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.
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