Year Book: The Treatment of Colles' Fracture: Immobilisation With the Wrist
Dorsiflexed. Gupta, A. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 9-12.|Original Article:|J Bone Joint Surg. 1991. 73-B. pp 312-315.. Background.--Colles' fracture is a common injury, for which there is lack of agreement about the best form of treatment. Colles' fracture can usually be reduced easily, but the reduction may be difficult to maintain. A trial involving 204 patients was conducted to compare the results of immobilization in 3 different positions: palmar flexion, neutral, and dorsiflexion. Methods.--The wrists were immobilized in plaster in 1 of the 3 positions, which were assigned randomly. Sixty wrists were immobilized in palmar flexion, 75 in neutral position, and 69 in dorsiflexion. Mean patient age was 46 years. Using manual traction, the distal radial fragment was pressed in a volar direction with dorsal counter pressure applied against the proximal fragment; the assistant moved the wrist into the selected position while the surgeon molded the plaster (Fig 9-8). Plaster was kept on for 5 or 6 weeks. Types I and II fractures were excluded; 46% were type III fractures, 26% were type IV, and 28% were type V. Results.--For type IV and V injuries, loss of dorsal tilt was least in a position of dorsiflexion; these patients usually maintained volar tilt even if they had significant collapse. The 3 positions resulted in almost the same loss of radial angulation, but loss of radial length was greatest in the neutral position and least in a position of dorsiflexion. Position of immobilization made no difference in the anatomical results in type III fractures. Dorsiflexion produced the best functional results, even in type III injuries. Conclusions.--Wrist immobilization in a position of dorsiflexion appears to provide better maintenance of reduction in patients with Colles' fracture. Although collapse is probably unavoidable in grossly comminuted fractures, dorsiflexion appears to minimize it. Further trials are needed to confirm these findings.
Original Text by Clifford R. Wheeless, III, MD.
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