The Plate Isn’t There to Make the Bone Strong. It’s There So You Can Move.
You’ve had a broken wrist fixed with a metal plate and screws, and you’ve been told you can start moving it almost straight away.
That worries people.
…cos it just feels too soon after a traumatic injury that caused the bone to break. They may relive the trauma of the accident, fall or trauma, and they can’t reconcile that the bone is strong enough to move with the plate and screws.
Here’s the logic.
A wrist in a cast for six weeks heals a fracture and produces a stiff, weak, frightened wrist that then takes months to rehabilitate. The plate exists to skip that. It holds the fracture stable enough that the joint can move while the bone knits.
So the movement isn’t a risk you’re taking despite the surgery. It’s the entire reason the surgery was done.
What early movement does and doesn’t mean
Two things get confused constantly, and getting them straight will save you a lot of anxiety.
- Movement is encouraged early. Bending, straightening, and turning the palm up and down, gently, within days.
- Load is NOT. No pushing up out of chairs, no carrying shopping, no leaning on that hand, no lifting anything heavier than a cup of tea until you’re told.
The plate resists the small forces of movement well. It does not want your bodyweight going through it at week two.
The timeline
- Days 0 to 14: removable splint, worn for comfort and protection. Elevation above heart level, and take this seriously in the first week because swelling is what becomes stiffness. Fingers, elbow and shoulder moving fully from day one. Gentle wrist movement usually starts within the first week on the surgeon’s word. Stitches around 10 to 14 days.
- Weeks 2 to 6: the range-of-motion phase, and the one that decides your result. Wrist bending, straightening, side-to-side and forearm rotation, several short sessions daily rather than one long one. Still no loading. Scar management once the wound is closed.
- Weeks 6 to 12: the fracture is usually united. Strengthening starts and progresses steadily. Grip work, then weight-bearing through the hand, then gradually heavier tasks.
- Months 3 to 6: back to manual work, sport, and impact. Grip strength is the slowest thing to normalise.
- Months 6 to 12: aching in cold weather, and a wrist that feels not-quite-yours at the extremes of movement, are both common and both usually settle.
The number worth asking about at each review is your wrist extension and your forearm rotation, in degrees, compared with the other side. Those two predict function better than anything on the X-ray.
The complication nobody mentions and everyone should know
Most plates sit on the palm side of the radius, and the tendon that bends the tip of your thumb runs directly across the lower edge of that plate.
If the plate sits slightly proud, that tendon rubs on the edge of the metal. It can fray over months and then rupture, sometimes a year or more after an otherwise perfect operation.
Try to bend the very tip of your thumb, on its own, once a week. If it stops working, that’s a tendon, not stiffness, and it needs reporting quickly.
Same idea on the back of the wrist: a tendon running to the thumb can rupture after wrist fractures too, showing up as a thumb that won’t lift away from the hand.
Neither is common. Both are far easier to deal with early, and neither is something you’d guess at without being told.
Other things to report
- New or worsening numbness and tingling in the thumb, index and middle fingers, which can mean the median nerve is being squeezed by swelling.
- Pain that escalates rather than settles after the first fortnight, with a shiny, swollen, exquisitely sensitive hand and fast-worsening stiffness. That’s the CRPS pattern, and wrist fractures are one of the commonest triggers. Early, not later.
- Range that has stopped improving entirely between weeks 3 and 8.
- Fingers that are getting stiffer rather than looser, which usually means swelling isn’t being controlled.
Does the plate come out?
Usually not. It doesn’t set off airport scanners in any meaningful way, it doesn’t ache in the cold on its own, and removal is a second operation with its own risks.
It gets removed when it’s causing a specific problem: irritating a tendon, sitting prominently, or being blamed for genuine ongoing pain that nothing else explains. That conversation usually happens after a year.
The short version
Move it early, load it late. That’s the whole protocol in five words.
Elevate hard in week one, chase wrist extension and forearm rotation between weeks 2 and 6, and don’t be alarmed that strength lags months behind movement. It always does.
And check your thumb tip bends, once a week, for the first year.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Follow your own surgeon’s protocol where it differs from anything here.