- 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 fix, orif)
- 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? Commentary on an article by Christian J. Zaino, MD, et al.: ’The Effectiveness of Bivalving, Cast Spreading, and Webril Cutting to Reduce Cast Pressure in a Fiberglass Short Arm Cast“.?
- The Effectiveness of Bivalving, Cast Spreading, and Webril Cutting to Reduce Cast Pressure in a Fiberglass Short Arm Cast