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ORIF of the Forearm



Open Reduction and Internal Fixation (ORIF) of the forearm is a surgical procedure to treat a fractured ulnar and radius (bones in forearm). Open reduction refers to open surgery to realign and set bone and is necessary for some fractures. Internal fixation refers to the fixation of screws and / or plates to enable or facilitate healing. Physiotherapy after ORIF surgery of the forearm is essential to mobilise and return function in the forearm.

A forearm fracture occurs when there is a fracture of one or both bones of the forearm. The two bones of the forearm include the radius and the ulna. Fractures of the forearm result from a fall onto the hand, or a direct blow to the forearm. Symptoms of a forearm fracture include pain, swelling and deformity of the forearm. Types of forearm fractures include:
  • Radial Shaft Fracture
  • Ulnar Shaft Fracture
Fractures of the forearm can be non displaced (bones are still in position) or displaced (out of position). Treatment of forearm fractures can vary depending on the severity of the fracture. If the bone is still in its correct alignment (non-displaced) then immobilisation with use of a splint or cast followed by physiotherapy is recommended. In severe cases where the bone is displaced (out of correct position) then open reduction and internal fixation (ORIF) of the radius, ulnar or both forearm bones is required.

ORIF surgery is performed in an operating room, normally under general anaesthesia. During ORIF to the forearm, an incision is made over the area of the fracture. If both bones are affected, then these are approached through a separate incision, therefore there will be two incisions made to the forearm. The fractured bones are then realigned (open reduction) and held in place with a combination of pins, screws, and / or wires (internal fixation). The wound is then closed up using stitches or sutures. The pins / screws may remain in place permanently or they could be taken out at a much later stage. It is important to undergo ORIF immediately after suffering a displaced fracture of the forearm as this will reduce pain, prevent deformities, aid the healing process and prevent further problems in the future.

Physiotherapy is imperative once the fracture site has healed sufficiently as this will maximise the success of the ORIF surgery and help ensure the return of full or near to full function in the forearm.


Symptoms after ORIF of the Forearm



Once you have undergone ORIF of the forearm you will experience pain, swelling and decreased mobility in your affected arm. You will be given modalities to control pain and you will be advised to keep your forearm elevated to reduce swelling and increase circulation to your forearm. You will be provided with a sling to use for support, protection and elevation in the initial period post operation. The bones in the forearm can take from between 6 and 8 weeks to heal sufficiently. You will suffer a reduction in function, strength and muscle control in the forearm due to numerous muscle attachments in this area. Physiotherapy should begin as soon as possible as early mobilisation is encouraged. Physiotherapy is also important immediately for a rapid and problem free recovery; however, you will be unable to take part in a full and intense physiotherapy programme until the fracture site has healed adequately. You will be unable to drive until you have full and painless function in your affected arm.


Physiotherapy after ORIF of the Forearm



Physiotherapy is required as soon as possible once you have undergone ORIF surgery to reduce pain, stiffness and improve mobility, range of movement and strength in your affected arm. A comprehensive physiotherapy programme with Physio.co.uk will help you achieve the return of full or near to full function in your forearm whilst also helping to prevent any future problems occurring. Rehabilitation can take 4 months or longer after you have had ORIF surgery to your forearm depending on the severity of the injury. Physio.co.uk offers a programme that includes goals that are personal to you. Goals include:
  • To restore a pain free forearm
  • To restore full range of motion (ROM)
  • To restore full muscle strength
  • To restore full muscle length and flexibility
  • To improve cardiovascular fitness and muscle endurance
  • To re-establish function and independence

0-4 weeks



In the initial month after your ORIF surgery to your forearm the main aim of your physiotherapy with Physio.co.uk will be to reduce pain and swelling that you will be experiencing at this time. Physio.co.uk will encourage early mobility to maintain range of movement in your affected arm. Your physiotherapy programme will include exercises that aim to gradually introduce you back to gentle activity. Physio.co.uk also recognises the importance of maintaining strength and range of movement in your opposite arm for essential support. Your physiotherapy will include:
  • Pain killers (to control pain)
  • Elevation (to control swelling)
  • Passive (assisted) range of movement exercises for affected arm (wrist, hand, elbow and shoulder)
  • Active (on your own)range of movement exercises for affected arm (wrist, hand, elbow and shoulder)
  • Strengthening and range of movement exercises for unaffected arm

5-8 weeks



During the second month of your rehabilitation with Physio.co.uk your physiotherapy will focus on the continuation and progression of activities from previous weeks. The goals of your rehabilitation include controlling pain and swelling, improving range of movement and flexibility along with increasing muscle strength and control. Your physiotherapy will include:
  • Continuation of modalities for pain and swelling
  • Passive (assisted) and active (independent) range of movement exercises
  • Gentle strengthening exercises (isometric – hold) for muscles of affected arm (biceps, triceps, pronator teres, supinator, brachioradialis)
  • Passive (assisted) stretching exercises for muscles of affected arm (biceps, triceps, pronator teres, supinator, brachioradialis)
  • Range of movement, strengthening and stretching exercises for unaffected arm
  • Mobilisation of radius and ulnar
  • Hand grip strengthening exercises
  • Wrist, hand and elbow exercises
  • Hydrotherapy
  • Arm cycle

9-12 weeks



In the third month of your rehabilitation your physiotherapy programme will continue to focus on the progression from previous weeks. The main goals of your physiotherapy programme with Physio.co.uk will aim to minimise pain, improve range of movement, and increase strength in your affected arm. At this stage, your physiotherapy will also begin to include activities that will improve your cardiovascular fitness and muscle endurance. Your physiotherapy will include:
  • Pain control
  • Range of movement exercises
  • Flexibility exercises
  • Passive stretching (assisted) programme-with combined movement
  • Strengthening exercises for muscles in affected and unaffected arm (biceps, triceps, pronator teres, supinator, brachioradialis)
  • Hand grip strengthening exercises
  • Hydrotherapy
  • Arm cycle

3 months onwards



Following three months of successful rehabilitation with Physio.co.uk you will have minimal if no pain and swelling and you will have seen marked improvements in the function and strength of your forearm. The main goals of your physiotherapy at this stage will continue to focus on the progression of exercises from previous weeks. Your physiotherapy will aim to improve the strength in the muscles of your forearm by consistently building up resistance in the strengthening exercises. You should now have full range of movement therefore your physiotherapy will aim to maintain and improve flexibility of both your upper limbs. Cardiovascular activities such as hydrotherapy, arm cycling, jogging and even cross training (x-trainer) can be included in your programme to improve fitness, muscles endurance and personal wellbeing. Physio.co.uk will also include more functionally specific activities for your hand, wrist and forearm to promote independence.

The success of your recovery after open reduction and internal fixation surgery of your radius and ulnar will highly depend on you commitment to your physiotherapy programme as well as the severity of your fracture prior to the surgery. Recovery may take three to four months.


Summary



Open Reduction and Internal Fixation (ORIF) of the forearm is a surgical procedure to treat a fractured ulnar and radius (bones in forearm). A forearm fracture occurs when there is a fracture to one or both of the bones of the forearm. Forearm fractures result from either a landing badly on the hand after a fall or from direct trauma. Treatment of the fracture depends on its severity. If the fracture remains in position (non-displaced) then a conservative approach is recommended which involves immobilisation and a course of physiotherapy. If the fracture is out of position (displaced) then ORIF surgery is required to enable the return of function and to facilitate effective healing of the forearm. ORIF surgery involves open reduction to realign the bones back into their correct position followed by internal fixation to fix the bones using screws or plates. Physiotherapy after ORIF surgery of the forearm will maximise the success of the surgery, reduce pain and stiffness, aid the healing process and improve mobility and function in the forearm. A personal physiotherapy programme with Physio.co.uk will help you achieve the return of full or near to full function in your arm and get you back to what it is you love doing the most as soon as possible. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.


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