Comparison of local anaesthetic techniques in the reduction of Colles' fracture.

A trial comparing the use of Bier's block and the direct infiltration of the fracture site with local anaesthetic was carried out to assess their effectiveness in the reduction of Colles' fracture. This showed Bier's block to be superior in terms of patient acceptability and in ease of reduction. The results of the reduction were also significantly better using the Bier's block, as judged by the measurement of the residual displacement on the X-ray.     

Activities and impairments in the early stage of rehabilitation after Colles' fracture

PURPOSE: The purpose of this study was to investigate problems in performing activities after Colles' fracture, and to correlate activity limitations with impairments in the early stage of rehabilitation. METHOD: Assessments were performed 1 and 5 weeks after removing plaster casts. A client-specific instrument, The Canadian Occupational Performance Measure, and a disease-specific dichotomous scale of 10 activities of daily living were used. Range of motion, grip strength, pain and dexterity were also assessed according to standardized methods. RESULTS: Thirty-three women, aged 51-87 years, with Colles' fracture treated with closed reduction and a plaster cast participated. Highly significant statistical and clinical improvements were found in the capacity, number and performance of activities. Problems were mainly classified as self-care activities at 1 week, and as productivity activities at 5 weeks, while problems in leisure activities were practically the same. However, one-third of the patients were not able to perform all basic activities of daily living at 5 weeks. Improvements in pain frequency, range of motion, grip strength and dexterity did not correlate very well with improvements in performance or the patients' satisfaction with the performance of their activities. CONCLUSIONS: The importance of assessing both impairments and activities in patients with Colles' fracture must be stressed.     

Activities and impairments in the early stage of rehabilitation after Colles' fracture

Purpose:?The purpose of this study was to investigate problems in performing activities after Colles' fracture, and to correlate activity limitations with impairments in the early stage of rehabilitation.

Method:?Assessments were performed 1 and 5 weeks after removing plaster casts. A client-specific instrument, The Canadian Occupational Performance Measure, and a disease-specific dichotomous scale of 10 activities of daily living were used. Range of motion, grip strength, pain and dexterity were also assessed according to standardized methods.

Results:?Thirty-three women, aged 51?–?87 years, with Colles' fracture treated with closed reduction and a plaster cast participated. Highly significant statistical and clinical improvements were found in the capacity, number and performance of activities. Problems were mainly classified as self-care activities at 1 week, and as productivity activities at 5 weeks, while problems in leisure activities were practically the same. However, one-third of the patients were not able to perform all basic activities of daily living at 5 weeks. Improvements in pain frequency, range of motion, grip strength and dexterity did not correlate very well with improvements in performance or the patients' satisfaction with the performance of their activities.

Conclusions:?The importance of assessing both impairments and activities in patients with Colles' fracture must be stressed.     

Evaluation of grip strength measurements after Colles' fracture: a methodological study

Maximal isometric grip strength during short and sustained contractions was registered in 28 females and five males with displaced Colles' fracture involving the distal radio-ulnar joint. After reduction the patients were immobilized with plaster cast or with external fixation. The reliability of the measurements of the uninjured side was high and stable over a two-year follow-up period. The between-occasion reliability of the injured side was lower than that of the uninjured side. At each session the intensity of pain was measured. There was a reduction in pain after two years. The discriminatory ability of the measurements was satisfactory. It is suggested that the measurement methods and the present findings may serve as guidance in physiotherapy for these patients, especially if the uninjured side is used as reference.     

Recovery of isometric grip strength after Colles' fracture: a prospective two-year study

Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients.     

Comparison of two passive mobilizing techniques following Colles' fracture: a multi-element design

SUMMARY. This study compared the outcomes of using two passive mobilizing techniques, passive sustained stretches and oscillations, to treat post-immobilization sequelae of Colles' fractures types I and III. The study used a type of single subject, multi-element design, to enable comparisons of the two techniques in the same subject, when rapid change and limited reversibility was expected and research had to occur concurrently with treatment. Eight female subjects were randomly assigned to predesigned sets of treatment conditions for six consecutive sessions. Each subject had completed the usual 6 weeks of immobilization of their affected arm within 3 days of commencing the study. Results indicate that both passive mobilizing techniques increased the range of wrist extension, but, if pain was present, oscillations were more effective. Consistent with this, sustained stretches were more effective in the absence of pain or later in a series of treatments. Copyright 2000 Harcourt Publishers Ltd.     

Reliability and validity of measurement and associations between disability and behavioural factors in patients with Colles' fracture

The aims of the study were to 1) investigate the test-retest reliability, the internal consistency in instruments that measure behavioural factors and disability as well as to investigate convergent validity between the Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH) and the Patient-Rated Wrist Evaluation (PRWE), in patients with Colles' fracture; and 2) assess the relationship between the behavioural measures and the region-specific measures addressing the patient perceptions of impairment, functional loss, and disability. Two samples (sample 1?=?16; sample 2?=?16) of patients with the fracture immobilised in plaster cast were included. The participants answered the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH), Tampa Scale of Kinesophobia (TSK), Catastrophizing Subscale (CAT) of the Coping Strategies Questionnaire (CSQ), and Self-Efficacy Scale (SES) twice. Test-retest reliability was satisfactory for all instruments. The internal consistency examined with Cronbach's alpha was between 0.68 and 0.97. Because acceptable to good test-retest reliability and internal consistency were demonstrated for the PRWE, DASH, TSK, CAT of the CSQ, and SES, they can be used to detect and monitor fear of movement/(re)injury, catastrophic cognitions, and self-efficacy in patients with radius fracture in the acute and subacute phase. Generally low to moderate correlations were found between behavioural and region-specific measures, indicating that there are two distinct concepts that are not interchangeable.     

Reliability and validity of measurement and associations between disability and behavioural factors in patients with Colles' fracture

The aims of the study were to 1) investigate the test-retest reliability, the internal consistency in instruments that measure behavioural factors and disability as well as to investigate convergent validity between the Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH) and the Patient-Rated Wrist Evaluation (PRWE), in patients with Colles' fracture; and 2) assess the relationship between the behavioural measures and the region-specific measures addressing the patient perceptions of impairment, functional loss, and disability. Two samples (sample 1?=?16; sample 2?=?16) of patients with the fracture immobilised in plaster cast were included. The participants answered the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand Outcome Questionnaire (DASH), Tampa Scale of Kinesophobia (TSK), Catastrophizing Subscale (CAT) of the Coping Strategies Questionnaire (CSQ), and Self-Efficacy Scale (SES) twice. Test-retest reliability was satisfactory for all instruments. The internal consistency examined with Cronbach's alpha was between 0.68 and 0.97. Because acceptable to good test-retest reliability and internal consistency were demonstrated for the PRWE, DASH, TSK, CAT of the CSQ, and SES, they can be used to detect and monitor fear of movement/(re)injury, catastrophic cognitions, and self-efficacy in patients with radius fracture in the acute and subacute phase. Generally low to moderate correlations were found between behavioural and region-specific measures, indicating that there are two distinct concepts that are not interchangeable.     

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?

OBJECTIVE: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks. METHODS: This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block. RESULTS: 72 patients were recruited into the Bier's block group, and 70 into the haematoma block group. Bier's block was less painful to give than the haematoma block (median pain score 2.8 v 5.3; P << 0.001), and fracture manipulation was also less painful in the Bier's block group (median pain score 1.5 v 3.0; P < 0.01). There was no significant difference in overall A&E transit time between the two groups. There was better initial radiological outcome in terms of dorsal angulation in the Bier's block group (-3.6 degrees v 2.1 degrees; P = 0.003). More remanipulations were required in the haematoma block group (17/70 v 4/72; P = 0.003). There was a trend towards decreased pain on administration of the alkalinised haematoma block when compared with non-alkalinised haematoma block, but this did not reach significance. There was no difference in pain score on fracture manipulation. There were no complications in either group. CONCLUSIONS: Bier's block is superior to haematoma block in terms of efficacy, radiological result, and remanipulation rate; transit times are equal, both procedures are practical in the A&E environment, and there were no complications. Bier's block is the anaesthetic management of choice for Colles' fractures requiring manipulation within the A&E department.     

Bone mass of the axial and the appendicular skeleton in women with Colles' fracture: its relation to physical activity

Summary. The aim of this investigation was to elucidate whether Colles' fractures in middle-aged women were indicative of generalized bone loss (osteopenia) and whether bone mass of the axial and the appendicular skeleton was related to the extent of daily physical activity. Thirty-six patients (aged 50–73 years) with previous Colles' fracture were studied. The median time elapse after the injury was 18 months (range 9–20·5 months). Bone mineral content of the 2nd, 3rd, and 4th lumbar vertebrae (lumbar BMC) and both distal forearms (forearm BMC) were determined by dual-photon (¹⁵³Gd) absorptiometry. The physical activity level was graded according to a standard interview and a bicycle ergo meter test. Mean lumbar BMC was reduced by 9% compared to age-matched normal women (P < 0·05), mean forearm BMC was reduced by 5% (NS). Twenty patients showed spinal osteopenia by either conventional radiography or absorptiometry (95% confidence limits 38–72%). The fracture-related bone loss from the forearms was most prominent when the fracture had occurred in the dominant forearm, suggesting that the loss of ‘dominant’ forearm activity per se results in bone loss. No relation between working capacity and forearm BMC was found. However, the working capacity was positively related to lumbar BMC (P < 0·01), even if the common relationship to age was eliminated (P < 0·05). The data suggest that the bone mass of the axial skeleton reflects the extent of daily physical activity. Patients with Colles' fractures represent an easily definable population which might benefit from prophylactic measures against vertebral bone loss and compression fractures. One of these could be physical exercise.     

Recognising and treating Colles' type fractures in emergency care settings.

In this article, the author explains how to identify a Colles' type fracture, explains how to insert a haematoma block, and gives a step by step guide to reducing this type of fracture.     

Simultaneous Colles' and scaphoid fractures: treatment by combined internal and external fixation

The authors present the case of a young woman who sustained ipsilateral scaphoid and Colles' fractures that were treated by a combination of Herbert screw fixation of the scaphoid fracture and external fixation of the colles' fracture. This form of treatment provides optimal conditions for both the early return of wrist function and for the maintenance of the manipulated position.