How long is the operation?

The operation typically takes 60–90 minutes. It is performed as day surgery. Patients usually leave hospital within a few hours of waking from the anaesthetic, with a soft splint, a wound dressing, and analgesia.

When does hand therapy start?

Within the first week. Almost every patient sees a hand therapist after ORIF — typically twice a week for the first month, then weekly, then as needed. The construct is stable from day one, so early active and active-assisted wrist motion does not threaten the fixation. The hand therapist's role is to recover the last 20% of function that the operation alone cannot deliver.

How long until I can return to manual work?

Light non-manual or desk work: typically 1–2 weeks. Light manual work and household tasks: 6 weeks. Heavy manual work, repetitive lifting, and impact-loaded sport: 3–4 months. The timeline is paced by the hand therapist's strength assessments rather than by a fixed calendar.

Will my wrist be the same as before?

Most patients regain functional motion and grip. A small loss of extreme range (the last few degrees of wrist extension or supination) is common and rarely limits daily life. Heavy overhead manual work and impact-loaded sport are the activities most likely to highlight a residual limitation.

Distal radius open reduction and internal fixation (ORIF) · Dr Joe Coory

Q: Why a volar locking plate?

The volar (palmar) approach has become the contemporary standard because the plate is placed on the strong palmar cortex of the distal radius, away from the extensor tendons that historically caused trouble with dorsal plates. Locking screws hold the small distal articular fragments without relying on the often-poor bone quality of the metaphysis — particularly important in older patients. The combination of a volar approach and a locking plate gives reliable fixation that allows immediate post-operative mobilisation.

Q: Does the plate stay in forever?

Yes, in almost every case. Modern titanium volar locking plates are low-profile and well-tolerated. Plate removal is occasionally considered for hardware irritation or tendon issues, but this is uncommon and is a separate decision made well after the fracture has healed.

Q: How long until I can drive?

Driving usually resumes at 4–6 weeks, once the splint is off, the wrist is comfortable, and you can perform an emergency stop with a firm grip on the wheel. Returning to driving in the first 2–3 weeks is not safe — the wrist cannot grip strongly enough and the medication is not compatible.

Type: Open fixation, volar approach
Anaesthesia: General ± regional block
Day surgery: Yes
Splint: 1–2 weeks soft splint
Hand therapy: Starts within the first week
Return to driving: 4–6 weeks
Heavy manual work: 3–4 months
Final outcome: 9–12 months

When the operation is indicated.

A distal radius fracture is the most common adult fracture and many are treated without surgery. ORIF is reserved for the fracture patterns that will not heal to acceptable function in a cast — significant displacement (typically more than approximately 10° of dorsal angulation, or more than 5 mm of radial shortening), volar (Smith) angulation, intra-articular extension with a step or gap, multi-fragment patterns, and fractures that lose reduction in the cast at the 1- or 2-week check. Patient factors also weigh on the decision: active patients with manual occupations, sport, or a dominant hand benefit from anatomical restoration of wrist mechanics that a cast cannot always deliver.

The operation is best performed within approximately 2–3 weeks of injury. Beyond that window the early fracture haematoma has consolidated, the fragments are harder to mobilise, and the reduction is technically more demanding. Same-week assessment is the right pathway for any displaced distal radius fracture — phone the rooms directly on 07 5493 8038.

How it is performed.

The operation is performed as day surgery, under general anaesthesia (occasionally regional block alone), and takes 60–90 minutes. The standard approach is:

Volar (palmar) incision. A small longitudinal incision is made on the palm side of the wrist, between the flexor carpi radialis tendon and the radial artery. The dissection is taken down to the bone in a tissue plane that protects the median nerve, the radial artery, and the flexor tendons.
Pronator quadratus reflection. The pronator quadratus muscle is reflected off the bone to expose the volar surface of the distal radius.
Reduction. The fracture fragments are manipulated back into anatomical position — restoring radial height, radial inclination, volar tilt, and (critically) the articular surface of the wrist joint. Provisional fixation with fine wires holds the reduction.
Volar locking plate. A low-profile titanium plate is applied to the volar surface of the bone. Locking screws are placed into the distal fragments under fluoroscopic guidance — these screws thread into the plate as well as the bone, creating a fixed-angle construct that supports the subchondral bone of the wrist joint even when the bone quality is poor. This is what makes the modern operation reliable in older patients with osteoporotic bone.
Verification. The reduction and screw lengths are confirmed on intra-operative imaging in multiple planes. No screw should protrude into the wrist joint or the extensor compartments of the wrist.
Closure. The pronator quadratus is repaired over the plate (protecting the flexor tendons), the wound is closed in layers, and a soft splint is applied.

Modern volar locking plates from major implant manufacturers (DePuy Synthes Variable Angle, Acumed Acu-Loc, Stryker VariAx, Medartis Aptus) are all well-validated; Dr Coory selects the plate based on the fracture pattern.

What to expect after surgery.

Day 0–1

Discharge home from day surgery within a few hours of waking.
Soft splint and a sling for comfort. Regional block (if used) covers the first 12–18 hours of pain.
Fingers actively moved from the first afternoon — this prevents the stiff hand that used to be the most common problem after wrist surgery.

Week 1–2

Wound check at the rooms or with the local GP at day 10–14.
Hand therapy commences within the first week — gentle active wrist range of motion, finger work, oedema control, scar massage once the wound is sealed.
Light activities of daily living — eating, dressing, computer work — resume as comfort allows.
Return to non-manual desk work within 1–2 weeks for most patients.

Week 2–6

Splint discontinued at the first or second hand-therapy visit.
Active and active-assisted range of motion progressing under therapy supervision.
Driving resumed at 4–6 weeks once the wrist is comfortable and a safe emergency stop is possible.
Six-week X-rays confirm bony union is progressing.

Week 6–12

Strengthening commences in hand therapy.
Light manual work and household tasks at 6–8 weeks.
Lifting restrictions are progressed by the hand therapist based on functional assessment.

Month 3–12

Return to heavy manual work and impact-loaded sport at 3–4 months in most patients.
Final functional outcome at 9–12 months. Most patients regain near-normal grip and motion; a small loss of the last few degrees of wrist extension or supination is common.

Bone health afterwards.

For patients over 50, particularly women, the wrist fracture is often the first marker of bone fragility. Independent of the surgical decision, every patient in this group should be offered a DEXA scan after the operation and a discussion of bone-protective treatment if indicated. A distal radius fracture in a 60-year-old significantly increases the risk of a hip fracture in the years that follow — the wrist event is a chance to change that trajectory.

Recovery guidance

Your physiotherapist receives specific post-operative instructions on the day of surgery. View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.

Frequently asked questions.

Why a volar locking plate?

The volar approach places the plate on the strong palmar side of the bone, away from the extensor tendons. Locking screws hold the small distal fragments without relying on weak metaphyseal bone — particularly important in older patients. The combination allows reliable fixation and immediate hand-therapy mobilisation.

Does the plate stay in forever?

Yes, in almost every case. Modern titanium plates are low-profile and well-tolerated. Removal is occasionally considered for hardware irritation or tendon issues but is uncommon and is a separate decision well after the fracture has healed.

How long until I can drive?

Typically 4–6 weeks — once the splint is off, the wrist is comfortable, and you can grip firmly enough for an emergency stop.

How long until I can return to work?

Desk work: 1–2 weeks. Light manual work: 6 weeks. Heavy manual work and impact-loaded sport: 3–4 months. The timeline is paced by the hand therapist's strength assessments.

What if my wrist is still stiff at 3 months?

Some residual stiffness at 3 months is normal and responds to ongoing hand therapy. Functional recovery continues for up to 12 months. Persistent significant stiffness or pain at 6 months prompts a focused review — for hardware irritation, regional pain syndrome, or carpal tunnel symptoms — with imaging and a treatment plan.

What are the main risks?

The risks discussed at consent include: median nerve symptoms (usually transient), stiffness (responsive to therapy), tendon irritation (rare with modern plates), hardware failure or loss of reduction (uncommon), infection (less than 1%), and complex regional pain syndrome (rare). The risk profile of ORIF is substantially lower than the disability of leaving a displaced intra-articular fracture to heal in poor position.

References.

Costa ML, Achten J, Plant C, et al. DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. Health Technol Assess. 2015;19(17):1–124.
Costa ML, Achten J, Rangan A, et al. Percutaneous fixation with Kirschner wires versus volar locking-plate fixation in adults with dorsally displaced fracture of distal radius: five-year follow-up of a randomized controlled trial. Bone Joint J. 2019;101-B(8):978–983.
Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018;49(2):211–222.
Lichtman DM, Bindra RR, Boyer MI, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of distal radius fractures. J Bone Joint Surg Am. 2011;93(8):775–778. (Updated 2020.)

Distal radius open reduction and internal fixation (ORIF).