Introduction, assessment, clinical features, surgical and physiotherapy management of Colle's Fracture post- surgical and conservative :- Akshata Hinge

1. Colle’s Fracture
Akshata Hinge​

2. Agenda
Introduction and definition
Mechanism of injury
Clinical Features
Investigations
Complications
Medical management
PT management
STG and LTG
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3. Definition
Colle’s fracture is a transverse fracture at the corticocancellous
junction in the distal radius often associated with a fracture of
the ulnar styloid process.
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4. Introduction
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• distal radius- biconcave – articulation with prox. Carpal and dist. Ulna
• displacements:- 1. dorsal displacement 2. dorsal tilt/ angulation 3.
impaction (proximal shift) 4. lateral displacement 5. lateral tilt/ angulation
6. supination
• Risk factors:- 1. post menopausal women
2. osteoporotic
3. in activities like line skating and skiing
4. low in Vitamin D intake

5. Mechanism of injury
• FOOSH
• DIRECT BLOW
• RTA
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6. Clinical features
• pain
• swelling
• tenderness- localized
• tip of radial styloid usually higher
• limitation of palmar flexion ROM at wrist
• dinner fork deformity
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7. FRYKMAN CLASSIFICATION
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8. Investigations
• Xray lateral and AP view
• MRI
• CT scan
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9. Radiological features
• A-P and lateral radiographs show
• break in the continuity of the bone
• dorsal displacement and tilt
• lateral displacement and tilt
• impaction
• comminuted fracture fragments
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10. Complications
• malunion
• carpal tunnel syndrome
• DRUJ subluxation
• stiffness of fingers and wrist
• reflex sympathetic dystrophy
• others:- 1. rupture of EPL
2. carpal instability
3. TFCC injury
4. delayed or non union.
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11. Management
• conservative:-
• below elbow cast (4-6 weeks)
• closed reduction under G.A
• position for reduction in
immobilization:-
I. disimpaction
II. palmar flexion
III. ulnar deviation
IV. pronation
• operative/ surgical:-
• Percutaneous ‘K’ wire fixation
• Plates and screws (rarely)
• some comminuted # - external
fixators
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12. Outcome measures
• DASH
• GREEN SCORE
• 0’ BRIAN SCORE
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13. Role of PHYSIOTHERAPIST
• Provide education , guidance and supervision
• intermittent evaluation
• provide functional independence
• restore pre injury status
• mobilise the immobilised joint
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14. PT management
• Post conservative
management
• short term goals
• long term goals
• Post surgical management
• Short term goals
• long term goals
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15. Post surgery management
• short term goals (0 – 4/6 weeks)
 patient education
 to reduce pain
 to restore and prevent cardiovascular complication (0-1 week)
 to initiate bed mobility (0-1 week)
 to prevent bed sore (0-1week)
 to maintain mobility of associated joints and improve strength (0-3 weeks)
 to initiate movement at affected site (0-3 weeks)
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16. Post surgery management
• long term goals (3-8 weeks)
 to restore complete ROM of affected joint (3 to 6 weeks)
 to restore muscle strength and power (3 to 6 weeks)
 to start weight bearing exercise (4-6 weeks)
 to develop muscle endurance (4-6 weeks)
 to start proprioception and plyometric training exc ( 6-8 weeks)
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19. Post conservative management
• short term goals (0- 4/6 weeks)
 patient education (0-1 week)
 to reduce pain (0-1 week)
 to maintain mobility at associated joints and improve strength (2-4 weeks )
 to initiate movement at affected joint (4-6 weeks)
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20. Post conservative management
• long term goals (6-8 weeks)
 to restore complete range of motion (6-8 weeks )
 to restore joint strength and power (6-8 weeks)
 to start weight bearing exercise(8-12 weeks)
 to develop muscle endurance (8- 12 weeks)
 to start proprioception and plyometric exc training (8-12 weeks)
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21. progression
De lorme and watkins
• strength training
• 10 lifts with ½ 10 R.M
• 10 lifts with ¾ 10 R.M
• 10 lifts with 10 R.M
• Thus 30 lifts 4 times
weekly progress 10 RM
once weekly
Oxford technique
• 10 lifts with 10 RM
• ----”----- minus1Lbs
• ----”----- minus 2 lbs
• ----”----- minus 3 lbs
• ----”----- minus 4 lbs
• ----”----- minus 5 lbs
• ----”----- mins 6 lbs
• ----”----- minus 7 lbs
and so on
• thus 100 lifts 5 times
weekly progress 10 RM
daily
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MacQueen
Technique
• 10 lifts with 10 RM
• 10 lifts with 10 RM
• 10 lifts with 10 RM
• 10 lifts with 10 R.M
• 40 lifts 3 times weekly
• progress 10 RM 1-2
weeks

22. THANK YOU