Distal Radius Fracture ORIF — Conservative

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) — custom cock-up or off-the-shelf wrist splint full time (remove for hygiene/dressing/eating/exercise)

Key Restrictions

Full-time splint (remove for hygiene/dressing/eating/exercise); avoid lifting/pushing/pulling/heavy machinery; do not test strength Phases I-III; avoid WB Phase II; wean from splint Phase II; 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 finger/elbow, gentle AROM wrist, overhead elevation with fisting), Phase II (wks 6-7, edema/scar management, AROM/AAROM wrist, gentle PROM pronation/supination, isometrics, wean from splint, retrograde massage), Phase III (wks 7-8, restore full AROM, gentle PROM+joint mobs, functional activities minimal resistance, gentle strengthening/light putty), Phase IV (wk 8+, wean from splint, full UE strengthening, isotonic, heavy putty, work simulation up to 5 lbs — DC when 90% AROM + manages 5 lb)

Notes

Conservative variant — Phase II begins at wks 6-7 (vs wks 2-4 in accelerated variant), reflecting longer immobilization period; references same Slutsky 2005 and Brehmer/Husband 2014 JBJS studies as accelerated version; Ellen Obenberger OT; Gilmer MD; forearm AROM not listed in Phase I (vs accelerated); PROM labeled gentler throughout; no publication date listed; both variants reach same DC criteria

Surgeon / Author

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