhieran a la cicatriz en proceso de curación.

La placa bloqueante volar está diseñada para fijar la fractura con suficiente firmeza para permitir el inicio temprano del movimiento; este protocolo se basa precisamente en ese principio. Los estudios que comparan el inicio temprano del movimiento de la muñeca con varias semanas de inmovilización tras la fijación con placa volar demuestran que iniciar el movimiento pronto mejora la movilidad, la fuerza de agarre y la comodidad a corto plazo, sin afectar la posición de la fractura [1][2]. Asimismo, ensayos que compararon el inicio del movimiento a las dos semanas con el inicio a las seis semanas revelaron que ambos grupos presentaban resultados similares a los tres o seis meses [3]. Por ello, aunque existen beneficios iniciales, no es necesario apresurarse; el progreso gradual descrito a continuación cuenta con sólido respaldo científico. La consolidación ósea sigue su propio cronograma, independientemente de cómo se sienta la muñeca; por eso, incluso cuando el movimiento resulte cómodo, se mantienen las precauciones posteriores (evitar soportar peso, levantar cargas pesadas o practicar deportes de contacto hasta 12 semanas después de la fractura).

Precauciones y limitaciones

Se recomienda un uso funcional moderado de la mano para tareas cotidianas como el aseo personal, la alimentación, vestirse, escribir y teclear.

Es fundamental evitar levantar pesos, hacer agarres fuertes, soportar cargas y exponer la mano a impactos durante las 8 semanas siguientes a la operación. A partir de la semana 4 aproximadamente, se introducirá gradualmente un entrenamiento de fortalecimiento suave, comenzando con movimientos ligeros de los dedos y ejercicios isométricos de la muñeca; este programa se irá intensificando con cuidado para no anular los efectos de la protección inicial.

A continuación se detallan los ejercicios que aparecen en el folleto, destinados a recuperar el movimiento de los dedos, la muñeca y el antebrazo. Si utiliza una férula, quítesela para realizar los ejercicios. Comience bajo la orientación del Dr. Hirpara y de su terapeuta.

Sus ejercicios

Estos son los ejercicios que aparecen en su folleto informativo. Comience a realizarlos únicamente bajo la guía del Dr. Hirpara y de su terapeuta ocupacional, respetando siempre los rangos y límites que le hayan indicado. Dado que la fractura se mantiene fija mediante una placa, la muñeca puede empezar a moverse en una etapa temprana, sin necesidad de esperar a que el hueso se una. El flexo-extensión de la muñeca, la rotación del antebrazo y los movimientos laterales evitan la rigidez articular; además, los seis ejercicios específicos para la mano ayudan a mantener en movimiento los dedos, el pulgar y las articulaciones — la rigidez de los dedos es un problema mucho más frecuente tras esta intervención que cualquier complicación ósea. Realícelos con frecuencia, pero en pequeñas series. Interrumpa cualquier ejercicio que provoque dolor intenso en la zona de la fractura.

Su protocolo clínico

El resto de esta página contiene el protocolo clínico acelerado para una fractura del extremo distal del radio, tratada mediante reducción abierta y fijación interna con placa volar. Esta sección debe entregarse a su fisioterapeuta o terapeuta de mano; cada fase a continuación comienza con una explicación sencilla en lenguaje coloquial sobre lo que está ocurriendo.

Días 1–4 después de la operación

En los primeros días, el objetivo es proteger la fijación ósea, reducir la hinchazón y mantener en movimiento los dedos, la muñeca, el antebrazo, el codo y el hombro. El vendaje quirúrgico se mantiene en su lugar hasta el día 3, momento en el que se afloja y se vuelve a cubrir la herida. Mantenga la mano elevada cuando esté en reposo; úsela para tareas cotidianas ligeras (de menos de 1–2 kg) dentro de los límites tolerables, y evite soportar peso con el brazo, realizar agarres fuertes o levantar objetos. Normalmente no se requiere una férula, pero se puede colocar si el paciente va a volver al trabajo o si la muñeca le duele más.

Para su fisioterapeuta:

Antes de iniciar el tratamiento, revise la radiografía del paciente, el informe quirúrgico y sus antecedentes médicos; además, consulte con el cirujano responsable sobre la estabilidad de la fijación de la fractura y el pronóstico esperado.

Educación y precauciones

  • Evite soportar peso con el brazo, realizar agarres fuertes o levantar objetos.
  • Fomente el uso de la mano afectada para actividades cotidianas ligeras (menos de 1–2 kg), dentro de los límites del dolor y siguiendo patrones de movimiento normales.

Manejo

  • Férula: no es necesaria, pero puede emplearse si el paciente vuelve al trabajo o si el dolor aumenta; considere una férula termoplástica o un soporte comercial.
  • Herida: el vendaje quirúrgico debe permanecer intacto hasta el día 3; a partir de ese momento se afloja y se vuelve a cubrir la herida; instruya al paciente sobre su cuidado.
  • Hinchazón: enseñe al paciente a mantener la mano elevada; aplique compresión y masaje retrógrado según sea necesario.
  • Ejercicios: indique ejercicios activos para mantener la amplitud de movimiento de los dedos; recomiende ejercicios activos para la muñeca, el antebrazo y los dedos; fomente ejercicios regulares para el codo y el hombro.

Semana 2–4 después de la operación

Los puntos de sutura se retiran al día 10–14, y se inicia el masaje de la cicatriz una vez que la herida haya cicatrizado lo suficiente. El programa de ejercicios continúa (los ejercicios de “six pack” se interrumpen cuando los dedos recuperen su movilidad completa), y comienza el fortalecimiento muscular suave (isométrico) de la muñeca. Durante esta fase, la muñeca debe moverse únicamente mediante la fuerza muscular propia: nadie, ni siquiera usted, debe estirarla o moverla pasivamente, ya que la fractura aún está en proceso de consolidación. Siga evitando soportar peso, realizar agarres fuertes o levantar objetos; se recomienda realizar tareas cotidianas ligeras de menos de 1–2 kg. No debe conducir mientras lleve la férula en la muñeca; la conducción se reanudará una vez retirada la férula, según se confirme en su revisión médica.

Para su fisioterapeuta:

Evaluaciones

  • Evaluaciones autorreportadas: Evaluación de la Muñeca según el Paciente (PRWE), Índice de Discapacidad del Brazo, Hombro y Mano (DASH)
  • Mediciones circunferenciales del edema
  • Escala analógica visual del dolor (EAV) o escala numérica de dolor
  • Mediciones de rango de movimiento activo (AROM) mediante goniómetro: mano y muñeca
  • Evaluación subjetiva, incluyendo el cumplimiento del régimen por parte del paciente, el uso funcional de la mano en actividades de la vida diaria, y cualquier problema o inquietud

Educación y precauciones

  • Evitar soportar peso con el brazo, realizar agarres fuertes o levantar objetos
  • No realizar movimientos pasivos de la muñeca
  • Fomentar el uso de la mano afectada para tareas cotidianas ligeras (menos de 1–2 kg), dentro de los límites del dolor y siguiendo patrones de movimiento normales
  • No conducir mientras lleve la férula; la conducción se reanudará una vez retirada la férula, según se confirme en la revisión

Manejo

  • Herida/cicatriz: retiro de los puntos al día 10–14; iniciar el manejo de la cicatriz según sea apropiado, dependiendo del progreso de la cicatrización
  • Edema: considerar el uso de vendajes de compresión, masaje retrógrado, movilización manual del edema (MEM), baños contrastantes y/o elevación si fuera necesario
  • Ejercicios: interrumpir los ejercicios de “six pack” al recuperar el rango completo de movimiento de los dedos; considerar ejercicios pasivos para dedos y pulgar, incluyendo posicionamiento y mantenimiento, si el rango de movimiento activo de la mano no es completo; continuar con ejercicios activos de rango de movimiento de la muñeca; fomentar ejercicios regulares de rango de movimiento activo para codo y hombro; iniciar el fortalecimiento isométrico de la muñeca

Detección de problemas

  • Vigilar signos de infección de la herida, cambios sensoriales en la mano o señales tempranas del síndrome de dolor regional complejo (CRPS)
  • Identificar patrones de movimiento anómalos e intervenir según sea necesario

Semana 4–6 después de la operación

En esta fase, el fortalecimiento comienza de forma suave: a partir de la semana 4 se inician ejercicios de fortalecimiento de los dedos con baja resistencia, mientras que los ejercicios isométricos de muñeca continúan y se intensifican gradualmente. Si la radiografía resulta satisfactoria y la fijación ósea es estable, a partir de la semana 4–6 se pueden iniciar estiramientos pasivos suaves de la muñeca (en los que se mueve la muñeca con ayuda de la otra mano o del terapeuta). Restaurar el rango de movimiento sigue siendo prioritario respecto al fortalecimiento muscular. Se debe seguir evitando soportar peso con el brazo y levantar cargas pesadas, mientras se sigue utilizando la mano para tareas cotidianas ligeras.

Para su fisioterapeuta:

Evaluaciones

  • Mediciones circunferenciales del edema
  • Escala analógica visual del dolor o escala numérica de dolor
  • Mediciones goniométricas del rango de movimiento activo y evaluación de la calidad de los patrones de movimiento
  • Revisión subjetiva: cumplimiento del régimen por parte del paciente, uso funcional de la mano en actividades de la vida diaria, así como problemas o inquietudes
  • Fuerza de agarre medida con dinamómetro (3 mediciones por extremidad)

Educación y precauciones

  • Evitar soportar peso con el brazo o levantar cargas pesadas
  • Fomentar el uso de la mano afectada para tareas cotidianas ligeras (menos de 1–2 kg), respetando los límites de dolor y los patrones de movimiento normales

Manejo

  • Cicatriz: continuar con el cuidado de la cicatriz según sea necesario
  • Edema: mantener la terapia de compresión, masaje retrógrado, MEM y elevación según sea necesario; suspender los baños de contraste
  • Ejercicios: continuar con los ejercicios pasivos de dedos y pulgar si el rango de movimiento aún no es completo; proseguir con los ejercicios activos de rango de movimiento de la muñeca; iniciar ejercicios de fortalecimiento de dedos con baja resistencia a partir de la semana 4; comenzar ejercicios pasivos suaves de muñeca a partir de la semana 4–6 si la osteosíntesis abierta y cerrada es estable y la radiografía resulta satisfactoria; fomentar ejercicios regulares de rango de movimiento activo del codo y hombro; continuar o intensificar los ejercicios isométricos de fortalecimiento de la muñeca

Solución de problemas

  • Revisar la presencia de signos de síndrome de dolor regional complejo y dolor en el hombro
  • Evaluar el volumen de ejercicios del programa domiciliario, priorizando el rango de movimiento sobre el fortalecimiento muscular
  • Si el rango de movimiento de la muñeca está notablemente limitado, considerar iniciar ejercicios pasivos suaves de ampliación del rango de movimiento, siempre que el dolor sea ≤ 4/10 en la escala analógica visual y cuente con la autorización del cirujano

Semana 6–8 después de la operación

En esta fase comienza un retorno gradual a la actividad plena durante las siguientes 3 semanas. El fortalecimiento de la muñeca se realizará con pesas ligeras (0.5–1.0 kg) o bandas elásticas de baja resistencia; asimismo, aumentará la resistencia en los ejercicios de fortalecimiento de los dedos. Persisten dos limitaciones estrictas: no se permite soportar peso, levantar cargas pesadas ni practicar deportes de contacto hasta 12 semanas después de la fractura. Su terapeuta evaluará la posibilidad de darle el alta una vez que haya recuperado el rango de movimiento completo y una función adecuada.

Para su fisioterapeuta:

Evaluaciones

  • Mediciones circunferenciales del edema según sea necesario
  • Escala analógica visual del dolor o escala numérica de valoración
  • Mediciones goniométricas del rango de movimiento activo
  • Fuerza de agarre
  • Evaluación subjetiva

Educación y precauciones

  • Retorno gradual a la actividad plena durante las próximas 3 semanas
  • Evitar soportar peso, levantar cargas pesadas y practicar deportes de contacto hasta 12 semanas después de la fractura

Manejo

  • Cicatriz: continuar el cuidado de la cicatriz según sea necesario
  • Edema: continuar el manejo del edema según sea necesario
  • Ejercicios: mantener los ejercicios pasivos para dedos y pulgar si el rango de movimiento aún no es completo; continuar los ejercicios activos y pasivos de movilidad de la muñeca si es preciso; aumentar la resistencia en los ejercicios de fortalecimiento de los dedos; iniciar los ejercicios de fortalecimiento de la muñeca utilizando pesas de 0.5–1.0 kg o bandas elásticas de baja resistencia; incrementar progresivamente el peso y la resistencia en el programa de fortalecimiento de la muñeca según la tolerancia del paciente

Solución de problemas

  • Si el rango de movimiento mejora lentamente, considerar o iniciar el uso de férulas progresivas nocturnas, férula tipo “guante de boxeo” o férulas dinámicas
  • Vigilar cualquier señal de inestabilidad en la muñeca y tratarla según corresponda
  • Considerar el alta cuando se haya alcanzado el rango de movimiento completo y una función adecuada
  • Evaluar la posibilidad de derivar al paciente nuevamente al médico tratante si no hay progreso o el resultado es insatisfactorio

Este protocolo fue redactado en colaboración con Sarah Farrell, BOccThy AHT, y Kristy Gerlach, BOccThy AHT.

Después de seguir este protocolo

Este protocolo se complementa con las recomendaciones generales de recuperación del consultorio; consulte control del dolor postoperatorio, cuidado de la herida y conceptos básicos de la terapia de la mano. En cuanto a la intervención quirúrgica y la lesión que se trata, consulte fijación de radio distal mediante osteosíntesis abierta y fractura de radio distal. El plan por fases descrito anteriormente se ajusta a la evidencia científica publicada sobre la rehabilitación tras la fijación con placa bloqueable volar; su recuperación continua será guiada individualmente por su fisioterapeuta o terapeuta de la mano, según la evolución de su muñeca.

Referencias

[1] Quadlbauer S, Pezzei C, Jurkowitsch J, et al. La movilización inmediata de las fracturas del radio distal estabilizadas con placa bloqueable volar produce mejores resultados a corto plazo que cinco semanas de inmovilización: un estudio aleatorizado prospectivo. Arch Orthop Trauma Surg. 2022;142(5):1–11. https://pubmed.ncbi.nlm.nih.gov/34852677/ [2] Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, et al. Eficacia de la movilización temprana frente a la tardía en pacientes con fractura del radio distal tratados con placa bloqueable volar: una revisión sistemática y metaanálisis. Hand Surg Rehabil. 2020;39(4):261–271. https://www.sciencedirect.com/science/article/abs/pii/S2468122920302231 [3] Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D. Movilización de la muñeca tras la fijación con placa volar de fracturas de la porción distal del radio. J Bone Joint Surg Am. 2008;90(6):1297–1304. https://pubmed.ncbi.nlm.nih.gov/18519324/ [4] Miller LK, Jerosch-Herold C, Shepstone L. Eficacia de las técnicas de manejo del edema para el edema subagudo de la mano: una revisión sistemática. J Hand Ther. 2017;30(4):432–446. https://pubmed.ncbi.nlm.nih.gov/28807598/

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Distal Radius Fracture (ORIF) — Post-operative Rehabilitation Evidence Brief

Topic scope: post-operative rehabilitation after open reduction and internal fixation (ORIF) of a distal radius fracture with a volar locking plate. This brief backs an early-motion-but-protected hand/wrist pathway delivered with hand therapy, where wrist motion begins early while bone-dependent loading (weight-bearing, heavy lifting, contact sport) is deferred until ~12 weeks. It does not cover the indications for surgery vs casting, nor fragment-specific/dorsal/bridge-plate constructs (which carry their own loading rules).

Defining principle of the rehab here: a volar locking plate is a fixed-angle construct stable enough to permit immediate wrist motion — the screws lock to the plate and hold the articular reduction independent of the cast. So (unlike a cast-treated fracture, and unlike a tendon or ligament repair) the wrist does not need weeks of immobilisation to protect the reduction: the rehab is an early-movement pathway — finger/forearm/wrist active motion and oedema control from day one, splint for comfort only, isometric then progressive strengthening from ~weeks 4–6. The one timeline that is not negotiable is bone healing: union takes ~6–12 weeks regardless of how the wrist feels, which is why weight-bearing, heavy lifting and impact are held to 12 weeks even once motion is comfortable.

A. PROCEDURE & CONSTRUCT — what the rehab is protecting

Volar locking plate fixation is the dominant operative construct for displaced distal radius fractures and is the reference standard against which other techniques are compared. Key surgical-outcome facts that shape the rehab:

  • Volar locking plates restore and hold articular reduction reliably, and across randomised comparisons give equivalent or better functional outcomes than non-operative care and competing fixation methods (dorsal plating, intramedullary nailing, fragment-specific), with most differences favouring early function rather than final endpoint [JAAOS controversies review 2014; Hand Clinics plate-fixation review 2021; IM-nail-vs-volar-plate RCTs].
  • The fixed-angle construct is the rationale for early motion. Because the locking screws hold the subchondral fragments rigidly, the plate — not a cast — maintains the reduction, so wrist motion can start before union without displacing the fracture [Hand Clinics 2021; accelerated-rehab RCT, JBJS 2014].
  • In older patients the operative-vs-conservative outcome gap is small. A 3-year RCT in patients >70 found volar plating and non-operative care converged on similar patient-reported function — context that keeps post-operative rehab pragmatic and patient-centred rather than aggressive [BMC Musculoskelet Disord 2022; Hand Clinics geriatric review 2021].
  • Recovery is gradual. Range, grip and patient-reported scores improve steadily over the first 3–6 months; the construct permits early motion but does not accelerate the biology of healing or the return of grip strength.

B. REHABILITATION / HAND-THERAPY EVIDENCE

The central rehab questions for this construct are (1) when to start wrist motion, (2) how much supervised therapy is needed, and (3) what the strengthening timeline should be. The evidence is clear on the first, nuanced on the second, and consensus-driven on the third.

  • Early motion is safe and gives a short-term advantage. Multiple RCTs and a systematic review show that starting wrist motion early after volar plating improves short-term ROM, grip and comfort without compromising the radiographic reduction [accelerated-rehab RCT, JBJS 2014; early-vs-late motion RCT, HAND 2018; Hand Therapy systematic review 2020]. This is the direct warrant for the day-1 finger/forearm/wrist program in this protocol.
  • "Early" need not mean "immediate," and the advantage washes out by 3–6 months. The landmark trial comparing wrist mobilisation at ~2 weeks vs ~6 weeks found the two groups equivalent by 3–6 months [Lozano-Calderón / JBJS 2008]. So there is a genuine early benefit but no penalty for a measured, comfort-led progression — which is exactly why this protocol can be unhurried.
  • Routine supervised physiotherapy adds little over a coached home program for most patients. Systematic reviews and RCTs repeatedly find that a structured home exercise program preceded by instruction/coaching performs as well as formal supervised therapy for uncomplicated cases, and that prescribed exercise programs add limited benefit over advice for impairment/activity outcomes [HEP-vs-supervised SR, J Hand Ther 2014; J Physiother SR 2017; Hand Clinics "is therapy needed?" 2021; Arch Orthop Trauma Surg 2020]. This supports a home-program-first model with hand-therapy review, escalating supervision for stiffness, oedema or slow progress — the structure of this protocol.
  • Oedema control and scar/tendon-glide management are standard therapy elements. Elevation, retrograde massage, manual oedema mobilisation and (early) compression are the evidence-informed oedema toolkit [edema-management SR, J Hand Ther 2017]; scar massage to keep the flexor tendons gliding under the volar incision is consensus hand-therapy practice rather than RCT-derived.

Phased post-op timeline (volar locking plate, early-motion pathway)

Phases match this topic's synthesis.md. Timings are post-operative weeks; the 12-week loading limit is referenced to the fracture (injury) date.

Phase Window Splint Motion / use Strengthening Notes
I — Protect & move Days 1–4 Comfort only, not routine Active finger (six-pack), wrist, forearm, elbow & shoulder ROM from day 1; light ADL < 1–2 kg within pain limits — Surgical bandage to day 3, then redress. Oedema control + elevation. No weight-bearing, gripping or lifting
II — Active range & oedema Week 2–4 Comfort/work only (no driving while splinted) Continue active wrist ROM (no passive yet); six-pack stops once fingers full Isometric wrist activation begins Sutures out day 10–14; start scar massage once healed. Watch for CRPS. PRWE/DASH baseline
III — Passive range & light load Week 4–6 Off Add gentle passive wrist stretches at 4–6 wk if x-ray satisfactory & fixation stable Finger strengthening (low resistance) from wk 4; upgrade isometrics Movement still prioritised over strength
IV — Graded strengthening & return Week 6–8 Off Restore/maintain full active & passive ROM Wrist strengthening with 0.5–1.0 kg / light theraband, progress as tolerated Graded return over ~3 wk. No weight-bearing, heavy lifting or contact sport until 12 weeks post-fracture. Discharge on full ROM + functional return

The phase structure mirrors published surgeon/hand-therapy ORIF protocols (early ROM → scar + oedema → passive range + light resistance → progressive strengthening, with heavy load/sport held to ~12–16 weeks) [Physiopedia Colles' ORIF protocol; institutional ORIF rehab guidelines].

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. How early to mobilise. Early motion (immediate–2 wk) gives a real short-term ROM/grip/comfort advantage that equalises by 3–6 months vs starting at ~6 weeks. The evidence therefore supports early motion but does not mandate aggression — a measured progression is fully defensible. Moderate–strong (multiple RCTs + SR).
  2. Supervised therapy vs coached home program. For uncomplicated fractures the best available evidence finds no consistent benefit of routine formal physiotherapy over a well-instructed home program; supervision is best targeted to stiffness, oedema, CRPS risk or slow progress. Moderate (SRs/RCTs), but heterogeneous.
  3. Strengthening and return-to-load timing. The week-by-week strengthening ramp and the 12-week loading hold are construct- and biology-based consensus, drawn from surgeon/hand- therapy protocols rather than a strengthening-timing RCT. Weak/consensus.
  4. Whether the wrist needs any immobilisation at all. Some trials report that omitting post-op immobilisation does not worsen outcomes after volar plating, supporting the "splint for comfort only" stance here. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG / MODERATE–STRONG (RCT / SR): early wrist motion after volar plating is safe and improves short-term ROM/grip/comfort without loss of reduction (accelerated-rehab RCT JBJS 2014; early-vs-late RCT HAND 2018; Hand Therapy SR 2020); ~2-wk vs ~6-wk mobilisation equivalent by 3–6 months (Lozano-Calderón JBJS 2008).
  • MODERATE: volar locking plate is a reliable fixed-angle construct with equivalent/favourable outcomes vs alternatives (JAAOS 2014; Hand Clinics 2021); operative-vs-conservative outcomes converge in the elderly (BMC 2022); coached home program ≈ supervised therapy for uncomplicated cases (J Hand Ther 2014; J Physiother 2017; Hand Clinics 2021); evidence-based oedema management (J Hand Ther 2017).
  • WEAK / CONSENSUS: the detailed strengthening ramp and 12-week loading limit (surgeon & hand-therapy protocols; biology- and construct-based, not trial-derived); scar/tendon-glide massage practice.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation. J Bone Joint Surg Am. 2014. DOI: 10.2106/jbjs.m.00860
  • Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am. 2008. DOI: 10.2106/jbjs.g.01368
  • Early versus late motion following volar plating of distal radius fractures. HAND. 2018. DOI: 10.1177/1558944718787880
  • A systematic review of how daily activities and exercises are recommended following volar plating of distal radius fractures and the efficacy and safety of early versus late mobilisation. Hand Therapy. 2020. DOI: 10.1177/1758998320967032
  • AAOS/ASSH Clinical Practice Guideline Summary: Management of Distal Radius Fractures. J Am Acad Orthop Surg. 2022. DOI: 10.5435/jaaos-d-21-00719
  • Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014. DOI: 10.5435/jaaos-22-09-566
  • Plate fixation of distal radius fractures. Hand Clinics. 2021. DOI: 10.1016/j.hcl.2021.02.008
  • Non-operative treatment or volar locking plate fixation for dorsally displaced distal radius fractures in patients over 70 years — a three-year follow-up of a randomized controlled trial. BMC Musculoskelet Disord. 2022. DOI: 10.1186/s12891-022-05394-7
  • Distal radius fracture: HEP versus supervised therapy — a systematic review. J Hand Ther.
  • DOI: 10.1016/j.jht.2013.08.017
  • Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. J Physiother. 2017. DOI: 10.1016/j.jphys.2017.08.009
  • Is therapy needed after distal radius fracture treatment — what is the evidence? Hand Clinics.
  • DOI: 10.1016/j.hcl.2021.02.012
  • Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg. 2020. DOI: 10.1007/s00402-020-03367-w
  • Management of complications of distal radius fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2014.12.002
  • A comparison of the accuracy of two sets of diagnostic criteria in the early detection of complex regional pain syndrome following surgical treatment of distal radial fractures. J Hand Surg Eur Vol. 2012. DOI: 10.1177/1753193412469142

Distal radius / rehabilitation literature (URLs)

  • AAOS/ASSH Clinical Practice Guideline Summary: Management of Distal Radius Fractures (full summary). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9196973/
  • Practical application of the 2020 distal radius fracture AAOS/ASSH clinical practice guideline: a clinical case. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9035062/
  • Rehabilitation for distal radial fractures in adults (Cochrane-style review). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9250132/
  • Rehabilitation after distal radius fractures: opportunities for improvement. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10569825/
  • Rehabilitation following surgically treated distal radius fractures: do immobilization and physiotherapy affect the outcome? PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343619/

Published rehab protocols (surgeon / hand-therapy — basis for the phase structure)

  • British Society for Surgery of the Hand / British Association of Hand Therapists — Distal Radius Fractures Working Group rehabilitation guidance (2024). https://www.hand-therapy.co.uk/_userfiles/pages/files/distal_radius_fractures_working_group_2024.pdf
  • Colles' Fracture Post-Operative Rehabilitation Protocol. Physiopedia. https://www.physio-pedia.com/Colles%E2%80%99_Fracture_Post_Operative_Rehabilitation_Protocol
  • Distal Radius ORIF Rehabilitation Guidelines. University of Virginia Department of Orthopaedic Surgery. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Distal-radius-ORIF.pdf
  • Distal Radius ORIF Rehabilitation. Jared Lee, MD. https://jaredleemd.com/pdf/distal-radius-orif-rehabilitation/

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