Colles Fractures

Charles Caltagirone

Wrist Anatomy

Motions
Boney anatomy
Soft anatomy
Colles fracture site

Mechanism

FOOSH
Deformity

http://www.youtube.com/watch?v=RWJ
K9udZAIM

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 0

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.