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Chapter: Medical Surgical Nursing: Management of Patients With Musculoskeletal Trauma

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Wrist - Fracture

Fractures of the distal radius (Colles’ fracture) are common and are usually the result of a fall on an open, dorsiflexed hand.

WRIST

 

Fractures of the distal radius (Colles’ fracture) are common and are usually the result of a fall on an open, dorsiflexed hand. This fracture is frequently seen in elderly women with osteoporotic bones and weak soft tissues that do not dissipate the energy of the fall. The patient presents with a deformed wrist, radial deviation, pain, swelling, weakness, limited finger ROM, and numbness.

Management

 

Treatment usually consists of closed reduction and immobili-zation with a short arm cast. For fractures with extensive com-minution or impaction, open reduction and internal fixation, arthroscopic percutaneous pinning, or external fixation is used to achieve and maintain reduction and to allow for early functional rehabilitation. The wrist and forearm are elevated for 48 hours after reduction to control swelling.

 

Active motion of the fingers and shoulder should begin promptly. The patient is taught to do the following exercises to reduce swelling and prevent stiffness:

 

·      Hold the hand at the level of the heart.

 

·       Move the fingers from full extension to flexion. Hold and release. (Repeat at least 10 times every hour when awake.)

 

·      Use the hand in functional activities.

 

·        Actively exercise the shoulder and elbow, including com-plete ROM exercises of both joints.


The fingers may swell due to diminished venous and lympha-tic return. The nurse assesses the sensory function of the median nerve by pricking the distal aspect of the index finger. The motor function is assessed by the patient’s ability to touch the thumb to the little finger. Diminished circulation and nerve function must be treated promptly by release of constricting bandages.

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