Case Study: Post-Conservative Rehabilitation of Colles’ Fracture

Clinical Experience (2010–2012)

Presenting Complaint:

A middle-aged patient (exact age not recalled) presented to the physiotherapy department following conservative treatment for a Colles’ fracture of the left wrist. The fracture had been managed with immobilization in a cast, which had recently been removed. The patient reported stiffness, restricted wrist and finger movement, reduced grip strength, and difficulty in performing routine activities such as lifting objects, turning doorknobs, and writing.

History and Background:

The patient sustained the fracture due to a fall on an outstretched hand and was managed non-surgically with a below-elbow cast for approximately 6 weeks. Upon removal of the cast, the patient was referred for physiotherapy to regain wrist mobility and function.

Assessment:

During initial assessment, I conducted the following:

• Observation: Mild swelling and visible atrophy of forearm muscles; healed scar at the dorsal wrist (from cast contact)

• Palpation: Local tenderness around the distal radius; no signs of instability

• Range of Motion (ROM):

o Wrist flexion, extension, radial and ulnar deviation – all restricted

o Forearm pronation/supination – mildly limited

• Grip Strength: Significantly reduced

• Functional Limitation: Difficulty holding utensils, opening bottles, and writing for extended periods

There were no neurovascular deficits. Based on the assessment, the patient was diagnosed as being in the post-immobilization phase of a Colles’ fracture, requiring rehabilitation for stiffness, muscle weakness, and functional restoration.

Treatment Plan:

A focused physiotherapy rehabilitation plan was implemented over multiple sessions, including:

1. Thermotherapy: Moist heat packs applied prior to mobilization to loosen soft tissues and reduce stiffness.

2. Joint Mobilizations:

• Passive and active-assisted wrist mobilization in all planes
• Gentle mobilization of the radioulnar and carpal joints to restore joint play

3. Soft Tissue Techniques: Cross-friction massage around the extensor tendons and scar area to address adhesions and tissue tightness.

4. Stretching Exercises:

• Targeted stretches for wrist flexors, extensors, and finger muscles
• Emphasis on regaining full extension and radial deviation

5. Strengthening Exercises:

• Gradual introduction of isometric and isotonic exercises using a soft ball, putty, and light dumbbells
• Functional strengthening through task-based activities (e.g., squeezing cloth, turning objects)

6. Proprioceptive and Coordination Drills: For fine motor control and wrist stability.

7. Home Exercise Program: Daily wrist mobility and grip strengthening exercises with a compliance log

Outcome Measures:

• Wrist ROM: Improved significantly by the third week, nearing full range

• Grip Strength: Recovered to approximately 80–90% of the unaffected hand

• Functional Recovery: Patient regained ability to perform daily tasks independently, including writing, cooking, and self-care activities

Prognosis:

With consistent attendance and good compliance with the home program, the patient made a full functional recovery. Long-term prognosis was favorable with continued use and strengthening of the wrist.

“This case reinforced the importance of progressive, stage-specific rehabilitation following immobilization. My hands-on interventions and structured approach allowed the patient to transition smoothly from stiffness and weakness to functional independence—a rewarding example of the role physiotherapy plays in fracture recovery.”