Charles Caltagirone

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Motions
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Boney anatomy
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Soft anatomy
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Colles fracture site

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

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Non- surgical
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Surgical
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Bridging external fixation
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Non-bridging external fixation
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Dorsal plating
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Radial column plating
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Volar plating

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Allows for flexion and extension to 0º
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Patients more comfortable
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Better functional testing
QuickTime™ and a
decompressor are needed to see this picture.

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Short term goals
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Control pain
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Reduce contractures
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Reduce inflammation
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Long term goals
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Equal ROM
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Equal strength
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Allow patient to be psychologically ready to return

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Start with the fingers
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PROM
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AAROM
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AROM
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DIP, PIP, MCP flexion/extension
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Radiocarpal
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PROM
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AAROM

AROM
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Flexion, extension, supination, pronation, radial deviation, and ulnar deviation

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Minimal pain
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Minimal to no swelling
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ROM almost equal to uninvolved (20% less than uninvolved)


Continue with ROM activities
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Wrist stretching
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Joint mobilizations
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Start with grade I and II
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Grade III and IV
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Concave/Convex rules

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Start isometric strengthening of the fingers, wrist, elbow, and shoulder
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Theraputty
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Against table/wall
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Pain free

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Theratubing/Therabar strengthening
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Theratubing- Light to heavy resistance
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Flexion, extension, ulnar deviation, and radial deviation
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Not just for the wrist
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Therabar

Supination and pronation


Full pain free range of motion equal to uninvolved

Strength close to the uninvolved side
(80% of uninvolved)


Continue to perform wrist stretches

Begin more complex strengthening

Free weight

Wrist flexion/extension, radial/ulnar deviation, and supination/pronation
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Elbow flexion/extension exercises
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Shoulder strengthening exercises


Work all three joints
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D1 and D2 patterns
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Pushup- on stable ground
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Pushup- hands and BAPS board
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Sport specific activities

Depend on sport and position in that sport


Pain free

Equal strength to uninvolved

Equal ROM to uninvolved

Athlete is confident they can return


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


Joint contractures

Carpal tunnel syndrome

Tendon irritation

Loss of reduction


Surgery

Start simple and work to complex

Patient is self confident to return


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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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.