I don’t know about you, but the turbulence of the last two years has played havoc with my routines and friendships. Returning to normal has highlighted how disjointed we as a community have become, especially as the return to work and life in general has been so stop-start and fragmented.
It was with this in mind that I turned to MHT’s HR guru and long-time associate Narelle Herring to help with a reconnection workshop for our fabulous staff. It was great fun and a terrific way to re-establish work bonds, friendships, procedures and to reinforce MHT’s core values which are steeped in patient-centred care.
This month I would like to congratulate one of our amazing staff members, James Carson, for smashing the State swimming championships of Special Olympics Victoria.
James, who is autistic and intellectually disabled, earned five medals out of five events. The championships came on the back of a tough triathlon series where James won five medals as part of a triathlon training group for intellectually disabled athletes. We are so proud of you, James.
This month’s in-depth clinical piece is on distal radius fractures, probably one of the more common fractures we see at MHT. The article is from our amazing physiotherapist Terri Stanley-Clarke who has been with MHT since 2019 and has a special interest and expertise in fracture management. It will tell you all you need to know about how it happens – surprisingly easily – and how it is best treated and managed.
And finally, one of my oldest friends and the first therapist to join me after I launched MHT, Colleen Moloney, has volunteered for this month’ Fast Five. Read about Colleen and what she does when she’s not caring for patients.
Have a good month.
The aim of the workshop was to reconnect as members of the MHT family and to reaffirm our purpose and goals as a practice.
After all that we as a community have been through during the past two years, Narelle talked to the MHT team about the important of acknowledging the upheaval in the world, our work and within our teams. She said that accepting and understanding these changes would help us move forward and re-establish workplace connections, contributions and a fresh post-pandemic culture.
As a team, we used the workshop to return “to basics” and revisit our core values of “Collaborative Care” and treating the whole person, of “Going Beyond” and doing those extra steps for patients and our overarching commitment to excellence and access to our team of experts.
After two years of destabilisation, it is easy to understand how employees have suffered from burnout and have lost connection with their work friends and the business purpose.
AT MHT, our patients will always come first, and we will continue to work as a team to ensure that never changes – pandemic or no pandemic.
James, 19, made the most of World Autism Day 2022 on April 2 at the Victorian swimming championships for Special Olympics, coming away with five medals out of five races.
Superfish James finished the meet with three gold medals for the 100m freestyle, 50m backstroke and the 50m freestyle relay and two silver medals for the 100m backstroke and 50m freestyle.
As well as his love of being in the water, James loves precision, order and routine and he works hard to support our patients by helping provide many of the therapeutic tools we use. For example, James helps provide the putty we use for improving hand strength and range by weighing it and placing it into containers. He also helps create our balance pipes by cleaning, measuring and precisely taping them for patient use.
MHT director and senior clinician, Jennifer Mathias, said she was proud to employ somebody like James who would struggle to find mainstream employment.
“James is awesome,” she said. “He has brilliant attention to detail.
“I have been lucky to work alongside James when he has helped me with administration work that needs to be done to keep the business going. “I got to know his music preferences as we both sung along while doing our tasks.
“And he was not shy to tell me that I am a “horrible singer”!
“It is an absolute privilege having him on board. He is reliable and never complains with the tasks I send his way. And he swims really really fast.” James is also a successful triathlete and competing in up to six triathlons a year as part of a triathlon training club for intellectually disabled athletes.
Fractures are broken bones. There are many different types of fractures seen in both children and adults. Childhood fractures are usually less complex and heal quicker than adult fractures. Fractures are usually caused by a trauma to the bone.
Distal Radius fractures fall under three different classifications:
Under the first classification, a Colle’s fracture makes up 90 per cent of all Distal Radius fractures. It is known as a bending fracture. These occur when the patient falls forwards and plants their outstretched hand in front of them. As the patient’s body falls, the transfer of load onto the wrist forces it into supination where it faces forwards or upwards.
The strength and quality of the bone, whether it’s osteopenic – weaker than normal – also plays a significant part.
These fractures can occur during:
Another type of extra articular fracture is a Smith’s fracture. This is a reverse of the Colle’s fracture, where there is volar angulation of the distal fragment. This commonly occurs when the patient falls backwards and plants the outstretched hand behind the body, causing a forced pronation type of injury where the palm faces backwards or downwards.
The signs and symptoms of a distal radius fracture vary depending on the severity and mechanism of the actual injury. It can present with localised pain without oedema (swelling) or deformity, or with a deformity, swelling, and bruising.
Depending on the severity of the fracture and the age of the patient, surgery might be required.
The surgery involves reduction of the fracture and then fixation of the fracture. The most commonly used fixation implants are plates. There are different variations of plates used in surgery and including volar locking plates, low-profile fragment-specific fixation plates, bridging plates, external fixators, and K-wires.
If surgery is not needed, then conservative treatment can be used and includes reduction of the fracture (generally by a doctor in a hospital emergency department) together with a cast or splint to immobilise the wrist for four to six weeks.
Although it is necessary, there are downsides to immobilisation and some negative aspects to using a cast or splint, particularly regarding its effect on soft tissue and bone. Downsides include loss of bone mass, length of muscle, muscle atrophy, ligament weakness, and changes in proprioception (which refers to your ability to sense the position and movement of your wrist).
It’s very important to balance the goal of supporting the joint through splinting to protect the healing fracture with the possible negative effects of immobilisation. To mitigate against the negative aspects associated with splinting, it is highly recommended that controlled protected movement is commenced as soon as it is deemed safe to do so.
Once the fracture is deemed stable enough, hand therapy can commence to help regain movement, strength and wrist functionality. Commencement of therapy largely depends on whether the patient has undergone surgery or not.
Rehab is split into different stages based on the degree of tissue healing. Initially – in both surgically and conservatively treated fractures – tendon gliding exercises are very important. In these exercises, patients are asked to continue to move and glide their fingers. This motion has been shown to reduce stiffness, tendon adhesion formation and also reduce swelling.
Patients who have undergone surgery and have had the facture fixed with a plate can still commence early movement due to the stability the plate provides to the break. There are recent studies to show that patients had better short-term outcomes – less than six months post-surgery – with a volar locking plate and grip strength if mobilisation with exercises is started within two weeks of surgery compared with those that started mobilisation after five weeks.
If the fracture is conservatively managed, formal exercise therapy can commence after the patient’s injury has been immobilised either in a cast or splint and deemed stable.
The initial focus is on restoring the movement in the wrist via active wrist exercises and to begin weaning off the support. These exercises will progress to proprioception, strengthening, stretching and occupational based movements.
The proprioception retaining is often overlooked in distal radius fractures and can often be impaired due to of immobilisation, pain, stiffness, or loss of feedback to the wrist ligaments which may have also been injured alongside the fracture. Some of these exercises involve multidirectional movements/stability or controlling the wrist with perturbations.
Splinting/casting provides external support to the vulnerable fracture in the initial stages of healing. It does that by restricting compressive, rotation and loads/forces at the fracture site.
Casting and splinting are both used in the treatment of distal radius fractures. They each have varying advantages and their use depends on the stability of the fracture and the patient. A thermoplastic splint is custom-made and re-mouldable to allow for changes in swelling and comfort.
A thermoplastic splint is also less likely to cause pressure or skin breakdown. It and can be used after surgery where there has been internal fixation with plates and screws. It also can be used for stable fractures in certain patients as deemed by the medical team. Casting can involve plaster of paris or fibreglass. Fibreglass has the advantage of being waterproof and is used for conservatively treated Distal Radius fractures.
Colleen might be one of MHT’s most experienced occupational therapists, especially when it comes to hand trauma, but did you know she is a secret fan of period drama?! Let’s throw the mike over to Colleen.
What football team do you support and why?
I don't have a footy team, (editor’s note: really????) however I love watching others get so much joy from the footy over the Melbourne winter. My elderly mum is a one-eyed Collingwood supporter.
What are you reading at the moment?
The Prodigal Sister. It’s a novel set in the early 1900s in Melbourne and involves a strong woman in a male dominated world. I think I picked it up because I loved the cover!
What is your guilty streaming pleasure?
That’s easy: Bridgerton, The White Queen, The Cook of Castamar – pretty much any period drama that I can find.
What do you do to relax?
I love reformer Pilates. Let's face it, there aren't too many classes at the gym you can do lying down!!!
What was your first job?
My first job as a therapist was at The Alfred working in acute burns and trauma. It was my pathway into hand therapy, and I absolutely loved it.