Closed Kinetic Chain Exercise Versus Russian Current Stimulation in Rehabilitation of Colles' Fracture.
Condition: Distal Radius Fracture
MeSH terms: Colles' Fracture; Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      This study compared the effects of closed kinetic chain exercise and Russian current
      stimulation on pain, functional disability, wrist range of motion (ROM) and grip strength in
      patients with colles' fracture. Forty five patients with stable colles' fractures are
      randomly classified into three groups with fifteen patients in each group; Group I received
      traditional exercise in the form of; Mobilization, stretching exercises, range of motion
      exercises (passive and active) and edema control of the wrist joint. Group II stimulated by
      electrical Russian current in addition to traditional exercise. Group III received closed
      kinetic chain exercise (wall press, plyometric wall push up, Quadruped rhythmic
      stabilization, and Push up exercises) plus traditional exercise. All outcome measures
      including Pain, function, Wrist ROM, and grip strength were evaluated before and after the
      treatment program.
    

Detailed description: 
      Material and Methods Patients Forty five patients with stable colles' fractures collected
      from October 6 hospital and elsahel hospital and treated conservatively with closed reduction
      and casting and after removal of plaster cast they involved in the study from January 2013 to
      May 2013. All patients were assigned randomly into three groups by drawing of lots; group I
      (traditional exercise), group II (Russian stimulation) and group III (CKC).

      Exclusion criteria were:

        1. Patient less than 20 years old.

        2. Intraarticular fracture of involved hand.

        3. Any problem affects shoulder /elbow joints of the involved side.

        4. Nerve lesions.

        5. Fracture of ulna.

      Intervention

      Group I received traditional exercise program in the form of;

        1. Mobilization: With patient sitting on high back support chair, gentle traction with
           oscillatory technique (gliding) for thirty seconds were used to increase wrist range of
           motion in all directions with the frequency of two strokes per one second and repeated
           six times during session. For progression ten seconds was added to the frequency of
           mobilization technique each session.

        2. Stretching exercises: Wrist flexors (flexor carpi radialis and flexor carpi ulnaris),
           extensors (extensor carpi radialis longus and brevis and extensor carpi ulnaris), radial
           deviators and ulnar deviators were stretched gently within the limit of pain with
           fifteen to twenty seconds hold at end of creeping movement of contractile and
           noncontractile elements (muscles and tendons). Stretching exercise for all muscles was
           repeated ten times during session.

        3. Passive range of motion: The wrist and fingers were moved slowly, gently and smoothly in
           all directions passively through the available range of motion. Passive range of motion
           was applied for five minutes at beginning and for five minutes at the end of session.

        4. Active range of motion: Patient was asked to perform wrist flexion, extension, radial
           and ulnar deviation as well as fingers flexion, extension and abduction actively as much
           as possible for two sets each set ten repetitions (i.e. twenty repetitions at beginning
           of session and twenty repetitions at end of session).

        5. Edema control: hand was elevated on towel with pressure applied to the volar and dorsum
           of the hand with passive ROM applied by the examiner firstly then patients was asked to
           perform flexion and extension of fingers for fifteen repetitions of fifteen second relax
           for three times.

      Group II received Russian current stimulation in addition to traditional exercise:

      Electrical stimulation was carried out using phyaction 787 device (Manufactured by Uniphy,
      serial number 24823, Netherlands). Two equal sized carbon rubber electrodes were placed on
      common flexor origin (below medial epicondyle of humerus) and the other on distal part of
      flexor carpi radialis and flexor carpi ulnaris, perpendicular to the longitudinal axis of the
      forearm for fifteen minutes time of stimulation. The frequency was 2.5 kHz, with a burst duty
      cycle of 50% and intensity adjusted according to patient tolerant. The burst duration is 10
      milliseconds at 50 Hz.

      Group III received closed kinetic chain exercise plus traditional exercise:

        1. Wall press exercise: The patient stood with feet shoulder-width apart, arms held
           directly out in front of the body at 90º of elevation against the wall. Feet are
           approximately two to three feet (0.6-0.9 meter) away from the wall. The patient pressed
           on the wall with the distal extremity fixed on stable surface and asked to keep pressing
           for thirty seconds.

        2. Plyometric wall push-up exercise: The patient stood away from the wall by about two feet
           with both arms in front of body at approximately 90o. The chest was lowered toward the
           wall until the elbows were bent approximately 45º to 60º. The patient then forcefully
           pushed the wall to return to starting position.

        3. Quadruped rhythmic stabilization exercise: Patient on hands and knees on a table or
           floor with the head and spine kept in neutral position. The examiner instruct the
           patient to hold the body without any movement. Against short, rapid pushing motions from
           side to side, front to back, and along diagonals. The pushing motions progressed from
           submaximal to maximal intensities and from slow to fast. The patient was asked to
           preserve the balance while the exercise maintained for thirty seconds, and each week the
           time increased by five seconds for progression.

        4. Push up exercise: Quadruped on a plinth or on the floor. The patient lowered the body
           into arms until the elbows bent approximately 45º to 60º. The patient then pushed the
           floor to return to the starting position.

      All patients in the three groups were applied the program 3 timed a weak.

      CKC exercises performed ten times and each week two more repetitions added as a progression.

      The aim of this study was explained and informed consent was obtained from all patients.

      Outcome Measures Pain, functional disability, ROM measurements (wrist flexion-extension,
      radial-ulnar deviation), and grip strength of injured hand were used as outcome measures.
      Pre-treatment (baseline) and post- treatment (after six weeks) measurements were recorded.

      Pain and functional disability Patient rated wrist evaluation (PRWE) questionnaire: The PRWE
      questionnaire considered a subjective outcome measure consisting of fifteen questions
      answered on a scale of one to ten. Five questions focus on wrist pain, and ten questions
      focus on function. The patient was asked to describe the pain as well as the function of the
      involved hand on the scale and the answered numbers for pain and function were calculated for
      each one separately for analysis.

      Range of Motion Baseline digital goniometer (Baseline ®, Aurora, IL, USA) for assessment of
      wrist ROM; flexion, extension [14], radial and ulnar deviation [15]. The device displays 0 to
      180 degrees on an LCD screen for viewing readings, and has the ability to freeze angle
      measurements for reference. The goniometer has a durable powder-coated steel or plastic
      exterior with inch/cm marks screened on its arms.

      Grip Strength A Jamar dynamometer for measurement of grip strength in kilograms (Jamar, J.A.
      Preston Co., Michigan, USA) [16,17]. The maximal muscle strength was measured with elbow
      flexion 90°, and wrist placed in neutral position [18].

      Range of motion and grip strength performed for 3 repetitions and the mean of the three
      trials was record.
    

Intervention name(s): traditional exercise; Russian current stimulation; closed kinetic chain exercise
Intervention type(s): Other; Other; Other
Intervention description(s): mobilization stretching exercise; stimulation to wrist flexors for 15 minutes; wall press exercise plyometric exercise
Other intervention name(s): I; II; III
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Colles' Fracture; CKCE; Russian current