- 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;
- in contrast, fractures which are stable in only extreme positions, should be considered to be
unstable
and probably require additional methods of fixation (
pins,
ex fix ect.)
- 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;
- taken as a whole, 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.
Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation.
The treatment of Colles' fracture. Immobilisation with the wrist dorsiflexed.
Colles' fracture. How should its displacement be measured and how should it be immobilized.
Brace treatment of Colles' fracture.
Forearm fractures in children. Cast treatment with the elbow extended.
