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Q: My son is 22 years old and had Colle’s fracture, please guide.
A: A Colles Fracture is a complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity (Dinner fork deformity).
Many patients will present to a physiotherapist with pain, oedema, decreased range of motion, decreased strength, and decreased functional abilities. Once a Colles fracture has healed rehabilitation is recommended in an attempt to restore function and strength to the fractured wrist. The primary focus in early rehabilitation is to mobilise the wrist, which is indicated approximately 7-8 weeks post-fracture. If the fracture has been managed using an internal fixation device, early mobilisation can begin as early as 1-week post-surgery. Caution should be paid to fractures that have been treated with external fixation as the wrist is often held in a pronated position. This can predispose the patient to a contracture at the distal radioulnar joint. Other soft tissue injuries that may affect rehabilitation progress include; oedema, cast impingement, infection, osteomyelitis, adherent scar, intrinsic or extrinsic muscle tightness, joint capsular tightness, neurovascular injury, ligament injury, and post-traumatic arthritis.
One of the primary goals in early rehab is to restore normal range of motion (ROM) at the wrist with both passive ROM and progression to active ROM. Wrist flexion and extension are often the first motions emphasised working within the patient's pain-free available range. The addition of ROM exercises helps to limit scar tissue and adhesion formation that commonly occur after surgery. It is also important to emphasise motion at the joints above and below (shoulder, elbow, and fingers) during all phases of rehab. One of the primary focuses in early rehab is to limit the pain and the amount of oedema present in the wrist and hand region.
The next phase of rehab in the treatment of Colles fracture continues to focus on increasing wrist ROM and the commencement of strengthening exercises. For fractures that were surgically treated, ROM should be regained between 6 to 8 weeks post-op. Examples of ROM exercises that can be performed include Wrist flexion/extension, Radial/ulnar deviation, Pronation/supination, Making a fist and opening
In the sub-acute phase, ROM exercises can progress into strengthening by performing all exercises with a weight in the hand or performing grip squeeze with a foam ball or a towel roll. During strengthening, it is important to address all forearm muscles but also the extrinsic and intrinsic hand muscles progressively building resistance as the individual gets stronger. During this phase, progressive stretching can begin to increase available ROM. Each stretch should be held for 30-60 seconds for 3 repetitions. If the patient is unable to tolerate a slow, prolonged stretch, shorter stretches of 10 seconds can be performed for 10 repetitions.
Heat whether in the form of a heat pack or paraffin wax can be very beneficial in the early stages to increase ROM and decrease pain. It is often used with cold therapy to improve venous return. Massage to reduce scar tissue and retrograde massage to reduce swelling are two effective modalities used in rehabilitation post Colles fracture. The benefit is that can also be taught to the patient to continue independently when in their own homes. Cryotherapy is an effective modality for controlling oedema in the acute phase after trauma and during rehabilitation due to its ability in helping to decrease blood flow through vasoconstriction limiting the amount of fluid escaping from capillaries to the interstitial fluid. Cryotherapy can also be combined with compression and elevation in the treatment of oedema.
The use of transcutaneous electrical nerve stimulation (TENS) may be used as an adjunct during any phase of rehab to address pain but can be particularly useful for patients that are increasing the level of activity of the wrist.
Exercise is beneficial in the restoration of range and also vital to strengthen the hand, wrist, elbow and shoulder. Immobility at the wrist has a huge effect on the range of movement and power. Exercises to increase ROM can be as simple as walking the hand up the wall, whereas exercises such as tearing paper, writing and drawing are great for strengthening the wrist and for improving the strength and dexterity of the hand. Being able to use opposition and pinching are vital for improving function and regaining independence in daily life activities.
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