Colles’ fracture

Colles’ fracture is a fracture of the distal end of the radius due to fall onto an outstretched hand. Typically, it is defined as one that occurs within 2.5 cm of the distal end of the radius, with associated dorsal angulation. It is a common fracture predominantly seen in the older population.

Treatment modalities include surgical correction or plaster cast application, and following this a period of rehabilitation is required. This is where physical therapy plays an important role.

Physical therapy modalities and input

Typically, physical therapy treatment is started around 7 – 8 weeks following the injury. Patients are subject to a variety of different treatment measures, and these can include muscle toning, strengthening, range of motion, wound healing, scar reduction, and pain/healing related modalities.

1. R.I.C.E
This treatment involves Rest, Ice pack application, Compression and Elevation. This treatment is usually offered immediately after the injury to reduce edema and allow for healing. This may be accompanied by hand exercises when the arm is elevated to reduce the swelling.

2. Therapeutic exercises
A variety of exercises are prescribed by physical therapists in managing patients post-Colles’ fracture surgery. This includes range of motion exercises (ROM), massage therapy, transverse scar massage treatment, and even resistance exercises.

Exercise programs are aimed at improving the strength of the forearm muscles and the intrinsic muscles of the hand. Exercises may include blackboard writing, drawing and pinching, to name a few. More complex exercises that improve grasp strength and improve the range of motion of the wrist and elbow will also be advised.

3. Balance therapy
Falls form a significant health problem in elderly population groups and often occur due to a variety of different reasons, sometimes many of them together. Correcting this by physical therapy aimed at improving balance is a key strategy in the rehabilitation of patients. Patients who fall will no doubt lose their confidence about walking independently due to the fear of falling again. By providing a steady physical therapy plan, patients can regain their confidence and independence. Of course, on some occasions, occupational therapists may need to get involved, especially with regards to making arrangements for walking aids at home. More recently, Tai Chi has emerged as an excellent treatment to maintain balance.

4. Electrical stimulation
Electrical stimulation of the muscle groups using TENS or neuromuscular stimulation is useful in pain management, with evidence suggesting it can control pain up to 5 hours following surgical treatment, and functional electrical stimulation to assist in edema reduction and muscle toning.

5. Massage therapy

This involves gently massaging the edematous area to reduce the edema and pain. Studies have shown this to be a useful treatment when used in conjunction with ROM exercises.

Conclusion
Physical therapy forms an is also beneficial at getting patients back on their feet and independent.

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