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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Multi-techniques approach for functional recovery of both wrists after comminuted fractures of radius and distal ulna in a climber

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  • presenting/speaker Francesco Romagnoli - 360° Rehabilitation, Parma, Italy
  • Davide Caselli - CRIMAS Parma, Parma, Italy
  • Alessandro Lanzoni - NODAIA Unit, Villa Igea Private Hospital, Modena, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSHT19-1292

doi: 10.3205/19ifssh1544, urn:nbn:de:0183-19ifssh15441

Published: February 6, 2020

© 2020 Romagnoli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Clinical issue/s: A 42YO climber fell from 12 meters, getting a severe comminute fracture of the distal radius and ulna of both wrists. After an urgent reduction surgery with external fixator, he underwent a second surgery of volar and dorsal plates/screws stabilization and fixation. After two months he came to our attention with: a full-blown CRPS, ROM impairments at all fingers of both hands (TAM 15° to 120°). The wrists movements did not reach the functional ROM minimum limits, especially in extension (-10°both) and supination (both < 15°). The Patient Related Wrist Hand Evaluation Scores (PRWHE)were high (>65/100) on both wrist, the Grip Strenght was zero. The patient also reported low mood, the total inability to perform basic ADL (Activities of Daily Living) and the need of full assistance.

Clinical reasoning: The concurrence of serious and already structured problems led us to create a therapeutic plan by steps, inserting it into the patient's daily life including detailed program of exercises at home. The treatment started with the recovering of the finger, it proceeded with active motion (Dart Throw Motion, DTM) with propioception exercises and sensitivity retraining, it was completed by progressive strengthening and making of functional splints.

Innovative, analytical or new approach: After an Occupational interview with the patient on his needs and expectations, the adopted holistic approach started with Colditz's CMMS protocol, proceeding with active recruiment of ECRB/L and FCU on a DTM way, propioceptions exercises, custom splint and Sensory and Motor Relearnig. The therapeutic exercises have been adapted to the interests of the patient, allowing him to rehabilitate himself doing significant activities for his life.

Contribution to advancing HT practice: Many different hand therapy techniques, if applied in the correct sequence and completely shaped in the patient's daily life, can quickly lead to consistent results (functional ROM of the fingers and wrists, functional grip strength, PRWHE <10, full autonomy in ADL).