Effect of Manipulation/Mobilization Techniques on Pain and Range Of Movement in Post Operative Management of Colles Fracture
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2017, Vol 2, Issue 5
Abstract
Since 1814 when Dr. Abraham Colles, defined a distal radial fracture as a low energy, extra-articular fracture to the distal radius in the elderly population several aspects of this ubiquitous fracture have changed 1. Presently,it is neither considered a specific low energy injury nor a exclusive to extra-articular region besides the singularity to elderly population has also drastically waned 2. Current studies point towards an increase in the incidence of distal radius fractures in younger individuals and an overall increase in the incidence also 3,4,5,6. Today it is believed that unsatisfactory results after colles fracture can be avoided with accurate reduction, properly holding the reduction and finally an early mobilization tailored to the specific fracture 7. For this third and final step, the role of physiotherapy can't be overemphasized. In this context Maitland and Mulligan techniques present two different but widely employed manual therapy techniques for treating pain and stiffness 8. The purpose of our study was to evaluate, the results of these 2 techniques separately during post operative management in patients who had undergone surgery for colles fracture. Material and Methods This was a study conducted on 60 patients who had undergone operative management of colles fracture in a tertiary care hospital. The study period extended from december 2015 to january 2017. Clear explanations regarding the study were given to all the patients. Written Informed consent were taken from the patients who agreed to share their treatment records for the study. Subjects who were included in the study were aged between 30-70 years.Side of involvement and gender were recorded. Patients with confirmed radiological diagnosis of colles fracture who were treated surgically with internal fixation only were included in the study. Patient with any other fracture in ipsilateral limb, osteopenia; previous distal radial fracture, wrist injury/deformity, pre existing inflammatory/degenerative joint conditions, sudeck's dystrophy, congenital deformities; stiffness for more than 8 weeks , uncooperative patients and patient with renal and cardiac disease were excluded from the study. Assessment had been done by goniometer for range of motion and the visual analog (VAS) had been used for the assessment of pain. Patients were then divided into two groups with 30 subjects in each groups. Those patients who had been managed by maitland technique were put in Group A and those patients who had been managed with Mulligan technique were added to Group B till the total number of subjects was 30 in each group. The 30 subjects of group A, received hot pack/ moist heat therapy for 15 min. Then maitland mobilization technique (grade 1 and grade 2) for first 10 sessions and (grade 3 and grade 4) for the next 10 sessions.For wrist flexion: the patient starting position was with the forearm supine in the middle of the plinth with elbow flexed to 90 degrees. The therapist used to stand on the affected side of the patient just beyond the flexed elbow. The medial border of the patient's hand was grasped by the same side hand of the therapist .The thumb was placed against the dorsum of the patients metacarpals. The fingers were placed by the palm of the patient's hand. The opposite hand of the therapist stabilized the forearm of the patient midway just proximal to the wrist joint. Then the therapist's thumb flexes the patient's wrist and hand to the limit of its range ; followed by the therapist's finger returning the patient's wrist to its starting position. The return movements were controlled by placing the index finger near the patient's MCP joint. Similarly the extension exercises were carried out. The group B patients received treatment with Mulligan mobilization with moist heat therapy as follows. The 30 subjects received hot pack/ moist heat therapy for 15 min. Then mulligan mobilization is given for 20 treatment sessions Patient position:Supine.
Authors and Affiliations
Dr. Saswat Samant
Keywords
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