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Colles
Fracture is:
Intraarticular
The mechanism of
injury is a fall onto a
hyperextended,
radially deviated
wrist with the
forearm in pronation.
younger patients high energy
older patients - low
energy / falls
Frykman
classification of
distal radius
fractures
Non Surgical
Surgical
Extra articular
<5 mm radial shortening
dorsal angulation<5 or within20 of
contralateral distal radius
Technique
Under anesthesia
Hand is grasped and
traction is applied in
the length of bone
Distal fragment is
pushed into rightful
place while
manipulating wrist
into flexion, ulnar
deviation, and
pronation
Apply short arm cast
Evaluation
Surgical
fixation
CRPP
External Fixation
ORIF
Indications:
Radiographic findings indicating instability (prereduction radiographs best predictor of
stability) displaced intra-articular fracture
Technique
CRPP (Closed Reduction Percutaneous Pinning)
Kapandji intrafocal technique
Rayhack technique witharthroscopically assisted
reduction
External Fixation
relies onligamentotaxisto
maintain reduction
place radial shaft pins under direct
visualization to avoid injury to
superficial radial nerve
nonspanning ex-fixcan be useful
if large articular fragment
avoid overdistraction(carpal
distraction < 5mm in neutral
position) and excessive volar
flexion and ulnar deviation
limit duration to8 weeks and
perform aggressive OTto maintain
digital ROM
dorsal plating
dorsal plating historically associated withextensor tendon irritation
and rupture
dorsal approach indicated for displaced intra-articular distal radius
fracture with dorsal comminution
Terima kasih
Matur Nuwun
Arigatou Gozaimasu
Motions
Boney anatomy
Soft anatomy
Colles fracture site
Radiocarpal
PROM AAROM AROM
Flexion, extension, supination, pronation, radial
deviation, and ulnar deviation
Minimal pain
Minimal to no swelling
ROM almost equal to uninvolved (20% less
than uninvolved)
Concave/Convex rules
Pain free
Theratubing/Therabar strengthening
Theratubing- Light to heavy resistance
Flexion, extension, ulnar deviation, and radial
deviation
Not just for the wrist
Therabar
Supination and pronation
Free weight
Wrist flexion/extension, radial/ulnar deviation, and
supination/pronation
Elbow flexion/extension exercises
Shoulder strengthening exercises
Pain free
Equal strength to uninvolved
Equal ROM to uninvolved
Athlete is confident they can return
Joint contractures
Carpal tunnel syndrome
Tendon irritation
Loss of reduction