Dinner Fork Deformity : Causes , Symptoms & Treatment

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Dinner fork deformity is due to colle’s fracture in which the fracture of the distal radius in forearm with dorsal(posterior) and radial displacmentof the wristand hand.

Dinner fork also called “bayonet” deformity due to the shape of the forearm.

CAUSES

Wrist fracture.
Over stretched hand (common in child)
People who are suffering from osteoporosis
Traumatic accident
Sports man,skiers .skaters and bikers.
Calcium deficincy is not the direct cause but a contributing factor for the deformity.

SYMPTOM

The patient finds difficulty in moving his wrist.
The pain increases when wrist is flexed.
There is swelling of the wrist area.
The area is tender to touch.
Bruising is common as a result of severe impact.
There is numbness in hand. Fingers may become pale.
Patient finds difficulty in gripping anything.

Dinner Fork Deformity

DIAGNOSIS

  1. Dorsal tilt
  2. Radial shortening
  3. Loss of ulnar inclination
  4. Radial angulation of the wrist
  5. Dorsal displacement of the distal fragment

Differential Diagnosis/ Associated Injuries

  • Scapholunate ligament tear
  • Median nerve injury
  • TFCC (triangular fibrocartilage complex) injury, up to 50% when ulnar styloid fx also present
  • Carpal ligament injury: Scapholunate Instability(most common), lunotriquetral ligament
  • Tendon injury, attritional EPL rupture, usually treated with EIP tendon transfer
  • Compartment syndrome
  • Ulnar styloid fracture
  • DRUJ (Distal Radial Ulnar Joint) Instability
  • Galeazzi Fracture: highly associated with distal 1/3 radial shaft fractures

At home

The most important treatment initially is immobilizing your wrist in a splint. You can simply use a magazine wrapped around your wrist to help support it. Elevate your wrist above the level of your heart to prevent further swelling. Putting an ice pack on the injury also helps reduce swelling.

Over-the-counter medications such as acetaminophen and ibuprofen can help relieve pain.

Don’t try to straighten your wrist, and avoid moving it around. Schedule an appointment with your doctor immediately, or go to an urgent care center for medical treatment. Go straight to the emergency room if the pain is severe or if your wrist is numb.

Nonsurgical treatment

If your fracture isn’t serious, your doctor might place your wrist in a lightweight cast or splint and let it heal. They may need to straighten the bone if the fracture is displaced. This procedure, called a reduction, is done before your wrist is put in the cast. In most cases, the cast is taken off after a few weeks.

Surgery

If your wrist is severely fractured, your doctor will recommend surgery to correct it. Your bones will be straightened and held together using pins, a plate and screws, or an external device that holds the pins in place. After surgery, you may need to wear a splint or cast to immobilize your wrist and help with pain relief.

Physical Therapy Management

Many patients will present to a physiotherapist with pain, oedema, decreased range of motion, decreased strength, and decreased functional abilities. Once a Colles’ fracture has healed rehabilitation is recommended in an attempt to restore function and strength to the fractured wrist. The primary focus in early rehabilitation is to mobilise the wrist, which is indicated approximately 7-8 weeks post-fracture. If the fracture has been managed using an internal fixation device, early mobilisation can begin as early as 1-week post-surgery. Caution should be paid to fractures that have been treated with external fixation as the wrist is often held in a pronated position. This can predispose the patient to a contracture at the distal radioulnar joint.Other soft tissue injuries that may affect rehabilitation progress include; oedema, cast impingement, infection, osteomyelitis, adherent scar, intrinsic or extrinsic muscle tightness, joint capsular tightness, neurovascular injury, ligament injury, and post-traumatic arthritis.

Initial Rehabilitation

One of the primary goals in early rehab is to restore normal range of motion (ROM) at the wrist with both passive ROM and progression to active ROM. Wrist flexion and extension are often the first motions emphasised working within the patient's pain-free available range. The addition of ROM exercises helps to limit scar tissue and adhesion formation that commonly occur after surgery. It is also important to emphasise motion at the joints above and below (shoulder, elbow, and fingers) during all phases of rehab. One of the primary focuses in early rehab is to limit the pain and the amount of oedema present in the wrist and hand region.

Sub-Acute Phase

The next phase of rehab in the treatment of Colles’ fracture continues to focus on increasing wrist ROM and the commencement of strengthening exercises. For fractures that were surgically treated, ROM should be regained between 6 to 8 weeks post-op.[31] Examples of ROM exercises that can be performed include:
  • Wrist flexion/extension
  • Radial/ulnar deviation
  • Pronation/supination
Making a fist and opening.
In the sub-acute phase, ROM exercises can progress into strengthening by performing all exercises with a weight in the hand or performing grip squeeze with a foam ball or a towel roll. During strengthening, it is important to address all forearm muscles but also the extrinsic and intrinsic hand muscles progressively building resistance as the individual gets stronger. During this phase, progressive stretching can begin to increase available ROM. Each stretch should be held for 30-60 seconds for 3 repetitions. If the patient is unable to tolerate a slow, prolonged stretch, shorter stretches of 10 seconds can be performed for 10 repetitions.


Modalities

Heat/Paraffin Wax

Heat whether in the form of a heat pack or paraffin wax can be very beneficial in the early stages to increase ROM and decrease pain.It is often used with cold therapy to improve venous return.

Massage

Massage to reduce scar tissue and retrograde massage to reduce swelling are two effective modalities used in rehabilitation post Colles fracture. The benefit is that can also be taught to the patient to continue independently when in their own homes.

Cryotherapy

Cryotherapy is an effective modality for controlling oedema in the acute phase after trauma and during rehabilitation due to its ability in helping to decrease blood flow through vasoconstriction limiting the amount of fluid escaping from capillaries to the interstitial fluid. Cryotherapy can also be combined with compression and elevation in the treatment of oedema.To control pain using cryotherapy, the modality should be applied to the area for 10-15 minutes which can result in pain control up to 2 hours post-application. Precautions for the use of cryotherapy include: over a superficial branch of the nerve, over an open wound, poor sensation or mentation, and very young or very old patients. Contraindications for cryotherapy include; Acute febrile illness, Vasospasm e.g. Raynaud’s disease, Cryoglobinaemia, Cold urticaria.

Electrical Stimulation

The use of transcutaneous electrical nerve stimulation (TENS) may be used as an adjunct during any phase of rehab to address pain but can be particularly useful for patients that are increasing the level of activity of the wrist. Conventional (high-rate) TENS is useful for disrupting the pain cycle through a prolonged treatment session as great as 24 hours a day. Low-rate TENS is another form of electrical stimulation that is successful in diminishing pain by targeting motor or nociceptive A-delta nerves. Low-rate TENS has been reported to be effective in pain control for up to 4-5 hours post-treatment.

The literature is still not conclusive on this topic and the results of one study may contradict or, on the contrary, reinforce the results of another study. Yet there is evidence supporting the beneficial effects of electrical stimulation, especially in combination with physiotherapy exercises.

Exercise

Exercise is beneficial in the restoration of range and also vital to strengthen the hand, wrist, elbow and shoulder. Immobility at the wrist has a huge effect on the range of movement and power. Exercises to increase ROM can be as simple as walking the hand up the wall, whereas exercises such as tearing paper, writing and drawing are great for strengthening the wrist and for improving the strength and dexterity of the hand. Being able to use opposition and pinching are vital for improving function and regaining independence in ADLs. Even simple tasks like buttoning a shirt can be difficult after a Colles fracture.

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