Colles’ fractures, named after Abraham Colles who first described in 1814 the common fracture of the last inch of the radius and ulna near the wrist, is a very common consequence of a fall on the outstretched hand (FOOSH). Typical treatment is immobilisation in a plaster of Paris or similar material for five to six weeks to allow bony union, followed by a rehabilitation period of a month or more, a short period of which might involve a wrist brace for comfort during activity. Due to the functional importance of the hand, the period of immobilisation is kept to a minimum to prevent dysfunction of the hand and wrist.

Once the Plaster of Paris has been removed the physiotherapist will examine the wrist for appropriate healing by firmly palpating the area over the fracture, which should not show much more than mild tenderness. The hand should look a natural colour, have no tightness or swelling in the fingers and muscle wasting should not be severe. Movements of the wrist will be restricted in a few planes but should not be affected in all planes of motion, neither should there be severe pain on movement nor pain on all movements. If many problems are present the physiotherapist will take urgent steps to rehabilitate the patient.

Initial treatment is to instruct the patient in range of motion exercises to be performed every two hours. For many fractures this is all that is required as the movements are easily restored with a few days’ exercises, concentrating on the end ranges of movement. The shoulder and elbow are checked to make sure they are not limited as they may have been injured in the initial incident or kept very still by the patient whilst in plaster. The pronation and supination movements of forearm rotation are functionally very important, and the physiotherapist checks wrist extension and flexion and finger and thumb movements.

Patients often report that the wrist feels at risk after the plaster has been removed and this may be due to the early removal of the plaster to prevent functional loss from immobilisation. A futura brace, a fabric support stiffened with a metal piece under the wrist, is applied with Velcro straps to give support during normal activities of daily living. The brace should be taken off during rests or light activity and for regular performance of the exercises. Too much further immobilisation at this stage could be harmful so patients should understand the limited use of the splint for comfort during activity.

If the ranges of motion do not improve as they should then the physiotherapist will consider using joint mobilisations to ease the movements. Accessory movements can be performed to the inferior radio-ulnar joint to help pronation and supination, and to the radiocarpal (wrist) and midcarpal joints, with the physiotherapist fixing one side of the joint as he or she moves the other side of the joint passively. This can be done gently or more vigorously at the end of range to push against the restrictions within the joint. Mobilisations can also be performed with the joint at the end of its available movement to give it the sliding and gliding movements it requires.

Returning steadily to normal use of the wrist and hand is the easiest and often the most successful way to regain forearm strength. In some cases more must be done to return the hand to normal if it is very weak or the person needs to return to a heavy manual job or has particular upper limb strength requirements for a sport or hobby. Instruction in practicing all the different hand movements against resistance can be accomplished in a hand class, where patients can use equipment designed to strengthen particular movements such as gripping, pulling, twisting, turning and to improve fine hand function.

If the hand is very painful, swollen and restricted in motion then treatment may be urgently directed to preventing a pain syndrome developing, once the fracture has been reviewed by a doctor to make sure healing has progressed as it should. Hot and cold contrast bathing for the hand can be useful for the pain and swelling, with massage and sensory work to reduce the hypersensitivity which can be troublesome. Patients need to be very clear that they need to work hard through the pain in these cases to regain a normal hand.

About ten percent of emergency department visits are the result of ankle injury. Most of these injuries are simple ankle sprains. These injuries are most commonly treated with RICE therapy. Patients are instructed to rest and ice the joint for 20 minutes sessions. Then, the injury is wrapped in compression bandages and elevated. The Jones compression uses alternate layers of elastic bandages and compression bandages. Finally, patients are instructed to elevate the ankle. To reduce pain, ibuprofen is usually provided. Patients who are ibuprofen-intolerant are given acetaminophen instead. This is the common procedure for ankle injuries.

RICE therapy is a short term solution; it does not provide long term care. It simply serves as damage control for the initial injury. Future injury prevention is crucial. Approximately 25% to 40% of ankle sprains are recurrent injuries. When the initial injury receives improper treatment, future ankle damage is likely to lead to either temporary or permanent disability. Osteopathic manipulative treatment, or OMT, is one possible solution to this problem.

This treatment gives each patient the individual care that they require. Treatment varies patient to patient and ankle to ankle. The osteopath is responsible for deciding what treatment each injury calls for. Soft tissue treatments are often prescribed. Ankle injuries can be treated with a variety of soft tissue techniques. The average treatment session usually lasts 10-20 minutes. Studies have proven that OMT sessions lower the pain level and provide patients with an increased range of motion.

There are many soft tissue treatments. The physician studies the bones, from toe to ankle, and decides where most attention should be focused. Osteopaths have many options for ankle treatment. Sometimes muscle energy and strain-counter strain techniques prove useful. In other situations, lymphatic drainage is the main focus of the treatment. Drainage is an important part of the pain reduction process. The majority of ankle injury pain is the result of the fluid that builds up in the joint areas around the bones. This fluid can severely decrease mobility and slow down the recovery process.

Ankle sprains are injuries that require full attention. Physicians try to bring the ankle back to its previous working order. They also work to improve the range of motion and decrease the amount of fluid that has accumulates around the joints. Short OMT sessions work to prevent swelling and reduce the level of pain the patient experiences. Just one osteopathic manipulative treatment can drastically shorten ankle injury recovery time.

Ankle injuries are not to be thought of lightly. Even a slight sprain should receive medical attention. If injuries go untreated, proper healing may never occur, leading to permanent disability. Fortunately, treatment is readily available. RICE (rest, ice, compression, and elevation) therapy and a quick session with an osteopath physician can reduce pain and shorten recovery time. Osteopath therapy also reduces the risk of future ankle injury.