Distal Radius Fracture (post-immobilisation)

The single most likely fracture rehabilitation a student is handed on a five-week placement.

Illness script in one line: a wrist six weeks out of a cast or off a volar plate — stiff, weak, swollen, ginger about being used — usually an older adult after a fall onto an outstretched hand, or a younger one after something faster.

Caseload frequency: high, and it arrives on your list already labelled. That label is the problem this page is about.

Finally, a guideline

Every other page in this region carries some version of no Australian guideline and no CPG of any kind. This one is different.

Distal Radius Fracture Rehabilitation has been published as a clinical practice guideline in the Journal of Orthopaedic and Sports Physical Therapy [1]. Go and read it — it is written for you. Read further: rehabilitation for distal radial fractures in adults [2], an evidence-based review of the fractures [3].

The Australasian anchor is a comparison of surgical plating with closed reduction in older patients in the ANZ Journal of Surgery [4], with a scoping review of occupational performance during recovery in the Australian Occupational Therapy Journal [5].

The fracture is the label. The complications are the reasoning.

Six things after a distal radius fracture have their own literature, and every one of them changes what you do:

The usable point: "post-fracture stiffness" is one of six explanations, not the only one — and the other five are the reason a student should examine this wrist rather than just mobilise it.

Written for a patient who already has a diagnosis.

Main problem

"They fixed my wrist and now it doesn't work."

The interesting version of this history is not what happened to the bone. It is what the patient has stopped doing. Read further: occupational performance during recovery (Bredy et al. 2024), symmetry of hand use (Iitsuka et al. 2025). Ask what they now do one-handed. That list is your treatment plan.

Body chart

Map it properly, because "wrist pain" after a fracture can be four different problems.

Behaviour

Aggs: weight through the hand — pushing up out of a chair, a plank, a pram, a walking frame; turning taps and keys; carrying; end-range extension.
Eases: support, avoiding load, keeping it still — which is exactly the pattern that produces the non-use problem.
Severity: VAS 0–10 at best / at worst / right now.

Ask about night pain and night numbness separately. They point in different directions.

History

Get the treatment history precisely, because it changes what you expect:

• Cast or plate? Read further: volar locking plate versus cast [14], surgical versus conservative treatment in the elderly [15], plating versus closed reduction in older patients (Howell et al. 2022). None of it is your decision.
• How long immobilised, and above or below the elbow? Read further: above-elbow versus below-elbow casting [16]. An above-elbow cast means the elbow needs examining too.
• Was there a reduction, and were there repeat films?
• When did the symptoms start — immediately, or after the cast came off?
• What are they allowed to do? Get the surgeon's or the fracture clinic's restrictions in writing if you can. Guessing them is how students get into trouble.

Special / screening questions

• Numbness or tingling in the thumb, index or middle fingers, especially at night? Section 4.
• Pain out of proportion, swelling, colour or temperature change, hypersensitivity to light touch? Section 4.
• A sense of the forearm giving way on rotation? Section 4, and the DRUJ page.
• Can they straighten the thumb? Section 4.
• Falls history, bone health, and what caused the fall in the first place. A low-trauma wrist fracture in an older adult is a fall and a bone-health conversation, not just a wrist.

Not "which condition is it" — the fracture is known. This is "what is limiting this wrist today".

The discriminator that does most of the work: is this wrist getting better every week, or isn't it? A post-fracture wrist that is not improving week on week has a reason, and the reason is on this list.