Colles fracture, a fracture of distal radius of the forearm, is probably by far the most common type of fracture across all age groups. This injury is usually acquired from falling on an outstretched hand, in which the strength of this long bone is challenged by the force of impact.
Depending on presence of displacement, stability of fractured site, number of fragments, patient’s age and level of tolerance to immobilization, fracture of this kind will need to be treated with POP (plaster of paris) or surgically with internal fixation. Owing to its location (upper limb vs lower limb & vertebrae) and type of the bones, healing of radius is usually fast (in relative term) and complete. Restoration of bone integrity however does not translate into return of full function, as soft tissues including muscles and ligaments are usually penalized during and after the period of immobilization and disuse.
A locally conducted research has investigated the clinical impact of progressive and structured exercise program on functional outcomes of patients following Colles fracture. Among the total sample size of 29, 16 were assigned to experimental group where, in addition to structured advice, patients also received progressive exercises prescribed by physiotherapists at Week 1, 3, and 5 post removal of POP.
Prescribed exercises in experimental group include:
– active movement / mobility exercises for fingers and wrist
– strengthening exercises
– stretching exercises
– loading exercise that promotes bone healing
The primary outcome measure used was questionnaire designed to allow participants to rate the wrist-related activity limitations on the scale of 0-10 and their ability to perform upper limb tasks. Analysis of data between control and experimental groups suggested that in the case of simple Colles fracture managed with POP, prescription of progressive exercises provided no additional benefit to structured advice delivered by physiotherapists. The result of this 2016 study is conflicting to the finding of previous trial where it has demonstrated exercise program provided by physiotherapists has improved patient’s wrist function. However, there is currently no trial that has investigated the advice provided to patients as a manipulated variable, hence we aren’t sure whether it was the instruction to patients that encourages use of hand via practice of daily activities that make up the most of return of functions.
Given to the finding of this study, it’s certainly a delightful news to patients with simple Colles fracture, as it seems that only delivery of structured advice and treatment to reported symptoms are all it requires to obtain satisfactory return of hand function.
Reference:
Bruder, A., Shields, N., Dodd, K., Hau, R., & Taylor, N. (2016): A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture. Journal of Physiotherapy 62 (2016), 145-152