Colles FracturesCharles Caltagirone

Wrist AnatomyMotionsBoney anatomySoft anatomyColles fracture site

MechanismFOOSHDeformity

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

Immediate TreatmentNon- surgicalSurgicalBridging external fixationNon-bridging external fixationDorsal platingRadial column platingVolar plating

Functional BraceAllows for flexion and extension to 0Patients more comfortableBetter functional testing

Goals of RehabilitationShort term goalsControl painReduce contracturesReduce inflammationLong term goalsEqual ROMEqual strengthAllow patient to be psychologically ready to return

Phase I (week 1-6)Start with the fingersPROM AAROM AROMDIP, PIP, MCP flexion/extensionRadiocarpal PROM AAROM AROMFlexion, extension, supination, pronation, radial deviation, and ulnar deviation

Graduating From Phase IMinimal painMinimal to no swellingROM almost equal to uninvolved (20% less than uninvolved)

Phase II (week 7-12)Continue with ROM activitiesWrist stretchingJoint mobilizationsStart with grade I and IIGrade III and IVConcave/Convex rules

Phase II StrengtheningStart isometric strengthening of the fingers, wrist, elbow, and shoulderTheraputtyAgainst table/wallPain free

Phase II Strengthening Cont.Theratubing/Therabar strengtheningTheratubing- Light to heavy resistanceFlexion, extension, ulnar deviation, and radial deviationNot just for the wristTherabarSupination and pronation

Graduating From Phase IIFull pain free range of motion equal to uninvolvedStrength close to the uninvolved side (80% of uninvolved)

Phase III (week 13- return to play)Continue to perform wrist stretchesBegin more complex strengtheningFree weightWrist flexion/extension, radial/ulnar deviation, and supination/pronationElbow flexion/extension exercisesShoulder strengthening exercises

Phase III Cont.Work all three jointsD1 and D2 patternsPushup- on stable groundPushup- hands and BAPS boardSport specific activitiesDepend on sport and position in that sport

Return To ParticipationPain freeEqual strength to uninvolvedEqual ROM to uninvolvedAthlete is confident they can return

Cardiovascular TrainingCan begin right away in phase IDepends on sportFITT PrincipleFrequency- 3x per weekIntensity- minimum 60% THRType- treadmill, elliptical, bikeTime - 20 minutes minimum

Set Backs To RehabilitationJoint contracturesCarpal tunnel syndromeTendon irritationLoss of reduction

DiscussionSurgeryStart simple and work to complexPatient is self confident to return

LiteratureBiomechanics of the wristBreaks down healing of boneReducing contracturesDifferent surgeries may allow for slower recoveryKeep 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 .Balsky, S., Goldford, R. Rehabilitation Protocol for Undisplaced Colles Fracture Following Cast Removal. Journal of Canadian Chiropractor Association. 2000; 44, 29-33.

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