The most common fracture of the extreme distal of the radius is the one affecting the Colles bone, usually due to a direct fall on the hand in hyperextension.
The 60-70% of cases of people who suffer from this injury are women facing menopause, being a typical condition for an osteoporotic bone.
The same mechanism of the fall usually determines in young people fractures of the scaphoid, in children “green stick” fractures of the radius.
This is a very painful fracture that causes an evident deformity, that is why you will be prescribed medicines (fans or local anaesthetics), so that you can feel some relief.
The standard radiography together with further oblique projections are enough to reach a precise diagnose. Sometimes it is necessary an electromyography to estimate the possibility of associated neurologic injuries.
After a proper therapy with drugs to contain pain, the treatment aims at reducing the fracture through manipulation or surgery and stabilise it.
Residual deformities are common and, during the immobilisation, also the compartmental syndromes due to a too tight plaster. When the plaster is removed, even if the wrist will still be maintained under protection, you can start the rehabilitation to mobilise shoulder, elbow and fingers. After some days you will also start exercising actively the wrist articulation and the forearm muscles.
Despite of a proper therapeutic process, however, the 20-30% of these fractures will result unstable.
Depending on the type of fracture, the location and the shape there are various types of radio and ulna fracture (Colles, smith, burton). The different types of fractures have different surgical or conservative directions but broadly rehabilitation program is the same.
The first goal of the treatment protocol is the recovery of the physiological joint ROM through passive and active mobilization of the shoulder, elbow and fingers first in flexion/extension and pronation/supination progressively. In this phase it is important draining and stress relieving massage therapy for arm and forearm, muscle stretching and the use of analgesic if necessary (laser therapies, ice).
After reaching the full range of motion you can progress to the next phase of the rehabilitation program characterized by reinforcement of the muscles of flexion/extension and pronation/supinaton of the wrist, by manual resistance and progressively with weights and elastic, shoulder stabilizers and by the recovery of the tropism of thenar and hypothenar of the hand. In parallel you will perform exercises to regain control of the hand through proprioceptive exercises and preparation for the resumption of the fine and coarse dexterity and coordination of grasping forceps.
The treatment protocol ends with the last phase on the sports field through sport specific exercises with particular attention to new onset of complications, especially compartment syndromes, residual deformity, stiffness and pain for a gradual recovery and safe return to physical activity.