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External Fixation of Distal Radius Frx: Post Operative Care



- See: Over Distraction of Wrist

- Discussion:
      - patient is instructed to move all unaffected joints throughout the joint;
      - avoid pronation and supination of forearm since this applies skin tension over most proximal screw; (infection is most common here);
      - when limited finger or thumb motion is present, a mechanical reason such as transfixation of tendons and muscles must be ruled out;

- Duration of Treatment:
      - depending on the type of frx and its fixation, the period of immobilization in the fixator is about 4-6 weeks;
             - it is noteworthy that prolonged immobilization in the fixator will not prevent late frx collapse;
             - the bottom line is that unstable fractures, that are properly reduced, immobilized (pins and ex-fix), and bone grafted will not collapse, where as, unstable fractures that are not properly managed (not bone grafted) may go on to collapse (whether they are immobilized for 3 weeks or for 8 weeks);
       - w/ in 4 to 5 wks after fixator removal most patients regain a normal range of finger motion;

- Painful Wrist:
     - ischemia (tight dresings, compartment syndrome of the hand or forearm)
     - transfixation of tendons or muscles
     - overdistraction
     - over flexion of the wrist causing carpal tunnel syndrome



Treatment of External Fixation Pins About the Wrist: a Prospective, Randomized Trial.