Colles' fracture & physiotherapy management

COLLES' FRACTURE
By Annie Blessie
04-10-2020 ANNIE BLESSIE 1

Introduction
• The Colles' fracture is named after Abraham Colles, an Irish surgeon,
who first described it in 1814 by simply looking at the classical
deformity before the advent of X-rays.
• The fracture originates from a fall on the outstretched hand and is
usually associated with dorsal and radial displacement of the distal
fragment, and disturbance of the radial-ulnar articulation.

Definition :
A Colles' Fracture is a complete fracture of the radius
bone of the forearm close to the wrist resulting in an
upward (posterior) displacement of the radius and
obvious deformity. It is commonly called a “broken
wrist” in spite of the fact that the distal radius is the
location of the fracture, not the carpal bones of the
wrist.

Etiology :
• The Colles' fracture is most commonly caused by a fall, landing on
an outstretched hand with the wrist in dorsiflexion-"FOOSH injury."
• Road traffic accident (RTA)
• Direct blow

Risk factors :
• Osteoporosis.
• Elderly age group.
• Having low muscle mass or poor muscle strength,
or lack agility and have poor balance (these conditions
make you more likely to fall).
• Walking or doing other activities in snow or on ice,
or doing activities that require a lot of forward momentum,
such as in-line skating and skiing.
• Having an inadequate intake of calcium or vitamin D.

Types
Types of fractures include:
• Open fracture: if the bone broke through your skin
• Comminuted fracture: if the bone broke into more than two pieces
• Intra-articular fracture: if the bone broke into your wrist joint
• Extra-articular fracture: if your joint isn’t affected

Clinical features :
• Dinner Fork" Deformity.
• History of fall on an outstretched hand.
• Dorsal wrist pain.
• Swelling of the wrist.
• Increased angulation of the distal radius.
• Inability to grasp object.

FRYKMAN CLASSIFICATION
Gosta Frykman identified many
different forms of Colles fracture
and classified it into eight
different types based on the extra-
or intra-articular nature of
fractures involving the distal ends
of the radius and ulna.

• Type I: transverse metaphyseal fracture
• includes both Colles and Smith fractures as angulation is not a feature
• Type II: type I + ulnar styloid fracture
• Type III: fracture involves the radiocarpal joint
• includes both Barton and reverse Barton fractures
• includes Chauffeur fractures
• Type IV: type III + ulnar styloid fracture
• Type V: transverse fracture involves distal radioulnar joint
• Type VI: type V + ulnar styloid fracture
• Type VII: comminuted fracture with the involvement of both the
radiocarpal and radioulnar joints
• Type VIII: type VII + ulnar styloid fracture

Complications :
• Malunion.
• Persistent translation of the carpus.
• Shortening of radius.
• Stiffness of the wrist and the forearm

Diagnosis
Diagnosis is most often made
upon interpretation of
posteroanterior and lateral views
alone.
(X-ray of a Colles' fracture of the
left wrist accompanied by an ulnar
styloid fracture.)

The classic Colles fracture has the following characteristics;
• Transverse fracture of the radius.
• 2.5 cm (0.98 inches) proximal to the radiocarpal joint.
• dorsal displacement and dorsal angulation, together with the radial tilt.
Other characteristics on plain radiographs may include:
• Radial shortening.
• Loss of ulnar inclination.
• Radial angulation of the wrist.
• Comminution at the fracture site.
• Associated fracture of the ulnar styloid process in more than 60% of cases.

Differential diagnosis/associated injuries
• Scapholunate ligament tear.
• Median nerve injury.
• TFCC (triangular fibrocartilage complex) injury, up to 50% when ulnar styloid fx
also present.
• Carpal ligament injury: Scapholunate Instability(most common), lunotriquetral
ligament.
• Tendon injury, attritional EPL rupture, usually treated with EIP tendon transfer.
• Compartment syndrome.
• Ulnar styloid fracture.
• DRUJ (Distal Radial Ulnar Joint) Instability.
• Galeazzi Fracture: highly associated with distal 1/3 radial shaft fractures.

Outcome measures
• DASH.
• Patient Rated Wrist Evaluation (PRWE).
• Green Score.
• O'Brian Score.

Medical management :
• The treatment will depend on the type of Colle's fracture present,
the age and activity level of the patient.
• Management of a Colle's fracture depends on the severity of the fracture.
An undisplaced fracture may be treated conservatively with a cast alone.
The cast is applied with the distal fragment in palmar flexion and ulnar deviation.
• Surgical options- external fixation, internal fixation, percutaneous pinning,
and bone substitutes.
• A fracture with mild angulation and displacement may require closed reduction.
• Significant angulation and deformity may require an open reduction and
internal fixation or external fixation. The volar forearm splint is best for temporary
immobilisation of forearm, wrist and hand fractures, including Colles fracture.

Physiotherapy management
• Patients will present to a physiotherapist with pain, oedema,
decreased ROM, decreased strength, and decreased functional abilities.
• Once a Colles’ fracture has healed rehabilitation is recommended
in an attempt to restore function and strength to the fractured wrist.
• The primary focus in early rehabilitation is to mobilise the wrist,
which is indicated approximately 7-8 weeks post-fracture.
• If the fracture has been managed using an internal fixation device,
early mobilisation can begin as early as 1-week post-surgery.
• Fractures that have been treated with external fixation as the wrist is
often held in a pronated position. This can predispose the patient to a contracture
at the distal radioulnar joint.

Initial rehabilitation :
• To restore normal range of motion (ROM) at the wrist with both
passive ROM and progression to active ROM.
• Wrist flexion and extension are often the first motions emphasised
working within the patient's pain-free available range.
• It is also important to emphasise motion at the joints above and
below (shoulder, elbow, and fingers) during all phases of rehab.
• To limit the pain and the amount of oedema present in the wrist and
hand region.

Sub acute phase :
The next phase of rehab continues to focus on increasing wrist ROM and the
commencement of strengthening exercises.
For fractures that were surgically treated, ROM should be regained between 6 to 8 weeks
post-op. Examples of ROM exercises that can be performed include:
• Wrist flexion/extension.
• Radial/ulnar deviation.
• Pronation/supination.
• Making a fist and opening.
In the sub-acute phase, ROM exercises can progress into strengthening by performing all
exercises with a weight in the hand or performing grip squeeze with a foam ball or a towel
roll. During this phase, progressive stretching can begin to increase available ROM. Each
stretch should be held for 30-60 seconds for 3 repetitions. If the patient is unable to
tolerate a slow, prolonged stretch, shorter stretches of 10 seconds can be performed for
10 repetitions.

Modalities /Other method:
• Heat/Parrafin wax.
• Massage.
• Cryotherapy.
• Electrical stimulation-TENS
• Exercise-Isometric exercises.
Active ROM exercises.
Intrinsic hand muscle exercises.

Prevention :
• Proper intake of nutritious food.
• Exercise.
• Wrist guard.

Thank you

Colles' fracture & physiotherapy management

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