Beruflich Dokumente
Kultur Dokumente
Charles Caltagirone
Wrist Anatomy
Mechanism
FOOSH Deformity
http://www.youtube.com/watch?v=RWJ K9udZAIM
Immediate Treatment
Bridging external fixation Non-bridging external fixation Dorsal plating Radial column plating Volar plating
Functional Brace
Allows for flexion and extension to 0 Patients more comfortable Better functional testing
Goals of Rehabilitation
Control pain Reduce contractures Reduce inflammation Equal ROM Equal strength Allow patient to be psychologically ready to return
PROM AAROM AROM DIP, PIP, MCP flexion/extension PROM AAROM AROM Flexion, extension, supination, pronation, radial deviation, and ulnar deviation
Radiocarpal
Minimal pain Minimal to no swelling ROM almost equal to uninvolved (20% less than uninvolved)
Concave/Convex rules
Phase II Strengthening
Pain free
Theratubing/Therabar strengthening
Flexion, extension, ulnar deviation, and radial deviation Not just for the wrist Supination and pronation
Therabar
Full pain free range of motion equal to uninvolved Strength close to the uninvolved side (80% of uninvolved)
Free weight
Wrist flexion/extension, radial/ulnar deviation, and supination/pronation Elbow flexion/extension exercises Shoulder strengthening exercises
D1 and D2 patterns Pushup- on stable ground Pushup- hands and BAPS board Depend on sport and position in that sport
Return To Participation
Pain free Equal strength to uninvolved Equal ROM to uninvolved Athlete is confident they can return
Cardiovascular Training
Frequency- 3x per week Intensity- minimum 60% THR Type- treadmill, elliptical, bike Time - 20 minutes minimum
Discussion
Surgery Start simple and work to complex Patient is self confident to return
Literature
Biomechanics of the wrist Breaks down healing of bone Reducing contractures Different surgeries may allow for slower recovery Keep protocol flexible
Sources
Dekkers, M., Soballe, K. Activities and Impairments in the Early Stage of Rehabilitation After Colles Fracture. Disability and rehabilitation. 2004; 26, 662-668. Moir, J., Murali, S., Ashcroft, G., Wardlaw, D., Matheson, A. A New Functional Brace For the Treatment of Colles Fracture. Injury. 1995; 26, 587-593.
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, 182-186.
Starkey, C. Therapeutic Modalities third edition. Philadelphia, PA. F.A. Davis Company. 2004; 204-264.
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, 1568-1577. Slutsky, D., Herman, M. Rehabilitation of Distal Radius Fracture: A Biomechanical Guide. Hand Clinics. 21: 2005, 455-468. Larson, Jeffrey. "Contractures" Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 28 Mar. 2011 <http://www.encyclopedia.com>. Balsky, S., Goldford, R. Rehabilitation Protocol for Undisplaced Colles Fracture Following Cast Removal. Journal of Canadian Chiropractor Association. 2000; 44, 29-33.