Colles’ Fractures

Charles Caltagirone

Wrist Anatomy Motions Boney anatomy Soft anatomy Colles fracture site

Mechanism FOOSH Deformity

http://www.youtube.com/watch?v=RWJK9udZAIM

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.