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Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Adult Distal Radius Frx: Non Operative Treatment

- Discussion: (distal radius fracture menu)
      - technique of closed reduction
      - position of immobilization:
           - generally need to avoid positions of marked palmar flexion & ulnar deviation (Cotton-Loder position);
             - a truly stable fracture will probably be stable in any position once it is reduced;
             - fractures which are stable in only extreme positions, should be considered to be unstable and probably require additional methods
                     of fixation (pins, ex fixorif)
             - natural history of non displaced fracture:
                     - Incidence of Displacement After Nondisplaced Distal Radial Fractures in Adults
      - immobilization w/ wrist dorsiflexed:
             - while most orthopaedists probably immobilize distal radius frxs in slight flexion and pronation, but there is some evidence to suggest that
                     distal radius frx should be immoblized w/ the wrist extended (ref);
             - as noted by Gupta, et al:
                     - position of wrist made no difference w/ regards displacement, in displaced extra-articular frx w/ no comminution;
                     - in comminuted fractures, both extra articular and intra articular, best results occured in frxs treated in dorsiflexion;
                     - results were superior when frxs were treated in dorsiflexion & in contrast palmar flexion was assoc w/ higher rate of frx displacement;
                     - dorsiflexion is also a better position for rehab of the fingers;
           - reference:
                     - The treatment of Colles' fracture. Immobilisation with the wrist dorsiflexed.

      - immobilization w/ forearm supinated:
           - if frx involves ulnar styloid or R-U joint, place upper extremity in long arm posterior splint in mid supination for 3-4 weeks;
                   - supination is normal anatomic position of forearm & reduces subluxation of the ulnar head;
                   - repair of trainagular fibrocartilage is generally not necessary;
           - immobilization of frx w/ forearm in supination offers advantage of holding distal R-U joint in a reduced position and minimizing
                   tendency of BR to cause distal fragment to displace in radial direction;
           - position of supination will reduce deforming force of brachioradialis, while pronation will reduced deforming force of pronator quadratus;
           - finally, its notable that positioning in slight supination will more likely allow the patient to regain supination;
           - its notable that even if there is some loss of pronation, internal rotation of the shoulder will compensate for this;
           - reference:
                   - Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation.

- Brace vs Cast Treatment:
    - references:
          - Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation.
          - Colles' fracture. How should its displacement be measured and how should it be immobilized?
          - Brace treatment of Colles' fracture.
          - [Effects of circumferential rigid wrist orthoses in rehabilitation of patients with radius fracture at typical site].
          - Conservative interventions for treating distal radial fractures in adults.
          - Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial. 
          - Long-term results of conservative treatment of fractures of the distal radius.
          - Conservative interventions for treating distal radial fractures in adults.
          - Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast
          - Comparison between external fixation and cast treatment in the management of distal radius fractures in patients aged 65 years and older.
          - New Clinical Practice Guidelines For Treating Distal Radius Fractures Issued By AAOS
          - AAOS: The Treatment of Distal Radius Fractures Guideline and Evidence Report
          - Circumferential Casting of Distal Radius Fractures.
          - Are Cast Application and Maintenance of Complications a Lost Art?
          - The Effectiveness of Bivalving, Cast Spreading, and Webril Cutting to Reduce Cast Pressure in a Fiberglass Short Arm Cast

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, March 17, 2015 11:26 am

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