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Colles’ Fractures
Charles Caltagirone
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Wrist Anatomy Motions Boney anatomy Soft anatomy Colles fracture site
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Mechanism FOOSH Deformity
http://www.youtube.com/watch?v=RWJK9udZAIM
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Immediate Treatment Non- surgical Surgical
Bridging external fixation Non-bridging external fixation Dorsal plating Radial column plating Volar plating
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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.
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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
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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
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Graduating From Phase I Minimal pain Minimal to no swelling ROM almost equal to uninvolved (20%
less than uninvolved)
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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
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Phase II Strengthening Start isometric strengthening of the
fingers, wrist, elbow, and shoulder Theraputty Against table/wall
Pain free
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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
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Graduating From Phase II Full pain free range of motion equal to
uninvolved Strength close to the uninvolved side
(80% of uninvolved)
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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
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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
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Return To Participation Pain free Equal strength to uninvolved Equal ROM to uninvolved Athlete is confident they can return
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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
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Set Backs To Rehabilitation Joint contractures Carpal tunnel syndrome Tendon irritation Loss of reduction
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Discussion Surgery Start simple and work to complex Patient is self confident to return
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Literature Biomechanics of the wrist Breaks down healing of bone Reducing contractures Different surgeries may allow for slower
recovery Keep protocol flexible
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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.