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The purpose of this study was to compare the functional and radiological result of two different positions of the wrist in a plaster cast following Colles' fracture. For this prospective study, each of 50 patients with type A 2.2, A 3.3, C 1.2 or C 2.2 (AO classification) fractures of the radius was randomly assigned to one of two groups. Both groups were treated in the same way as far as anaesthesia and reduction were concerned. The only difference in treatment lay in the position of fixation in plaster. In group 1 the wrist was immobilized in neutral flexion-extension. In group 2 the wrist was dorsiflexed 20 degrees, while the carpus was pushed in a volar direction by an impression in the plaster cast. At review 2-7 years after the accidents, the two groups were compared with reference to symptoms, range of motion at the wrist, power of first closure and radiographic appearance. In group 1 there were 5 patients with significant disability, compared with only 1 in group 2. A significant difference was found in the range of movement between the two groups for flexion and ulnar abduction (p < 0.01). The loss of power of first clenching (difference between injured and healthy hand) was 6.2 mmHg for group 1 and 3.8 mmHg for group 2 (not significant). The radiographic examination showed significant differences both in sagittal inclination (p < 0.001) and in radial shortening (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

This is a report on the stabilisation of fractures of the distal end of the radius type C2 and C3 and open fractures by external fixator. Between 1982 and 1989 38 patients with 43 fractures were treated. A follow-up was done 8 to 80 months after operation including 35 patients. 14 patients were polytraumatised. Especially in this group of patients, the advantages of this procedure can be seen. This advantages are a small stress for the patient, involving only a short time of assembling of the external fixator besides a high stability of the system. Our results show, as well as the results of the literature, that the external fixator has its place in a differentiated therapeutic concept of intraarticular fractures, open fractures and fractures with a defect of the distal radius.

In this retrospective study, the results of conservative treatment of 406 fractures of the distal radius are analysed and the limitations of conservative therapy indicated. In all, 107 male patients (average age 45 years) and 299 women (average age 65 years) were examined. In only one-third of these cases were both radiographically and clinically. Of the primarily dislocated fractures, 19% healed in the correct anatomical position with satisfactory to good clinical results. Up to now, treatment of fractures of the distal radius with dorsal tilting has been regarded as a form of conservative therapy. Although certain types of fracture, in particular unstable ones, have always been regarded as cases for operative treatment, no attempt has ever been made to define the limits between conservative and operative treatment. Evaluation of the results clearly indicates that the classification according to Frykman, the one most commonly in use, cannot be used as a primary criterion for operative treatment. In the course of a meticulous statistical evaluation, we defined the radiological parameters precisely with reference to shortening, dorsal tilt and instability and drew up a classification to define the primary indications for operation in cases of fracture of the distal radius. Shortening by over 3mm, dorsal tilting by over 10 degrees, presence of a dorsal debris zone, rupture, or osseous avulsion of the radioulnar syndesmosis as a further instability factor show the limits of conservative therapy and are clear indications for operative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

In Colles' fractures of the radius the distal fragment is slanted dorsally and radially, dislocated dorsally and radially and supinated. The radius is shortened. Furthermore a comminution-zone of the dorsal cortex is found. In closed reduction the fracture is unwedged and reduced by recreating the mechanism of trauma in neutral position, rather a light dorsiflection is maintained to check secondary dislocation of the distal fragment and shortening of the radius. The cast should push the carpus slightly palmwards and hold the hand in light ulnar-duction. Immobilization is retained for four to six weeks. Radiologic review is performed 4, 8, 12 and 16 days post reduction so that timely change to a different form of fixation is possible in case of secondary dislocation.

The results of 78 displaced Colles' fractures treated with reduction and below-elbow plaster were investigated. The follow-up varied from 11 to 24 months (phi 14 months). According to the schema of Sarmiento 66.7% of the patients had a very good or good result; 33.3% had a moderate or poor result. Most of the poor results were intraarticular fractures type C (AO). Primarily anatomical reduction leads to the best results. Every further reduction leads to a poor result, as well as to a higher number of Sudeck's disease.

The fundamental differences of general anesthesia and somatic blockade have to be considered. When selecting the method of anesthesia to reduce distal fractures of the radius. Brachial plexus block and local anesthesia within the therapeutic dose of the drug leave vital centers intact and metabolism undisturbed. Somatic blockade can be applied without further investigations when urgency is indicated. If an anesthesiologist is not present, the surgeon can apply the method. Experience reduces the rate of drawbacks.

The question of our study was, if in the case of such a numerous fracture as the distal radius fracture, a different individual treatment would be possible and if the results could be thereby improved. Both can be replied by yes. Of the 200 fractures 157 cases in the plaster cast on the forearm or in the plaster cast on the upper arm in the restored position are healed in bone. Forty three times only the conservative routine treatment has not been enough, that means for about 2 patients a week. These ones need an individual adjusted treatment, care and control, a consumption which can absolutely be required. By distinctive operative treatment it was managed to reduce the number of the secondary deviations of the whole collective to 16%. That mainly was for the benefit of the age group 20-59 years, by the patients over 60 years an operation, indicated by the fracture, is not always possible regarding the above-mentioned reasons. In such a case it is useful to discuss with the patient the problems and the result which can be expected for preventing disappointments.

The article reports on the functional treatment of intra-articular comminuted fractures of the distal end of the radius (Colles' fracture). The results of the method described by Sarmiento, which is based on flexion of the elbow joint by 90 degrees and supination of the forearm, are satisfactory both from the functional and the anatomical points of view.

In Colles fracture good functional results can be achieved by conservative treatment. Surgical procedures should only be performed in rare cases of comminuted fractures.

The early and late complications of fractures of the distal end of the radius are evaluated from the records of 853 cases treated in a private surgical practice. Whilst the morbidity of the 123 fractures in children and adolescents is practically negligible, the incidence of complications in the series of 730 fractures in adults amounts to 28%. The complications in adults are analysed and separated into 8 categories: early dislocations, healing in malposition, compressive neuropathies, reflex dystrophy syndromes, persistent pains, rupture of the extensor pollicis longus tendon, stenosing tenosynovitis, and other complications. The most complications, especially those with a permanent invalidity, are associated with an early instability or a malposition.

Normally, the distal forearm fracture is treated conservatively. The classic conservative therapy mostly obtains good results. Certain fracture-types cannot expect a good result for a long time by the treatment of conservative measures. So, they should be recommended to an operative therapy. In addition to the classical osteosynthesis the external fixator is currently used. The principle of the joint-reconciling fixator can be realized in many ways. Of common use is the small fixator of the AO and also the tube fixator is described in the literature. A real alternative to both treatments is the small extension machine of Wagner. This method has nearly been forgotten in the clinical training. We are talking in a few pages about our experiences and the advantages of that measures.

56 distal radius fractures were followed for a median period of 54 months (31-88 months) following the accident. Conservative treatment (immobilisation in a plaster alone) was compared to percutaneous K-wire fixation. The two groups of patients were matched in regard to type of fracture, age (+/- 5 years) and sex. The functional end result was assessed according to the scoring system of Gartland/Werley, which was modified by Solgaard. The operative treatment modality showed better functional end results, especially for intraarticular fractures, when compared to the conservatively treated fractures.

The results of conservative treatment of fractures of the distal radius in 303 patients over a period of two years are demonstrated. 226 patients could be followed-up. The healing of the fracture was satisfactory in 78%, while the results regarding the various age groups showed considerable differences. Along with the demonstration of the functional and anatomical results in relation to age, sex, and localization the technique of fracture treatment as well as follow-up treatment are discussed.