Transcript Colles` Fractures

Colles’ Fractures
Charles Caltagirone
Wrist Anatomy




Motions
Boney anatomy
Soft anatomy
Colles fracture site
Mechanism



FOOSH
Deformity
http://www.youtube.com/watch?v=RWJ
K9udZAIM
Immediate Treatment


Non- surgical
Surgical





Bridging external fixation
Non-bridging external fixation
Dorsal plating
Radial column plating
Volar plating
Functional Brace



Allows for flexion and extension to 0º
Patients more comfortable
Better functional testing
QuickTime™ and a
decompressor
are needed to see this picture.
Goals of Rehabilitation

Short term goals




Control pain
Reduce contractures
Reduce inflammation
Long term goals



Equal ROM
Equal strength
Allow patient to be psychologically ready to return
Phase I (week 1-6)

Start with the fingers



PROM  AAROM  AROM
DIP, PIP, MCP flexion/extension
Radiocarpal


PROM  AAROM  AROM
Flexion, extension, supination, pronation,
radial deviation, and ulnar deviation
Graduating From Phase I



Minimal pain
Minimal to no swelling
ROM almost equal to uninvolved (20%
less than uninvolved)
Phase II (week 7-12)



Continue with ROM activities
Wrist stretching
Joint mobilizations



Start with grade I and II
Grade III and IV
Concave/Convex rules
Phase II Strengthening

Start isometric strengthening of the
fingers, wrist, elbow, and shoulder



Theraputty
Against table/wall
Pain free
Phase II Strengthening Cont.

Theratubing/Therabar strengthening

Theratubing- Light to heavy resistance



Flexion, extension, ulnar deviation, and radial
deviation
Not just for the wrist
Therabar

Supination and pronation
Graduating From Phase II


Full pain free range of motion equal to
uninvolved
Strength close to the uninvolved side
(80% of uninvolved)
Phase III (week 13- return to
play)


Continue to perform wrist stretches
Begin more complex strengthening

Free weight



Wrist flexion/extension, radial/ulnar deviation,
and supination/pronation
Elbow flexion/extension exercises
Shoulder strengthening exercises
Phase III Cont.

Work all three joints




D1 and D2 patterns
Pushup- on stable ground
Pushup- hands and BAPS board
Sport specific activities

Depend on sport and position in that sport
Return To Participation




Pain free
Equal strength to uninvolved
Equal ROM to uninvolved
Athlete is confident they can return
Cardiovascular Training



Can begin right away in phase I
Depends on sport
FITT Principle




Frequency- 3x per week
Intensity- minimum 60% THR
Type- treadmill, elliptical, bike
Time - 20 minutes minimum
Set Backs To Rehabilitation




Joint contractures
Carpal tunnel syndrome
Tendon irritation
Loss of reduction
Discussion



Surgery
Start simple and work to complex
Patient is self confident to return
Literature





Biomechanics of the wrist
Breaks down healing of bone
Reducing contractures
Different surgeries may allow for slower
recovery
Keep protocol flexible
Sources

Dekkers, M., Soballe, K. Activities and Impairments in the Early Stage of Rehabilitation After Colles’
Fracture. Disability and rehabilitation. 2004; 26, 662-668.
Moir, J., Murali, S., Ashcroft, G., Wardlaw, D., Matheson, A. A New Functional Brace For the Treatment of
Colles’ Fracture. Injury. 1995; 26, 587-593.

Colles, A. On the Fracture of the Carpal Extremity of the Radius. The Edinburgh Medical
and Surgical Journal: Exhibiting a Concise View of the Most Important Discoveries in
Medicine, Surgery, and Pharmacy. 1814; 10, 182-186.

Starkey, C. Therapeutic Modalities third edition. Philadelphia, PA. F.A. Davis Company. 2004; 204-264.

Wei, D., Raizman, N., Bottino, C., Jobin, C., Strauch, R., Rosenwasser, M. Unstable Distal Radial
Fractures Treated with External Fixation, a Radial Column Plate, or a Volar Plate. The Journal of
Bone and Joint Surgery.2009; 91, 1568-1577.
Slutsky, D., Herman, M. Rehabilitation of Distal Radius Fracture: A Biomechanical Guide. Hand
Clinics. 21: 2005, 455-468.
Larson, Jeffrey. "Contractures" Gale Encyclopedia of Medicine, 3rd ed.. 2006.
Encyclopedia.com. 28 Mar. 2011 <http://www.encyclopedia.com>.
Balsky, S., Goldford, R. Rehabilitation Protocol for Undisplaced Colles’ Fracture Following Cast
Removal. Journal of Canadian Chiropractor Association. 2000; 44, 29-33.


