Evaluation of and recovery from impairment after Colles' fracture : A physiotherapeutic approach

Abstract: Colles' fracture is one of the most common fractures and is particularly frequent in middle-aged and elderly women. Following acute surgical interventions and immobilization, many of the patients are referred for physiotherapy; but physiotherapy has not been shown to have a beneficial effect on the rate of functional recovery and on residual impairment. It appears that the available methods forassessing degree of impairment may cause uncertainty concerning physiotherapeutic treatment rationales.The general aims of this dissertational work were to evaluate and refine methods for measuring maximal isometric grip strength and active range of motion (AROM) in the wrist and forearm in order to identify possible specific needs for physiotherapy after immobilization. Hence, methods for measuring grip strength and AROM in the wrist and forearm were developed and the reliability evaluated in clinically healthy subjects and in 33 patients initially immobilized for Colles' fracture. The capacity of the methods to quantitatively and reliably discriminate between impaired and unimpaired grip strength and also AROM was evaluated. Recovery of grip strength and AROM was followed for up to two years after the fracture.The reliability and discriminative capacity of the methods were high, a finding which may support their clinical use. The course of grip strength and AROM recovery varied interindividually and AROM generally recovered faster than grip strength. When handedness was taken into account, neither grip strength nor AROM recovered completely within the two-year follow-up. These findings indicate that after Colles' fracture there is, at least in physiotherapy, a need for well-designed and adequately tested assessment methods upon which rationales for physiotherapy can be based.