Post-surgery hand fracture advice and treatment
Date issued: May 2023
Review date: May 2025
Ref: C-528/JT/Occupational Therapy/Post-surgery hand fracture advice and treatment
PDF: Post-surgery hand fracture advice and treatment final May 2023.pdf[pdf] 260KB
Surgical Management
In some cases, it is required to surgically fix a fracture. This can be done either by an Open Reduction and Internal Fixation (ORIF) or using surgical wires called K wires.
ORIF fixations
This involves using screws with or without a metal plate to permanently support the fracture site so it can heal in a good position. Unless there is a problem with the skin or metalwork, the metalwork is not removed and remains long-term. You will have a wound/scar where they have opened the skin for the operation.
Wound care
It is important to keep your wound clean and dry whilst you have stitches in. You may wash the wound and start scar management once the stitches are removed and the wound is healed.
Scar Massage
You should spend at least 5 minutes 3-4 times a day performing scar massage. Use an unperfumed moisturiser to massage into the skin, rub firmly using circular movements up/down the scar. This will flatten the scars appearance, prevent sticking/adhesions and avoid any tightness.
K- Wire Fixations
K wires are a short-term fixation involving metal wires that hold a fracture in place. These wires are inserted through the skin into the bone. The wires are usually left in place for 4 weeks and then removed in an outpatient clinic. The wires are removed using a set of forceps, the wire is pulled out and is usually pain free.
Pin Site Care
It is important to keep the skin around the k wires clean and dry. Initially you will have a bandage/cast around the hand. When you return for a cast change, your pin sites will be cleaned, and you will be shown how to care for them. You will be provided with sterile water, gauze, and dressings.
Once a week:
Remove splint and old dressing
Remove x2 gauze from packet
Poor sterile water onto remaining x3 gauze in packet
Clean each individual pin site with a clean gauze
Dry pin site with dry gauze
Re-dress and re-apply splint
Important: If you notice any increased redness, pain, discharge from the pin site please contact the clinic ASAP Tel. 01752 432105
Thermoplastic Splint (TP) Information
Your splint has been made from:
Please wear your splint:
How to care for your splint:
Wash splint regularly using lukewarm water and small nailbrush. Rinse well.
Always keep splint away from direct heat source i.e. radiators, fires, tumble dryers, hot water bottles and sunlight through glass
Your splint will lose shape and become sticky at temperatures of 65 degrees and over.
Never attempt to re-shape or alter the splint yourself.
If you are concerned about your splint, seek advice from your therapist.
Swelling
Swelling is normal and can take months to resolve. Try to keep your hand elevated. When sitting down, put some pillows on the arm of the chair to rest your hand above the level of your heart and use a sling when you are walking around.
Once any wounds/pin sites are healed and the splint/support/strapping can be removed contrast bathing is an excellent way to ease the swelling, stiffness, and pain in your hand. Fill one bowl with water hot enough to comfortably tolerate and another with cold water and ice cubes/unopened bag of frozen peas. Immerse your hand in each bowl for 30 seconds at a time starting in the hot water, repeat 7 times ending in the hot water. You can repeat this regularly throughout the day to help with pain and swelling.
Exercise
It is normal for your joints to feel stiff and uncomfortable after an injury, but this will ease by doing regular exercises.
Tendon gliding exercises are specific exercises which promote the motion of tendons in the surrounding soft tissues. These exercises help to reduce the adhesion between tendons and surrounding tissues, including the underlying bone, while you are recovering from your injury.
These exercises also help to reduce swelling in your hand.
Your therapist will advise you with specific exercises to do which are safe for your condition/injury and when to start them.
Active Tendon Gliding Exercises
If you would like to access the exercise videos, please visit www.hep.video and type in the specific access code related to the exercise.
The following exercises are to be performed:…………times a day.
Each movement is to be performed for:…….….repetitions. Holding each position for:…………..seconds.
Access code: VV6H7CMGT
Passive Exercises
Not to be started until 6 weeks post-injury unless otherwise direct by your therapist.
If you would like to access the exercise videos, please visit www.hep.video and type in the specific access code related to the exercise.
The following exercises are to be performed:…………times a day.
Each movement is to be performed for:…….….repetitions. Holding each position for:…………..seconds.
Access code: Access code: Access code:
VVYZUYHRX VVC4S9XKB VVSXBUN85
Use other hand to push fingers into palm of hand.
Hold for:………..seconds.
Access code:VVGS979QR
Use other hand to push fingers straight/push fingers straight on a flat surface. Hold for:…………seconds.
