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March 04, 2019 5 min read

Answer a fun quick question about Colles Fracture, learn more about what defines this particular fracture and find some helpful tips on the best hand therapy treatment for Colles.

Answer this Quick Question

What type of displacement will you see in a Colles' fracture on an x-ray?

a) Dorsal
b) Volar
c) Lateral
d) Medial


    Answer: a) Dorsal

    Colles' Fracture Defined

    A Colles' fracture is "a linear transverse fracture of the distal radius approximately 20-35 mm proximal to the articular surface with dorsal angulation of the distal fragment"[1].

    This fracture was first described in 1814 by an Irish surgeon, Abraham Colles, simply by looking at the classical deformity (this was long before X-rays were invented!)

    A Colles' fracture is usually the result of a "FOOSH" (fall onto outstretched hand) and typically the distal fragment is dorsally and radially displaced and the radial-ulnar articulation disturbed. Sometimes the fracture may be comminuted or intra-articular.

    The reason the radius breaks where it does, is that distal metaphysis is relatively weak. This is because the bone cortex is thinner and there is more cancellous bone at the distal metaphysis than at the bone proximal and distal to this. This is especially true for clients with decreased bone density[2] which is why Colles' fractures are commonly seen in older women.  

    It is still the most common fracture across all adult age groups and demographics. Typically if you have a younger client with a Colles' fracture, their mechanism of injury may have been high impact trauma such as a motor vehicle accident, contact sports, or a serious fall (e.g. when skiing or horse riding.) [3]

    When deciding how to manage this fracture, the medical team will consider the fracture pattern (is it comminuted? intra-articular?), degree of displacement (will it result in pain? impaction? loss of ROM?), stability of the fracture (is it likely to change position / get worse before it heals?), as well as the age and physical demands of the client.[4][5] . Closed reduction may be required if there is mild angulation and displacement. However, if there is more significant angulation and deformity, or it is unstable, an ORIF (open reduction internal fixation) may be indicated. 

    Usually, clients heal well with no complications. Unfortunately though, sometimes there may be complications such as malunion (healed in a poor position), persistent translation of the carpus (the entire carpus is displaced radially or ulnarward on the radio-ulnar surface), shortening of radius (often resulting in DRUJ issues and / or ulnar sided pain from positive ulna variance), stiffness of the wrist / forearm, or sometimes CRPS.

       

      Hand Therapy for Colles Fracture

      • Sometimes we see these clients while they are still in their cast. This is usually if they present with pain, swelling and / or stiffness in their fingers (or sometimes elbow and shoulder).

      • More often though, hand therapy starts once the client comes out of his / her cast. They may present to hand therapy with residual pain and oedema, or as to be expected, decreased range of motion, strength, and decreased functional ability having been immobilized for 6 weeks![6] 

      • Our goal as hand therapists is usually to control swelling and reduce pain, increase range of motion and strength, and thereby also improve the client's ability to engage in functional activities of daily living. [6][7] We would usually start with active range of motion exercises, and only progress to passive ROM and strengthening around 8/52 post injury.

      • If our client has had ORIF, we are lucky enough to see them 7-10 days post-op to change their dressings and fabricate a removeable splint instead of a cast, so that they can commence early AROM.[8]  

      Here are my top 3 hand therapy techniques for Colles' Fracture

      1. Heat and massage! Most clients love the soothing relief provided by a heated wheat bag or soak in the wax bath, followed by soft tissue massage. This not only works wonders to reduce swelling and discomfort, but also preps those viscoelastic soft tissues, making them easier to stretch and easier to MOVE! I usually start the session with heat and massage before progressing to AROM exercises.

      2. Exercise in the PAIN FREE RANGE. I can't stress this enough! With hands it is not a case of "go hard or go home". There is nothing to be gained by pushing hard through pain, especially in the early stages of rehab. Overzealous clients or therapists pushing too hard often results in increased swelling and pain, which in turn means reduced ROM and increased stiffness, so it is counter-productive. 

      3. Education and collaboration. If the client understands why you are asking them to do something, understands their injury and rehabilitation expectations, they are much more likely to comply. Your goal setting should be a collaborative process, so that the client is working (both in therapy and at home) towards achieving engagement in occupations that are meaningful to them. You are going to see much better outcomes!

       

      You could also try:

      1. If there is ongoing oedema, try using kinesiotape. Or if their skin is too sensitive, or gets irritated by repeated application / removal of tape, why not try an oedema glove or the Isotoner glove?

      2. Wrist supports. Sometimes clients voice concern about being in a splint / support once the cast has been removed as they "don't want to become weaker". In my experience the opposite is true, especially in the early days post cast removal. A soft support helps the client to feel protected / supported, so they are able to use their hands more for light ADLs. This engagement in functional activity is way more beneficial for their rehab than 3x/day AROM exercises. Here is a link to all the wrist supports or a particular favourite is the Thera-P Wrist Splint Universal. 

      3. Strengthening and proprioception. Try to find something your client loves to do, or wants to get back to doing. Use this as a therapy tool, as well as a goal. Think up bilateral tasks, activities crossing the midline, and those improving automatic positioning of joints in space (balls, slosh pipes, tool use, dance, games). You could also try Jura Putty. 

       

      Suitable supports after cast removal

      My professional favourites for wrist braces are:

      Thera P Wrist Splint


      Thera P Universal


      Jurapene Thumb Wrist Splint

      Juraprene Wrist Thumb Wrap

      These are excellent options to provide light support, compression and comfort. The client feels protected and supported, while the compression helps decrease swelling. Because of this, they are more likely to use their hand functionally, resulting in faster better outcomes. 

      For more support, if engaging in physically demanding tasks such as housework or gardening post cast removal, or during at-risk times (eg out at a party) they may prefer something a little more supportive, such as:

      If they have latex allergy, I would recommend the Latex Free wrist supports (short or long). If they have ulnar sided wrist pain as the result of malunion, you should try the ulnar-carpal wrist support 

      If your client is very slight, or has small wrists, they may be better suited to our paediatric wrist splint  range. 

      Paediatric Wrist Splint Range

      View our full range of wrist supports

      We have an excellent range of wrist supports that may be suitable for your clients after cast removal.

       

       

       

      Colles Fracture References and Links:

      1. Stephen Balsky, Rehabilitation protocol for undisplaced Colles' fractures following cast removal, the journal of the Canadian chiropractic association.
      2. http://www.orthopaedicsone.com/display/MSKMed/Distal+radius+%28Colles%29+fractures
      3. Munk PL, Munk P, Ryan A. Teaching Atlas of Musculoskeletal Imaging. Thieme Medical Pub. (2007) ISBN:1588903729.
      4. Wheeless CR. Wheeless' Textbook of Orthopaedics. Colles Fracture. http://www.wheelessonline.com/ortho/colles_frx
      5. https://en.wikipedia.org/wiki/Colles%27_fracture
      6. Bosch J, Walsh M. Standard of care: Distal upper extremity fractures. The Brigham and Women's Hospital Web site.
      7. http://morphopedics.wikidot.com/physical-therapy-management-of-colles-fracture
      8. Smith D, Henry M. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg. 2005;13:28-36

       

      What are your tips for treating Colles Fracture?

      This blog is a discussion format. We have listed our views above but would love to know what you think, what your comments are or how you best treat Colles Fracture in your practice. Add your comments below in the comments box or feel free to email Alison@handtherapyproducts.com


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