1. Colles’ Fractures
Charles Caltagirone

2. Wrist Anatomy
Motions
Boney anatomy
Soft anatomy
Colles fracture site

3. Mechanism
FOOSH
Deformity

4. Immediate Treatment Non- surgical Surgical Bridging external fixation
Non-bridging external fixation
Dorsal plating
Radial column plating
Volar plating

5. Functional Brace Allows for flexion and extension to 0º
Patients more comfortable
Better functional testing

6. 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

7. Phase I (week 1-6) Start with the fingers Radiocarpal
PROM  AAROM  AROM
DIP, PIP, MCP flexion/extension
Radiocarpal
Flexion, extension, supination, pronation, radial deviation, and ulnar deviation

8. Graduating From Phase I
Minimal pain
Minimal to no swelling
ROM almost equal to uninvolved (20% less than uninvolved)

9. 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

10. Phase II Strengthening
Start isometric strengthening of the fingers, wrist, elbow, and shoulder
Theraputty
Against table/wall
Pain free

11. 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

12. Graduating From Phase II
Full pain free range of motion equal to uninvolved
Strength close to the uninvolved side (80% of uninvolved)

13. 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

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

15. Return To Participation
Pain free
Equal strength to uninvolved
Equal ROM to uninvolved
Athlete is confident they can return

16. 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

17. Set Backs To Rehabilitation
Joint contractures
Carpal tunnel syndrome
Tendon irritation
Loss of reduction

18. Discussion Surgery Start simple and work to complex
Patient is self confident to return

19. Literature Biomechanics of the wrist Breaks down healing of bone
Reducing contractures
Different surgeries may allow for slower recovery
Keep protocol flexible

20. Sources
Dekkers, M., Soballe, K. Activities and Impairments in the Early Stage of Rehabilitation After Colles’ Fracture. Disability and rehabilitation. 2004; 26,
Moir, J., Murali, S., Ashcroft, G., Wardlaw, D., Matheson, A. A New Functional Brace For the Treatment of Colles’ Fracture. Injury. 1995; 26,
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,
Starkey, C. Therapeutic Modalities third edition. Philadelphia, PA. F.A. Davis Company. 2004;
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,
Slutsky, D., Herman, M. Rehabilitation of Distal Radius Fracture: A Biomechanical Guide. Hand Clinics. 21: 2005,
Larson, Jeffrey. "Contractures" Gale Encyclopedia of Medicine, 3rd ed Encyclopedia.com. 28 Mar <
Balsky, S., Goldford, R. Rehabilitation Protocol for Undisplaced Colles’ Fracture Following Cast Removal. Journal of Canadian Chiropractor Association. 2000; 44,