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 0 Patients more comfortable Better functional testing

QuickTime an d a decompressor are need ed to see this p icture.

Goals of Rehabilitation

Short term goals

Control pain Reduce contractures Reduce inflammation Equal ROM Equal strength Allow patient to be psychologically ready to return

Long term goals

Phase I (week 1-6)

Start with the fingers

PROM AAROM AROM DIP, PIP, MCP flexion/extension PROM AAROM AROM Flexion, extension, supination, pronation, radial deviation, and ulnar deviation

Radiocarpal

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 Supination and pronation

Therabar

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 Depend on sport and position in that sport

Sport specific activities

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.