Distal Radius Fracture ORIF — Accelerated

Mammoth Orthopedic Institute / Sierra Park PT · Brian Gilmer MD (US Ski Team Physician); Karly Dawson PA-C; Ellen Obenberger OT

Weight-Bearing

N/A (wrist) — off-the-shelf or custom cock-up wrist splint full time x6 weeks except during exercises

Key Restrictions

Full-time splint x6 weeks except for exercises (remove for hygiene/dressing/eating/exercise); avoid lifting/pushing/pulling/heavy machinery; do not test strength Phases I-II; avoid WB Phase II; wean from splint Phase III (except high-risk activities); fully wean from splint Phase IV; 5 lb work simulation limit Phase IV; DC when 90% AROM and manages 5 lbs independently

Timeline & Phases

4 phases: Phase I (wk 1, splint, tendon gliding with wrist ext >21 deg, AROM/PROM finger/elbow/wrist/forearm, overhead elevation with fisting), Phase II (wks 2-4, edema/scar management, AROM/AAROM wrist + PROM pronation/supination, isometric wrist/forearm, light putty, retrograde massage, lightly grasp beans/rice), Phase III (wks 4-5, restore full AROM, PROM+joint mobs if needed, functional activities minimal resistance, isotonic exercises, wean from splint for low-risk activities), Phase IV (wks 6-8, wean from splint, full UE strengthening, work simulation up to 5 lbs — DC when 90% AROM + manages 5 lb)

Notes

Accelerated variant — Phase II begins at wks 2-4 (vs wks 6-7 in conservative variant); references Slutsky 2005 and Brehmer/Husband 2014 JBJS accelerated rehab study as evidence base; Ellen Obenberger OT; Gilmer MD; key distinction from conservative: forearm AROM explicitly included in Phase I; earlier mobilization schedule; both variants reach same DC criteria (90% AROM + 5 lb management)

Surgeon / Author

Brian Gilmer MD (US Ski Team Physician); Karly Dawson PA-C; Ellen Obenberger OT