- See:
distal radius fracture menu
- Technique of Closed Reduction
- Position of Immobilization:
- discussion:
- 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 fix,
orif)
- 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;
- functional 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 the 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.
-
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.
-
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
