Rehabilitation of Colles Fractures by Physiotherapists

Posted on February 18, 2009 @ 2:25 am
by Jonathan Blood Smyth

Abraham Colles first described the fracture which bears his name in 1814 and it refers to a break of the final inch of the ulna and radius next to the wrist. A FOOSH (fall on the outstretched hand) is a very common injury and Colles’ fracture is a very common consequence. Immobilisation in a Plaster of Paris or similar material for 5-6 weeks is the typical treatment to allow union of the fragments, followed by a rehabilitation period of one to three months. Immobilisation is minimised to prevent serious side effects due to the hand’s functional importance, although a wrist brace can be used for the first week or so to reduce pain during activity.

Physiotherapy examination starts once the hand has been released from the Plaster of Paris, manually feeling the fracture site which should not be more than minimally uncomfortable, signifying the fracture is well on the way to healing. Hand colour should be normal, the hand should not be swollen much nor have severe muscle wasting. Wrist movements are often restricted in one or two planes but all the movements should not normally be reduced or not significantly. Pain may be present but again should not be severe or occur on all hand movements.

Two hourly range of motion exercises are the first treatment taught to the patient by the physiotherapist and in many cases the wrist movements improve sufficiently for this alone to be required. Elbow and shoulder movement should be reviewed to rule out restrictions before moving on to the rotatory forearm movements of pronation and supination which are important for normal hand use. Further movements assessed are flexion and extension of the wrist, fingers and thumb, along with thumb adduction and abduction. Wrist extension and forearm supination are the most commonly affected movements.

Patients often report that the wrist feels at risk after the plaster has been removed and this may be due to the early removal of the plaster to prevent functional loss from immobilisation. A futura brace, a fabric support stiffened with a metal piece under the wrist, is applied with Velcro straps to give support during normal activities of daily living. The brace should be taken off during rests or light activity and for regular performance of the exercises. Too much further immobilisation at this stage could be harmful so patients should understand the limited use of the splint for comfort during activity.

If the ranges of motion do not improve as they should then the physiotherapist will consider using joint mobilisations to ease the movements. Accessory movements can be performed to the inferior radio-ulnar joint to help pronation and supination, and to the radiocarpal (wrist) and midcarpal joints, with the physiotherapist fixing one side of the joint as he or she moves the other side of the joint passively. This can be done gently or more vigorously at the end of range to push against the restrictions within the joint. Mobilisations can also be performed with the joint at the end of its available movement to give it the sliding and gliding movements it requires.

Returning steadily to normal use of the wrist and hand is the easiest and often the most successful way to regain forearm strength. In some cases more must be done to return the hand to normal if it is very weak or the person needs to return to a heavy manual job or has particular upper limb strength requirements for a sport or hobby. Instruction in practicing all the different hand movements against resistance can be accomplished in a hand class, where patients can use equipment designed to strengthen particular movements such as gripping, pulling, twisting, turning and to improve fine hand function.

In some cases a pain syndrome can develop in the hand with tight swelling, poor joint motion, high pain and hypersensitivity, at which time a doctor’s opinion is needed to exclude complications with the fracture such as non-union. Painkillers and contrast bathing are treatments for the pain, with self massage used for swelling and desensitising techniques for the abnormal sensibility. The patient should be clear that they have to go through significant pain to get their hand better again.

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