Colles` Fractures
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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.