doi: 10.5455/ijtrr.000000179
E-ISSN
2278-0343
Background: The colle's fracture is the most common fracture site in the upper extremity; it causes functional
problems and disabling complications. Treatment of these common fractures and their dysfunctional sequalae
continues to challenge surgeons and therapists. Objective: The purpose of this study was to investigate effect of
Maitland's mobilization versus closed kinetic chain exercises after stable colle's fracture. Method: Thirty patients had
participated in this study. They were assigned randomly into two groups (Group A and Group B) with age ranged from
eighteen to fourty five years old. Group A consisted of 15 patients (15 females) received mitland's mobilization with
therapeutic ultrasound, group B consisted of 15 patients (15 females) received closed kinetic chain exercises with
therapeutic ultrasound for 3 times per week (12) sessions for 4 weeks. Patients were evaluated pre and post
treatment for their pain severity, function of the wrist joint, grip strength, wrist joint's ROM and proprioception at 20
wrist flexion, extension, radial and ulnar deviation. Result: The result revealed that there were significant differences
between both groups regarding the improvement in function, grip strength, range of motion of flexion, extension, radial
and ulnar deviation and there were no significant difference between both groups regarding the improvement in
function, grip strength, and joint position sense. Conclusion: Maitland's mobilization versus closed kinetic chain
exercises after stable colle's fractures no significant difference in improvement in function, grip strength, and joint
position sense, and Maitland's mobilization significantly improve wrist range of motion.
KEY WORDS:
Proprioception.
Photograph
INTRODUCTION
COLLE'S fractures are a very
common extra-articular fracture (1). They occur when a
person falls on the palm of the hand with wrist in 4090of extensions (2). Typical fracture is localized at 1.52.5 cm above wrist. Fractures below this level is
designated as low, while high fractures are situated
more than 4 cm above wrist (3). The management of
distal radial fractures depends on patient factors,
fracture patterns, and stability criteria. Stability criteria
can aid in assessing the risk for secondary fracture
displacement (4). Closed reduction with cast treatment
of all types of distal Radius fractures continues to be
the mainstay of treatment in our country. Intra or Extraarticular malunited fractures have been shown to alter
function and patient satisfaction with the outcome of
treatment (5). This fracture can result in some
complications as persistent pain and loss of motion
accompanied by moderate effusion of the distal radius.
Increased angulation of distal radius can lead to
inability to grasp objects after plaster cast (6).
Impairment in range of motion and strength after distal
radius fractures may lead to difficulty with functional
task (7).
The Goal for rehabilitation after wrist
fractures is to achieve complete and rapid recovery of
ROM, strength (8) and to restore optimal function, which
can be complicated by long-term impairments and
functional deficits that prevail after radial fractures
management (9).
Ultrasound (US) has been a widely used and
accepted adjunct modality for the management of many
musculoskeletal conditions Therapeutic ultrasound is
the use of alternating compression and rarefaction of
sound waves for therapeutic benefit (10). Ultrasound is
tought to enhance blood flow, increase membrane
permeability and alter nerve conduction (11).
Ultrasound (US) has been reported to stimulate a wide
variety of subjective somatosensations in humans (12),
as well as EPs in response to painful ultrasonic stimuli.
Based on those observations and our previous ones
that US can directly stimulate central neurons (13)
Maitlands exercises include application of
pressure and accessory oscillator movements to treat
stiffness. The aim is to restore the motion. This
technique includes 5 levels of grades. According to
Maitlands concept, there will be activation of different
mechanoreceptors (14). One factor that is essential in
normalizing proprioception is to restore joint motion at
the level of innervation, since restored joint motion
improves proprioception (15). One way of restoring joint
motion is mobilization/ manipulation, which is suitable
since it can have an immediate and significantly
beneficial effect on proprioceptive feedback (16) and
result in plastic changes from sensorimotor integration
(17)
. Acute decreases in pain following manipulation may
allow more active participation in exercise and
functional retraining earlier in the rehabilitation process
(18)
. Since soft tissues also are richly innervated with
mechanoceptors, some soft tissues may also be useful
in normalizing proprioception (16).
CKC strengthened the muscle through cocontraction, improved joint congruency, stability and
improved proprioception. Since the progressive
controlled weight bearing is a type of closed kinetic
chain exercise it helps in increasing the bone mineral
density of the fracture site, it decreased the period of
immobilization
because
of
which
secondary
complication like joint stiffness, decreased in muscles
strength are avoided and its promotes the cocontraction of the muscle which help in facilitating the
joint approximation. Thus early rehabilitation of the
fracture is useful in terms of functional range of motion
and abilities of performing activities of daily living
(ADL).The muscles are strengthened through the CKC
exercises then it helps in achieving the early functional
range of motion. Functional range of motion is such
ROM which is necessary to do the normal physical
activities of daily living (19).
It hypothesized that there was no significant
difference between Maitlands mobilization exercise
plus therapeutic ultrasound and closed kinetic chain
exercise plus therapeutic ultrasound on the wrist joint
range of motion, grip strength, proprioception, and
patient-rated wrist evaluation after colle's fracture.
RESULTS
In this study 30 patients (15 female and 15 female)
were assigned randomly into 2 groups; Group A (n=15)
their mean age was 36.13 8.5 years old. Group B
(n=15) their mean age was 36.535.75 years old (Table
1). The results at the end of the treatment program
revealed that Group A that received Maitland's
mobilization with therapeutic ultrasound showed a
greater statistical significant than Group B for ROM as
shown in (Table 2).
Group B
35.4 6.22
t- value
0.249
P value
0.418 (NS)
Table (2): Comparison between the mean values of the variable in the two studied groups after treatment.
t-value
Items
Group A
Group B
P value
-0.868
Function
10.21.923
12.23.492
0.502 NS
-0.185
Grip strength
13.82.049
14.23.114
0.861 NS
Range of motion
2.130
Flexion (degree)
51.224
2.81.303
0.003 Significant
1.672
Extension (degree)
4.81.643
2.91.083
0.016 Significant
2.356
Radial
deviation
2.050.570
1.150.335
0.014 significant
(degree)
2.623
Ulnar
deviation
2.20.758
0.950.325
0.009
(degree)
Significant
Proprioception
-0.981
Flexion
0.2640.276
0.530.379
0.043 NS
-0.265
Extension
0.330.33
0.390.276
0.625 NS
-0.33
Radial deviation
0.1320.180
0.1980.295
0.272 NS
-0.191
Ulnar deviation
0.2660.434
0.3320.408
0.426 NS
DISCUSSION
This study was conducted to investigate the effect
of Maitland's mobilization combined with therapeutic
ultrasound versus closed kinetic chain exercises
combined with therapeutic ultrasound in the
rehabilitation after stable colle's fracture. We had
investigated the effect of Maitland's mobilization on
functional disability, grip strength, wrist ROM, and
proprioception at four target angles; at 20 wrist flexion,
at 20 wrist extension, at 20 wrist radial and ulnar
deviation, and compared the results to those patients
who had received the closed kinetic chain exercises.
We had assessed function in the current study
using the patient- rated wrist evaluation questionnaire.
The Patient-rated Wrist Evaluation (PRWE) was
originally designed for the assessment of colle's
fracture and wrist injuries. Items were limited to 5 pain
questions and 10 function questions to permit a simple
scoring system. For answering each of questions, a 0
(no pain /no difficulty) 10 (worst pain / unable to do)
scale was selected. The reason we've chosen this
questionnaire is that it achieves highest possible patient
acceptance, simplicity in scoring, and responsiveness
to change. The test- retest reliability of the PRWE was
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