Rehabilitation Protocol After External Fixation of Wrist Fractures

Initial Phase (During External Fixation)

The American Academy of Orthopaedic Surgeons recommends starting active finger exercises immediately after diagnosis and external fixator placement to prevent stiffness, a common and disabling complication 1, 2
Applying ice in the first 3-5 days post-surgery can help reduce inflammation and pain, according to the American Academy of Orthopaedic Surgeons 4, 5
Limiting the duration of external fixation can help reduce complications, although there is no consensus on the exact duration, with some studies showing similar results between 3 weeks of external fixation plus 2 weeks of additional casting compared to 5 weeks of external fixation, as reported by the American Academy of Orthopaedic Surgeons 4, 6
Caution should be taken to avoid overdistraction, as it may contribute to finger stiffness, although conclusive evidence is lacking, according to the American Academy of Orthopaedic Surgeons 4, 7

The American Academy of Orthopaedic Surgeons suggests that early wrist mobilization may not be necessary after stable fixation, with mobilization initiated approximately 3 weeks after external fixation 3, 4
A well-structured home exercise program can be as effective as supervised therapy, according to the American Academy of Orthopaedic Surgeons 3

The American Academy of Orthopaedic Surgeons recommends adjuvant treatment with vitamin C to prevent disproportionate pain 4, 7
Limiting the duration of external fixation may improve functional outcomes, although the quality of this evidence is limited, as reported by the American Academy of Orthopaedic Surgeons 4, 6
There is no conclusive evidence to support the routine use of supervised physical therapy over a well-structured home exercise program, according to the American Academy of Orthopaedic Surgeons 8