66 years old female patient presented Emergency department with history of fall on an outstretched hand with the wrist in dorsiflexion. She falls by forced he wrist when she slid on floor in the bathroom, she use her hand and outstretched arm to try to break the fall with high energy injury outward. Patient was vitally stable as following (BP:131/80mmhg, HR:79, SPO2:99%, Tem:37 C). Patient with right hand deformity. Pain score was 8 according to numerical rating scale.
Investigation:
X-ray: Shows fracture distal radius with dorsal angulation-Colle, s fracture.
Mechanism of injury
Colles fracture typically occurs when a person falls and uses a pronated hand and outstretched arm to try to break the fall. In this position, the wrist is usually at 40-90° in dorsiflexion. The pressure from the fall over-extends the hand and breaks the radius just above the wrist. When this occurs, the distal part of the bone tends to become dorsally displaced. It is also frequently comminuted, meaning it is broken into multiple pieces.
The clinical presentation of
Colles fracture is frequently described as a
dinner fork deformity – distal fracture of the radius causes posterior displacement of the distal fragment, causing the forearm to be angled posteriorly just proximal to the wrist. With the hand displaying its normal forward arch, the patient’s forearm and hand resemble the curvature of a dinner fork.
(Kenhub ,2021)
Differentiate between the different modalities of care in managing musculoskeletal and soft tissue injuries
| Modalities in managing musculoskeletal |
Modalities in managing soft tissue |
|
1. A cast is holding a broken bone in place as it heals. Also help prevent or decrease muscle contractions, and are effective at providing immobilization, especially after surgery. Casts immobilize the joint above and the joint below the area that is to be kept straight and without motion (University of Rochester Medical Center Rochester,2021)
2. A splint: is a rigid or flexible device that maintains in position a displaced or movable part, also used to keep in place and protect an injured part to support healing and to prevent further damage (Morrison, 2017).
3.Traction: It is practice of slowly and gently pulling on a fractured or dislocated body part. It’s often done using ropes, pulleys, and weights. These tools help apply force to the tissues surrounding the damaged area.
(Morrison, 2017)
|
In the acute stage of an injury PEACE should be applied.
P: protect
E: elevate
A: avoid anti-inflammatories/ice
C: compression
E: educate
In the sub-acute stage LOVE should be used
L: load
O: optimism
V: vascularization
E: exercise
|
Reduction is done usually for a displaced fracture under general anesthesia or interscalene brachial block. A splint or cast is required to hold the forearm in a stable and in immobilized position. In case of displaced intra-articular fractures with palmar dislocation, open reduction and internal fixation are sometimes required. Physiotherapy is advised after fracture healing for better strengthening of muscles and range of movements.
(Kenhub ,2021)
Appropriate interventions and management according to patient’s condition:
- Assess if any: Deformity, tenderness, swelling, bruising, numbness or tingling.
- The six P” s of musculoskeletal assessment.
- Pain: on palpation, movement and constant.
- Pallor: pale skin or poor capillary refill.
- Paresthesia: ’pins and needles’’ sensation.
- Pulses: absent or diminished.
- Rest, immobilization, compression, and elevation.
- Paracetamol inj 1gram
- Xray
- Sedation (Ketamine 5mg inj and propofol 25mg inj.
- Close reduction under sedation
- Above elbow slab applied
- Patient kept under observation for 15 mint, then post reduction after xray done.
H
ome education to the patient.
- Avoid heat, re-injury, massage to prevent blood flow and swelling.
- Getting enough calcium and vitamin D to prevent osteoporosis.
- Wear wrist guards for certain high-risk activities
- Avoid walking on slick surfaces, such as icy sidewalks.
- Always use handrails when using the stairs.
References:
Morrison, W. (2017).
Splints cast and traction in fracture. Retrieved from: https://www.physio -pedia.com/Splint.
Kenhub (2021).
Colles fracture. Retrieved from:
https://www.kenhub.com/en/library/anatomy/colles-fracture
Physiopedia (2021).
Soft Tissue Injuries. Retrieved from: https://www.physio pedia.com/Soft_Tissue_Injuries.
Radiopaedia (2021).
Colles fracture. Retrieved from:
https://radiopaedia.org/articles/colles-fracture
University of Rochester Medical Center Rochester (2021).
CastTypes and Care Instructions. Retrieved from:
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02750.
