Skip to content

Patients › Rehabilitation

Fraktura ng Distal Radius (ORIF)

PDF Evidence

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

Updated Jun 2026
Illustrasyon ng mga buto ng pulso na may metal na plato at turnilyo na nag-aayos ng radius.
Isang plataporma at mga turnilyo na nag-aayos ng radius pagkatapos ng fracture sa pulso. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protokol na ito ay gabay sa iyong paggaling pagkatapos ng operasyong pagpapatibay (surgical fixation) ng frakturang distal radius (pulso) (open reduction and internal fixation, ORIF) kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, kasunod ang estrukturadong klinikal na protokol na isinulat para sa iyong physiotherapist o hand therapist: dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa terapiya upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Maaaring inaasahan

Para sa pangangalaga sa sugat, pamamagasan, at peklat, tingnan ang gabay ng klinika tungkol sa pangangalaga sa sugat.

Pagkatapos ng iyong operasyon, maaari kang irefer sa isang hand therapist para sa paggawa ng thermoplastic splint. Sa sitwasyong ito, ang splint ay suot pansamantala para sa kumportableng suporta at proteksyon, at kailangan pa ring tanggalin ang splint para sa iyong home exercise program. Kung irefer ka para sa splint, makakatanggap ka ng karagdagang impormasyon tungkol sa paggamit at pangangalaga nito.

Ang mga ehersisyo sa ibaba ay mahalaga para mabawi ang range of motion ng iyong mga daliri, pulso, at forearms. Ang init at yelo ay magagandang modalities na madalas ginagamit para mabawi ang galaw, muling mabawi ang function, at mapabuti ang kumportableng pakiramdam. Kapag ang sugat ay gumaling na, maaari kang maglagay ng init bago ang mga ehersisyo; ang ice pack ay maaaring gamitin pagkatapos upang pigilan o bawasan ang pamamaga.

Ang pamamahala sa peklat (lalo na ang masahe) ay napakahalaga pagkatapos ng distal radius surgery, upang ang mga tendon na dumadaan sa ilalim ng incision ay manatiling malaya ang paggalaw at hindi mahigpit (adherent) sa gumagaling na peklat.

Ang volar locking plate ay dinisenyo upang hawakan ang fracture nang sapat na matibay upang magsimula ang paggalaw nang maaga, at ang protocol na ito ay nakabatay doon. Ang pananaliksik na nagkukumpara ng maagang paggalaw ng pulso sa ilang linggo ng immobilisation pagkatapos ng volar plate fixation ay nagpapakita na ang pag-simula ng paggalaw nang maaga ay maaaring mapabuti ang short-term na paggalaw, grip, at kumportableng pakiramdam nang hindi kinompromiso ang posisyon ng fracture [1][2]. Sa parehong oras, ang mga trial na nagkukumpara ng pag-simula ng paggalaw ng pulso sa humigit-kumulang dalawang linggo sa pag-simula ng paggalaw sa humigit-kumulang anim na linggo ay nagpakita na pareho ang dalawang grupo sa loob ng tatlo hanggang anim na buwan [3], kaya kahit mayroong maagang benepisyo, walang kailangang magmadali, at ang steady na progresyon na inilalarawan sa ibaba ay mahigpit na sinusuportahan. Ang paggaling ng buto ay sumusunod sa sarili nitong timeline anuman ang pakiramdam ng pulso, kaya ang mga huling precautions (walang weight-bearing, mabigat na pagbuhat, o contact sport hanggang 12 linggo pagkatapos ng fracture) ay pinapanatili kahit na ang paggalaw ay kumportable na.

Mga Paalala at Limitasyon

Ang magaan na gamit ng iyong kamay sa pang-araw-araw na gawain tulad ng pag-aalaga sa sarili, pagkain, paghuhubad, pagsusulat, at pag-type ay inirerekomenda.

Mahalagang iwasan ang pag-angat, paghawak, pagdadala ng bigat, at pagtama ng impact hanggang 8 linggo pagkatapos ng iyong operasyon. Ang banayad na pagpapalakas ay dahan-dahang ipinakilala mula sa ika-4 na linggo, nagsisimula sa magaan na ehersisyo ng mga daliri at isometric na ehersisyo ng pulso, at dahan-dahang pinapalakas nang maingat upang hindi masira ang maagang proteksyong ito.

Ito ang mga ehersisyo mula sa iyong handout, para sa pagbawi ng galaw ng iyong mga daliri, pulso, at forearms. Kung mayroon kang splint, alisin ito bago magsimula ng iyong mga ehersisyo. Simulan ang mga ito ayon sa gabay ni Dr. Hirpara at ng iyong therapist.

Mga ehersisyo mo

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang pinapabilis na klinikal na protokol para sa fracture ng distal radius na ginagamutan ng open reduction at internal fixation gamit ang volar plate. Ang seksyong ito ay dapat ibigay sa iyong physiotherapist o hand therapist, at ang bawat yugto sa ibaba ay nagsisimula sa isang simpleng paliwanag sa wikang Ingles tungkol sa nangyayari.

Araw 1–4 pagkatapos ng iyong operasyon

Sa unang ilang araw, ang pokus ay sa pagprotekta sa fixation, pagpapababa ng pamamaga, at pagpapanatili ng galaw ng iyong mga daliri, pulso, forearms, siko, at balikat. Mananatiling naka-putol ang iyong surgical bandage hanggang araw 3, kung kailan ito babawasan at ang sugat ay muling dadalhin. Panatilihing itaas ang kamay kapag nagpapahinga, gamitin ito para sa magaan na pang-araw-araw na gawain (sa ilalim ng 1–2 kg) sa loob ng komportableng limitasyon, at iwasan ang pagdudulot ng bigat sa pamamagitan ng braso, mahigpit na pagkapit, o pag-angat. Karaniwang hindi kailangan ang splint, ngunit maaari itong ayusin kung babalik ka sa trabaho o mas masakit ang pulso.

Para sa iyong physiotherapist:

Bago ang paggamot, suriin ang x-ray, operation report, at nakaraang medikal na kasaysayan (PMHx) ng pasyente, at makipag-ugnayan sa treating surgeon tungkol sa katatagan ng fixation ng fracture at ang inaasahang prognosis.

Edukasyon at mga paalala

  • Iwasan ang pagdudulot ng bigat sa pamamagitan ng braso, mahigpit na pagkapit, o pag-angat
  • Hikayatin ang paggamit ng apektadong kamay para sa magaan (mas mababa sa 1–2 kg) na mga gawain sa pang-araw-araw na buhay (ADL) sa loob ng limitasyon ng sakit at normal na mga pattern ng galaw

Pamamahala

  • Splint: walang kinakailangan, ngunit maaaring gamitin kung babalik ang pasyente sa trabaho o sa pagkakaroon ng tumaas na sakit; isaalang-alang ang thermoplastic splint o off-the-shelf support
  • Sugat: ang surgical dressings/bandage ay dapat iwan na buo hanggang araw 3; bawasan ang bandage at muling dalhin ang sugat mula araw 3 pagkatapos ng operasyon; edukasyon tungkol sa pamamahala ng sugat
  • Oedema: magbigay ng edukasyon tungkol sa elevation; magbigay ng compression therapy at retrograde massage kung kinakailangan
  • Mga ehersisyo: magbigay ng active six pack exercises upang mapanatili ang range of motion (ROM) ng mga daliri; magbigay ng active wrist, forearm, at finger range of motion exercises; hikayatin ang regular na active elbow at shoulder ROM

Linggo 2–4 pagkatapos ng operasyon

Matatanggal ang mga sutura sa araw 10–14, at sisimulan ang masahe ng peklat kapag sapat na ang paggaling ng sugat. Patuloy ang programa ng ehersisyo (titigil ang mga ehersisyong "six pack" kapag nabawi ng mga daliri ang buong galaw) at sisimulan ang banayad na pagpapalakas ng pulso sa pamamagitan ng aktibasyon ng kalamnan (isometric). Sa yugtong ito, dapat gumalaw ang pulso lamang sa sariling lakas ng kalamnan: walang sinuman, kasama na ikaw, ang dapat itulak o i-stretch nang passive, dahil patuloy pa ring nag-uunite ang fracture. Patuloy na iwasan ang pagdadala ng bigat, mahigpit na paghawak, at pag-angat; ang mga magaan na pang-araw-araw na gawain na may bigat na hindi lampas 1–2 kg ay inirerekomenda. Hindi dapat magmaneho habang naka-splint ang pulso; maaari nang magmaneho kapag lumabas na sa splint, ayon sa kumpirmasyon sa iyong follow-up.

Para sa iyong pisyoterapeuta:

Pagsusuri

  • Mga self-reported na pagsusuri: Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand (DASH)
  • Sukat ng circumferential na edema
  • Visual analogue pain scale (VAS) o numerical rating scale
  • Sukat ng active range of motion (AROM) gamit ang goniometry: kamay, pulso
  • Subjektibong pagsusuri, kabilang ang pagsunod ng pasyente sa programa, functional na paggamit ng kamay sa mga gawain sa ADL, at mga problema/alalahanin

Edukasyon at mga paalala

  • Iwasan ang pagdadala ng bigat sa pamamagitan ng braso, mahigpit na paghawak, o pag-angat
  • Walang passive na galaw ng pulso
  • Hikayatin ang paggamit ng apektadong kamay para sa mga magaan (hindi lampas 1–2 kg) na gawain sa ADL sa loob ng hangganan ng sakit at normal na mga pattern ng galaw
  • Walang pagmaneho habang naka-splint; maaari nang magmaneho kapag lumabas na sa splint, kumpirmado sa follow-up

Pamamahala

  • Sugat/peklat: pagtatanggal ng sutura sa araw 10–14; simulan ang pamamahala ng peklat kung angkop, depende sa progreso ng paggaling
  • Edema: isaalang-alang ang paggamit ng compression bandaging, retrograde na masahe, manual na mobilisasyon ng edema (MEM), contrast bathing, at/o elevasyon kung kinakailangan
  • Mga ehersisyo: tigilin ang mga aktibong ehersisyong "six pack" kapag nakamit na ang buong range ng daliri; isaalang-alang ang mga passive na ehersisyo ng daliri at hinlalaki, kabilang ang place/hold, kung hindi pa buo ang active ROM sa kamay; patuloyin ang mga aktibong ehersisyo ng ROM ng pulso; hikayatin ang regular na aktibong elbow at shoulder ROM; simulan ang isometric na pagpapalakas ng pulso

Paglutas ng problema

  • Monitor para sa mga senyales ng impeksyon sa sugat, pagbabago ng sensasyon sa kamay, o maagang mga senyales ng complex regional pain syndrome (CRPS)
  • Tukuyin ang mga aberrant na pattern ng galaw at干预 kung kinakailangan

Linggo 4–6 pagkatapos ng operasyon

Ang pagpapalakas ay nagsisimula nang dahan-dahan sa yugtong ito: mababang resistensya sa pagpapalakas ng mga daliri mula linggo 4, habang patuloy ang isometric na trabaho sa pulso at unti-unting ina-upgrade. Kung sapat ang iyong x-ray at matatag ang fixation, maaaring magsimula ang mahinhing passive na pag-stretch ng pulso (kung saan ang pulso ay ginagalaw gamit ang tulong ng iyong ibang kamay o ng iyong therapist) sa 4–6 linggo. Ang pagpapanumbalik ng galaw ay nananatiling may mas mataas na prioridad kaysa sa pagpapalakas. Patuloy na iwasan ang pagbibigat sa pamamagitan ng braso at ang mabibigat na pag-angat, habang patuloy na ginagamit ang kamay para sa magaan na mga pang-araw-araw na gawain.

Para sa iyong physiotherapist:

Pagsusuri

  • Sukat ng circumferential na edema
  • Visual analogue pain scale o numerical rating scale
  • Sukat ng AROM goniometry at kalidad ng mga pattern ng galaw
  • Subjektibong pagsusuri, kasama ang pagsunod ng pasyente sa regimen, functional na paggamit ng kamay sa mga gawain sa ADL, at mga problema/alalahanin
  • Lakas ng hawak gamit ang dynamometer (3 bawat limb)

Edukasyon at mga paalala

  • Iwasan ang pagbibigat sa pamamagitan ng braso, o ang mabibigat na pag-angat
  • Hikayatin ang paggamit ng apektadong kamay para sa magaan (mas mababa sa 1–2 kg) na mga gawain sa ADL sa loob ng hangganan ng sakit at normal na mga pattern ng galaw

Pamamahala

  • Bakod: patuloy na pamamahala ng bakod ayon sa kinakailangan
  • Edema: patuloy na compression therapy, retrograde na masahe, MEM at elevation ayon sa kinakailangan; itigil ang contrast bathing
  • Mga ehersisyo: patuloy na passive na mga ehersisyo sa daliri at hinlalaki kung hindi pa buo ang ROM; patuloy na active na mga ehersisyo sa ROM ng pulso; simulan ang mga ehersisyo sa pagpapalakas ng daliri laban sa mababang resistensya sa 4 linggo; simulan ang mahinhing passive na mga ehersisyo sa pulso sa 4–6 linggo kung matatag ang ORIF at sapat ang x-ray; hikayatin ang regular na active na elbow at shoulder ROM; patuloy/upgrade ang isometric na mga ehersisyo sa pagpapalakas ng pulso

Paglutas ng problema

  • Suriin para sa mga senyales ng CRPS at sakit sa balikat
  • Isaalang-alang ang dami ng mga ehersisyo sa home programme at bigyang-priyoridad ang ROM kaysa sa lakas
  • Kung ang ROM ng pulso ay malaki ang limitasyon, isaalang-alang ang pagsisimula ng mahinhing passive range of motion (PROM) na mga ehersisyo sa pulso sa loob ng 4/10 VAS, sa pag-apruba ng surgeon

Linggo 6–8 pagkatapos ng operasyon

Ang yugto na ito ay nagsisimula ng unti-unting pagbabalik sa buong aktibidad sa loob ng susunod na 3 linggo. Ang pagsasanay sa pagpapalakas ng pulso ay tataas hanggang sa magaan na timbang (0.5–1.0 kg) o mababang resistensyang theraband, at ang resistensya para sa pagsasanay sa pagpapalakas ng daliri ay tataas. May dalawang mahigpit na limitasyon na nananatili: walang pagdudulot ng bigat, mabibigat na pag-angat o sports na may kontak hanggang 12 linggo pagkatapos ng fracture. Ang iyong terapepista ay mag-aalis sa iyo kapag ikaw ay may buong galaw at angkop na pagbabalik ng function.

Para sa iyong physiotherapist:

Pagsusuri

  • Sukatin ang circumferential na edema kung kinakailangan
  • Visual analogue pain scale o numerical rating scale
  • Sukatin ang AROM goniometry
  • Lakas ng hawak
  • Pagsusuri ng pakiramdam

Edukasyon at mga paalala

  • Unti-unting pagbabalik sa buong aktibidad sa loob ng susunod na 3 linggo
  • Iwasan ang pagdudulot ng bigat, mabibigat na pag-angat at sports na may kontak hanggang 12 linggo pagkatapos ng fracture

Pamamahala

  • Bakawan: patuloy na pamamahala ng bakawan kung kinakailangan
  • Edema: patuloy na pamamahala ng edema kung kinakailangan
  • Mga ehersisyo: patuloy na passive na ehersisyo sa daliri at hinlalaki kung hindi pa buong ROM; patuloy na active at passive na ehersisyo sa ROM ng pulso kung kinakailangan; dagdagan ang resistensya sa mga ehersisyo sa pagpapalakas ng daliri; magsimula ng mga ehersisyo sa pagpapalakas ng pulso gamit ang 0.5–1.0 kg na timbang o mababang resistensyang theraband; i-upgrade ang mga timbang at resistensyang ginagamit sa programa sa pagpapalakas ng pulso ayon sa kakayahan

Paglutas ng problema

  • Isaalang-alang/magsimula ng night serial progressive splinting, boxing glove o dynamic splinting kung mabagal ang pag-unlad ng ROM
  • Subaybayan ang anumang senyales ng kawalan ng katatagan ng pulso at gamutin nang angkop
  • Isaalang-alang ang pag-alis kapag buong ROM at angkop na pagbabalik ng function
  • Isaalang-alang ang pagpapa-refer sa treating doctor kung ang kondisyon ay huminto at/or may mababang resulta

Ang protocol na ito ay isinulat kasama si Sarah Farrell, BOccThy AHT, at si Kristy Gerlach, BOccThy AHT.

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat at mga batayan ng hand therapy. Para sa operasyon mismo at sa pinsala na pinapagaling nito, tingnan ang distal radius fixation (ORIF) at distal radius fracture. Ang phased na plano sa itaas ay naaayon sa publikadong ebidensya tungkol sa rehabilitasyon pagkatapos ng volar locking plate fixation, at ang iyong patuloy na paggaling ay indibidwal na pinamumunuan ng iyong physiotherapist o hand therapist ayon sa kung paano ang pag-unlad ng iyong pulso.

Mga Sanggunian

[1] Quadlbauer S, Pezzei C, Jurkowitsch J, et al. Ang agad na paggalaw ng mga fracture ng distal radius na na-stabilize gamit ang volar locking plate ay nagdudulot ng mas magandang maikling panahong resulta kaysa sa limang linggong immobilization: isang prospective randomized trial. 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. Epektibidad ng maagang kumpara sa huling paggalaw sa mga pasyente na may fracture ng distal radius na na-trate gamit ang volar locking plate: isang systematic review at meta-analysis. 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. Pag-galaw ng pulso pagkatapos ng volar plate fixation ng mga fracture ng distal bahagi ng radius. 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. Epektibidad ng mga teknik sa pamamahala ng edema para sa subacute hand edema: isang systematic review. 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

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/

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.