Transitioning From Cast to Brace For Patients With Distal Radius Fractures: A Framework
Welcome back for another ‘Frameworks’ article. These pieces are a distillation of the way I think about common upper extremity injuries and how to treat them.
If you’ve been to this site before, you may be aware that a distal radius wrist fracture is the most common fracture I treat. Some of these require surgery, and others do not.
Today, I’d like to go over my framework for bracing during the ‘weaning’ period. This phase usually begins about 6 weeks after either surgery or the initiation of cast wear for non-surgical fractures.
Wait For My Green Light
I cannot officially start you on this phase until I see some good bony healing on x-ray. But once I do, I’ll start talking to you about this process.
If you had surgery with me for this fracture, you likely already have a brace. If you didn’t need surgery and were treated in a cast, you will be given a brace at your 6-week appointment if I decide you’re ready for this stage (though more to come, an exciting study in 2023 hints that 4 weeks of casting may be enough!).
Once I give you the green light, here is how your next 4 weeks should look:
Week 1 (Week 7 after injury/surgery)
Spend the majority of your time in the brace, similar to cast wear
Enjoy some time out of it for hygiene/showers
3 times a day, spend 5 minutes of the cast gently moving your wrist around.
Week 2 (Week 8 after injury/surgery)
Progress to spending more time out of the brace for light activities, as tolerated.
Examples are brushing your teeth, typing, and writing.
As tolerated means: if you feel pain, stop and go back in the brace.
Week 3 (Week 9 after injury/surgery)
Progress to spending more time out of the brace for moderate activities, as tolerated.
An example would be taking milk out of the refrigerator or prepping a light meal (no heavy stovetop pots).Consider sleeping without the brace
Week 4 (Week 10 after injury/surgery
Progress to spending more time out of the brace for heavy activities, as tolerated.
An example would be carrying a laundry basket or lifting a pet.
I want you to think of this whole process as your ‘on-ramp’ back to life. This is not 0-60mph all in one go. Your wrist is weak and stiff. It is going to take significant time to return to its former strength.
A good rule is to regain your motion before progressing your strength. So each week as you go along, I want you to be able to stretch and move your wrist more and more.
The reality is, by week 10, you will likely not be completely done with a brace. But hopefully, you will be using it selectively for those one or two activities where you know it might bother you. Otherwise, you are living brace-free and working on your exercises.
If at any point something doesn’t seem right, or you are not making progress with your range of motion, I want you to come see me. We will re-evaluate and it may be that you would benefit from formal hand and wrist therapy to jumpstart your recovery.
Slow progress is normal. Failure to improve or worsening is not.
