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SUMMARY: Colles' fracture is a common type of injury. In order to improve hand, wrist and elbow functions
appropriate rehabilitation program should be applied soon after the orthopedic intervention. In the present
study, physical treatment was given to 55 patients with Colles' fracture. The treatment procedure consisted of
physical exercise and paraffin application. We compared pretreatment and post-treatment degrees of flexion,
extension, radial and ulnar deviation, supination and pronation of the wrist. We achieved satisfactory results
following physical therapy of the wrist. Rehabilitation program is of utmost importance in Colles' fracture so
it should be applied soon after the orthopedic manipulation.
Key Words: Colles' fracture, rehabilitation.

The extension fracture occurring 2 cm below the Flexion fracture of forearm is called as Smith' frac-
radioulnar joint is referred to as Colles' fracture. It is a ture or reverse Colles' fracture, where distal fragment
very common injury, where the styloid of ulna is broken is angulated volary. It is rarely seen. Open and close
in approximately 50% of the patients. The X-ray reduction techniques produce similar results in treat-
roentgenograms reveal fork-back deformity on the lat- ment of Colles' fracture.
Reflex sympathetic dystrophy, lesion of the n. medi-
eral view, whereas the distal part of the joint is laterally
anus and m. abductor pollicis longus, luxation of the
displaced on the dorsal aspect. Pronation and supina-
radioulnar joint are the complications of both types of
tion of the wrist is very restrictive and painful (1,2).
fractures. Epyphysolysis can be observed in young
The conservative treatment consisting of closed
adults and it interferes with bone growth (1,2,4). Reha-
reduction and application of circular cast brace below
bilitation is of spectacular importance in Colles' frac-
elbow to metacarpal joint for a period of 6 weeks gives ture.
promising results. Operative treatment is indicated for The aim of the present study was to evince the
patients with widely displaced fractures or with loss of importance of the early rehabilitation program in
reduction and mobility to reestablish joint congruity by patients with Colles' fracture.
closed treatment. Cast brace of forearm is applied for 6
Our study included 55 outpatients (25 males, 30 females)
* From Department of Physical Therapy and Rehabilitation, Ankara attending to Ankara Numune Hospital with Colles' fracture.
Numune Hospital, Ankara, Türkiye. The mean age for male and female was 39 ± 26 and 37 ± 12

Journal of Islamic Academy of Sciences 7:4, 247-250, 1994 247


respectively. Routine laboratory tests and x-ray roentge- ation and open reduction with internal fixation. How-
nograms were made in all patients. ever, the best therapeutic option still remains contro-
All patients were treated by closed reduction and the
versial. Immobilization of the wrist in Colles' fracture
application of an below dorsal elbow cast immobilizing the
consists of three different ways; immobilization in
wrist in 20° palmar flexion and in 20° ulnar deviation for 6
palmar flexion, neutral position and dorsal flexion.
Physical treatment was applied for all patients 7-8 weeks When the wrist is immobilized in palmar flexion, stiff-
after the Colles' fracture had occurred. All patients were ness seems likely to occur in fingers especially in the
treated with paraffin for 15 minutes and exercise for 15 min- metacarpo-phalangeal joints (5-8).
utes Flexion, extension, radial and ulnar deviation, supination Axial shortening may be the result of Colles' frac-
and pronation of the wrist were recorded before and after the
ture. Warvick et. al. demonstrated a correlation
physical examination.
between shortening of the radius and functions. Lind-

RESULTS strom and Smail found no change in functions after 3

-Flexion of the wrist after physical treatment months (7,9,10).

increased significantly compared to pretreatment Axial shortening in the radius is one of the major

degrees (p<0.001). complications in Colles' fracture. 1-2 mm shortening

-Extension of the wrist after physical treatment usually occurs. Minor relative shortening of the radius

increased significantly compared to pretreatment alternates the axial forces passing through the wrist to

degrees (p<0.001). a marked extent (7,11-13). Shortening of the radius is

-Radial deviation of the wrist after physical therapy the most significant radiographic finding one week after

increased significantly compared to pretreatment the reduction. Bacorn and Kurtzke supported this idea

degrees (p<0.001). and they demonstrated impairment of disc functions of

-Ulnar deviation of the wrist after physical treatment the joint. Involvement of radio-ulnar joints indeed

increased significantly compared to pretreatment results in weakness of grip functions rather than loss of

degrees (p<0.001). range of motion. The greater is the shortness in radius,

-Supination of the wrist after physical treatment the greater is the chance of developing weakness in

increased significantly compared to pretreatment grasping function (12-14). In our study shortening of

degrees (p<0.001). the radius was observed in 18 patients.

-Pronation of the wrist after physical treatment The physical therapy program of the Colles' fracture

increased significantly compared to pretreatment consists of muscle strengthening, recovery of range of

degrees (p<0.001). motion, wound healing and scar adhesion. Early reduc-

When the wrist functions of the patients were com- tion of oedema is of primary importance in determining

pared for sex and age, no correlation was noted hand functions. Elevation of the hand higher than the

between pretreatment and post-treatment values heart and active range of motion exercises were

(p>0.05). Wilcoxon test, Correlation Analysis, Mann- instructed to facilitate the pumping action of hand mus-

Whitney-U test (for sex) and Student's t test (for sex cles to decrease swelling.

and age) have been used for statistical analysis. Flexion and extension movements of the hand 15
minutes for each are rendered. The hand is kept in both
DISCUSSION cold and hot water in order to augment venous return.
Colles' fracture is frequently encountered in clinical Exercises help decrease musculotendinous stiffness
setting. A wide variety of methods have been and joint capsule contractures. The joint should be kept
described, including reduction and immobilization of in neutral position. Heating and paraffin application are
the wrist and forearm in various positions, external fix- also necessary. The hand is wrapped up with paraffin

248 Journal of Islamic Academy of Sciences 7:4, 247-250, 1994


for 20 minutes of treatment. Exercise programs seek 2) Grasp,

strengthening both extrinsic and intrinsic muscle 3) Target occurrency,
groups of the hand (6,15). 4) Activities of daily living.
Scarring or tendon adhesion often complicates Activities of daily living consists of writing, turning
progress in rehabilitation. Deep transverse friction over cards, manipulating small objects, simulated
massage is very useful in improving mobility of the scar eating, stacking checkers, manipulating large light
tissue and increasing range of motion. Exercise pro- objects, manipulating large heavy objects, toileting,
grams are very important in rehabilitation. Exercise dressing, grooming, buttoning, shoe lacing, buckling,
programs consists of passive range of motion, trans- burdening.
verse scar massage, progressive resistive exercise, All patients were treated with a long wrist elbow
massage and active range of motion exercises. Exer- plaster splint. This causes release of swelling and
cise combining shoulder-elbow and thumb range of oedema. Finger exercises begin just following the first
motion should also be included in the program. Treat- day of operation. Long wrist elbow plaster is used for
ment also may include graded active motion, clinics one week after operation (3,21).
and home activities and splinting. Functional status in our study is evaluated accord-
Activities include the 'Wall walking' with the fingers, ing to the wrist range of motions and grasp strength.
bilateral paper ripping, circular 'dusting', simple 'black- There was no correlation between age and functional
board writing' and drawing tasks, various opposition capacity (21).
and pinching exercises. These activities are graded
according to resistance, type of motion and grasp 1. Korkusuz Z : Upper extremity fractures-Colles' and Smith'
strength. Generally rehabilitation programs begin 7-8 Fracture. Orthopedy -Traumatology, Ankara University Medicine
weeks after the injury (6,5,16). Splinting helps develop Faculty, 435:160-161, 1983.
the range of motion. 2. Roumen RMM, Hesp W and Bruglish ED : Unstable Colles'

In our study patients attend to the rehabilitation pro- and Smith' Fracture in elderly patients. Journal of Bone Joint
Surgery, 73B:307, 1991.
gram at 7th week of the injury. Hand stiffness occurs
3. Coney WF and Berger RA : Treatment of complex fractures
commonly after the fracture of distal ulnar extremities,
of the distal radius : Combined use of internal and external fixation
but it is not of great concern (17,18). In our study 16 and atroscopic reduction. Hand Clin, 9:603-612, 1993.
patients had hand stiffness, we eliminated this problem 4. Drefakis EC, Kontakis GM, Steriopoulos, et al : Decreased
with rehabilitation. broad hand ultrasound attenuation of the calcaneus in woman with

Besides resistive exercises, passive range of fragility fracture. Acta Orthop, Scand, 65:305-308, 1994.
5. Gupta A : The treatment of Colles' fracture. The Journal of
motion exercises are given for wrist, elbow and hand to
Bone and Joint Surgery, 79:312-315, 1991.
patients. Physical therapy is followed by occupational
6. Aspenberg P and Kopilov P : Hidroxyapatite spacer for
therapy for 3 weeks (7,12,15). In our study we applied open reduction of Colles' fracture. Scand J Plast Recons Hand
physical and occupational therapy together. Early wrist Surgery, 28:157-159, 1994.
motions provides functional improvement in wrist and 7. Kopilov P, Johnell O, Beagaer, et. al. : Fractures of the
hand functions (2,19). In our study oedema was distal end of the radius in young adults: A thirty year follow up.

reduced with exercise. Journal of Hand Surgery, 18:45-49, 1993.

8. Jakins I, Preterse H and Sweet MBE : External fixation of
Algodistrophy may be seen after Colles' fracture (9)
the intra-articular fractures of the distal radius. J Bone Joint
while in our study it occurred 3 months after the frac-
Surgery, 73:302, 1991.
ture. Evaluation of the hand functions is rendered by 4 9. Warvick D, Field J, Prothera D, et. al. : Function ten years
movements: after Colles' fracture. Clinics Orthopedics and Releated Research,
1) Pinch movement, 295:270-274, 1993.

Journal of Islamic Academy of Sciences 7:4, 247-250, 1994 249


10. Adolpson P, Abbaszadegan H, Jonsson, et. al. : Computer 18. Altissimi M, Mancini GB, Azzara, et. al. : Early and late dis-
assisted prediction of the instability of Colles' fractures. Interna- placement of fractures of the distal radius: The prediction of insta-
tional, Orthopedics, 17:13-15, 1993. bility. Int Orthop, 18:61-65, 1994.
11. Aro HT and Kouvinen T : Minor axial shortening of the 19. Dias J, Wray J, Jones JM, et. al. : The value of early mobi-
radis affects outcome of Colles' fracture treatment. The Journal of lization in the treatment of Colles' fractures. The Journal of Bone
Hand Surgery, 16:392-398, 1991. and Joint Surgery, 69:463-467, 1987.
12. Roysam GS : The distal radio-ulnar joint in Colles' frac- 20. Jarus T and Paremba R : Hand function evaluation: A
ture. The Journal of Bone and Joint Surgery, 75:58-60, 1993. factor analyst study. The American Journal of Occupational Ther-
13. Warren PJ and Ferris BD : Colles' fracture: The use of apy, 47:439-442, 1993.
metacarpal index as a prognostic indicator investigated. JR Coll 21. Trumble T, Schmitt S, Vedder N, et. al. : Factors affecting
Surgery Edinburgh, 38:373-375, 1993. functional outcome of displaced intra-articular distal radius frac-
14. Villar RN, Marsh D, Rushton N, et. al. : Three years of the tures. The Journal of Hand Surgery, 19:325-340, 1994.
Colles' fracture. The Journal of Bone and Joint Surgery, 69:635-
638, 1987.
15. Morey KR and Watson AH : Team approach to treatment
of the posttraumatic stiff hand. Physical Therapy, 66:225-228,
16. Jones LA : The assessment of hand function: A critical
Sükrü Aydog
review of techniques, Journal of Hand Surgery, 14:221-228, 1989. Fiziksel Terapi ve
17. Leibovic SJ and Geissler WB : Treatment of complex intra- Rehabilitasyon Bölümü,
articular distal radius fractures, Orthop Clin North Am, 25:685-706, Numune Hastanesi,
1994. Ankara, TÜRKIYE.

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