Question

Maggie is a 61 year old female referred to home health OT on October 29th with a diagnosis of R Colles fracture. Maggie fell while shopping at her neighborhood department store on October 27th. The physician has ordered OT to evaluate and treat.

Often times the OT will be given the client’s name and diagnosis and little else. The information given above is typical of the information you may be given to start a case. With this information, the therapist can start to think about how the case should be approached.  

The stage of reasoning development should also be considered (novice - expert)

Even though the information given is minimal, there is much that you may already know about the case. Think about what you know already and what you will need to know to effectively manage the case. Consider your developmental stage/experience. You may have learned this information from school and/or from life experiences. To guide your analysis of what you do or do not know, answer the questions below:

• Do you know what a Colles fracture is? (procedural reasoning)

• Do you know what the clinical signs and symptoms of a Colles fracture are? Complicating factors? (procedural reasoning)

• Do you know the medical management for a Colles fracture? Precautions? (procedural reasoning)

• What is the prognosis of recovery post-Colles fracture? (procedural reasoning)

• What might this woman “look like” (client factors/clinical presentation) and be able to do 2 days post-Colles fracture? (procedural reasoning)

• Do you have an image of the capabilities of a 61-year old woman who goes shopping? (narrative reasoning)

• Might this image give you some indication of her prior level of function and roles as well as an idea of her discharge situation and goals? (conditional reasoning)

• Do you know her perception or how the woman feels about this injury? (interactive reasoning)

• Do you know what resources are available? physical, social and financial (pragmatic reasoning)

Answer 1

Let us start with the basics, So when Maggie came to the Home health OT,you need to do initial assessment first. Take her History like -

• Mechanism of injury
• Degree of trauma
• Whether the person is osteoporotic or not.
• Check if there is any loss of function.
• Radiographic features.
• Apart from that,you need to check pulse,Blood pressure etc.
• General history like family,status etc.
• Basic conselling to calm the patient.

Now, coming to the description.

What is Colles fracture?

Colles fracture is the fracture of distal radiusthat may occur as a result of fall on an outstretched hand(FOOSH). It is common in postmenopausal women as they are already prone to osterioporosis. The fracture can be intra or extraarticular. This may also extend to wrist joint.

Symptons-

• Pain
• Swelling
• Bruises
• Deformity(if the fracture is comminuted one)

Clinical assessment - I have already mentioned it above.

Treatment-

The treatment will completely depend on the degree of fracture,age,activity level of patient,surgeon's method of preference and patient's preference. The methods can be immobilization by means of cast or surgical.The recovery may take 6 weeks to months. The patient may need physical therapy to retain movements after recovery. A wrist guard may be helpful post treatment.

Post complications -

• The patient may develop "Carpal tunnel syndrome" post collen fracture i.e. numbness and tickling in hand and arm due to a pinched nerve in wrist which may be post surgical.
• There may be pain,tenderness of fingers.
• malunion or malposition if the bone is not healed in proper alignment.
• Restricted movements