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Background: Presently used Colles' fracture treatments have similar outcomes with significant complications. Previous studies of a dynamic functional fracture brace, achieving similar or better results had no significant complications. A novel brace design is described to achieve optimal patient outcomes., Methods: Patient forearm measurements combined with data from a previously tested brace provided parameters for a brace formed using computer assisted design. Fracture swelling was simulated using a 40 ml (ml) plastic water filled bag placed over the dorsum of the lower radius. The interface pressure between the brace, skin and bag were measured on twelve human volunteers, four with forearm measurements to fit each of small, medium and large brace sizes. Measurements were taken at intervals reducing volume of fluid in the bag by 10 ml until empty, first wearing a brace, and then with a Colles plaster of Paris cast., Findings: The brace produced interface pressures over the lower radius in the range of 62.5-90 (mm Hg) and when the bag was completely empty the pressure range was 43-83 mmHg. The initial interface pressures in the Colles casts were in the range of 15-18 mm of Mercury (mm Hg) and when 10 mls were removed from the plastic bag the interface pressure dropped immediately to almost zero., Interpretation: The brace measurements show pressures higher than a Colles cast which compensate for reduction of simulated swelling. It is safe and is potentially the optimal design to achieve significantly improved patient outcomes., Competing Interests: Declaration of competing interest At the time of the Study, the patents for this device were owned by NHS Grampian. Ownership of the patents have now been passed to the Douglas Wardlaw who now owns a patent for the brace covering the UK only., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: This study compared traditional rehabilitation as a treatment modality after plaster cast treatment of Colles' fracture with a combination of individualized blood flow restriction (BFR) and traditional rehabilitation., Methods: Twenty-eight participants were randomized into a BFR group and a non-BFR group after plaster cast treatment of Colles' fracture. The BFR group completed traditional rehabilitation with a medical grade tourniquet applied to the upper arm, and the non-BFR group underwent traditional rehabilitation only. Patients were followed up with radiographic outcomes (palmar tilt and radial inclination) to ensure the stability of the fracture. Clinical assessment of patient-rated wrist evaluation (PRWE) score, grip strength, pinch strength, wrist range of motion (ROM), and muscle stiffness was conducted at cast removal and 6 wk after cast removal. Two-way repeated-measures ANOVA determined significant interactions between time and group in the aforementioned variables. An independent-sample t -test assessed the differences in baseline variables and radiographic outcomes., Results: Significant interactions between time and group were noted for PRWE score ( F = 11.796, P = 0.002, η2p = 0.339), grip strength ( F = 5.445, P = 0.029, η2p = 0.191), and wrist ROM (ulnar deviation; F = 7.856, P = 0.010, η2p = 0.255). No significant interactions between time and group were found in measurements of pinch strength or wrist ROM (flexion, extension, radial deviation, pronation, supination). An independent-sample t -test showed no significant difference in baseline variables and radiographic outcomes between the groups before or after intervention., Conclusions: This study found that combining individualized BFR with traditional rehabilitation resulted in greater increases in PRWE score, grip strength, and wrist ROM (ulnar deviation) than traditional rehabilitation alone. Therefore, adding individualized BFR to traditional rehabilitation might be a better option for treatment for similar patients., (Copyright © 2023 by the American College of Sports Medicine.)

The present study aimed to evaluate the yearly number of Colles' fractures in Italy from 2001 to 2016, based on official information found in hospitalization records. A secondary aim was to estimate the average length of hospitalization for patients with a Colles' fracture. A tertiary aim was to investigate the distribution of the procedures generally performed for Colles' fractures' treatment in Italy. An analysis of the National Hospital Discharge records (SDO) maintained at the Italian Ministry of Health, concerning the 15 years of our study (from 2001 to 2016) was performed. Data are anonymous and include the patient's age, sex, domicile, length of hospital stays (days), primary diagnoses and primary procedures. From 2001 to 2016, 120,932 procedures for Colles' fracture were performed in Italy, which represented an incidence of 14.8 procedures for every 100,000 adult Italian inhabitants. The main number of surgeries was found in the 65-69- and 70-74-year age groups. In the present study, we review the epidemiology of Colles' fractures in the Italian population, the burden of the disease on the national health care system (in terms of length of hospitalization) and the distribution of the main surgical procedures performed for the treatment of the disease.

Fractures of the wrist are common in Emergency Departments, where some patients are treated with a procedure called Manipulation under Anaesthesia. In some cases, this procedure is unsuccessful and patients need to revisit the hospital where they undergo surgery to treat the fracture. This work describes a geometric semi-automatic image analysis algorithm to analyse and compare the x-rays of healthy controls and patients with dorsally displaced wrist fractures (Colles' fractures) who were treated with Manipulation under Anaesthesia. A series of 161 posterior-anterior radiographs from healthy controls and patients with Colles' fractures were acquired and analysed. The patients' group was further subdivided according to the outcome of the procedure (successful/unsuccessful) and pre- or post-intervention creating five groups in total (healthy, pre-successful, pre-unsuccessful, post-successful, post-unsuccessful). The semi-automatic analysis consisted of manual location of three landmarks (finger, lunate and radial styloid) and automatic processing to generate 32 geometric and texture measurements, which may be related to conditions such as osteoporosis and swelling of the wrist. Statistical differences were found between patients and controls, as well as between pre- and post-intervention, but not between the procedures. The most distinct measurements were those of texture. Although the study includes a relatively low number of cases and measurements, the statistical differences are encouraging., Competing Interests: The authors have declared that no competing interests exist.

Background and Aims: It still remains controversial how often the once-accepted radiological alignment of an AO type-C distal radius fracture deteriorates after conservative treatment, and to what extent this deterioration is perhaps associated with patient-rated outcome measures (PROms). Thus, we aimed to evaluate this radiological deterioration and its association with mid-term functional follow-up., Patients and Methods: We retrospectively reviewed 66 patients (mean age at fracture 53 years, SD 14.1, range 18-73, female 65%) with 68 C-type distal radius fractures at a mean of 6.7 years (SD 0.5 years, range 5.8-7.7 years) after primary closed reduction and cast immobilization. Radiographs of the wrists were taken and analysed for any radial shortening, dorsal tilt or step-off at the joint surface. Range of motion and grip strength were measured. In addition to the radiological result, primary outcome measures included Quick Disabilities of the Arm, Shoulder and Hand (QDash) and Patient-Rated Wrist Evaluation (PRWE)., Results: At mid-term follow-up, an acceptable anatomical radiological result was seen in only 22 wrists (32%). Deterioration of the once-achieved and accepted primary alignment was seen in a majority of cases (68%). Radial shortening of ≥ 2 mm was found in 34 wrists (51%, mean 4 mm, range 2-8 mm), with no association with QDash (12.8 vs. 5.5, p = 0.22) or PRWE (9.1 vs. 5.7, p = 0.40). Only four patients (6%) showed step-off at the joint surface (mean 1.1 mm, range 0.5-2 mm). Twenty-two wrists (32%) showed dorsal tilt of ≥ 10° (five with volar tilt of 15°-25°), with no effect on QDash or PRWE (14.7 vs. 6.5, p = 0.241 and 10.1 vs. 5.8, p = 0.226). Altogether, patients with dorsal tilt, step-off or shortening did not show significantly worse QDash (10.3 vs. 5.7, p = 0.213) or PRWE (8.1 vs. 5.1, p = 0.126) versus those with none. Twenty-nine (43%) of the patients had deficits in range of motion (ROM), either in extension (39%), flexion (43%), supination (16%) or pronation (4%), or combinations of these. Worse extension was associated with worse QDash (15.9 vs. 5.0, p = 0.037), flexion deficit with worse PRWE (11.5 vs. 4.4, p = 0.005) and supination deficit with both QDash (21.7 vs. 6.8, p = 0.025) and PRWE (18.9 vs. 5.2, p = 0.007)., Conclusions: The initially accepted radiological alignment of AO type-C radius fractures deteriorated in a majority of cases during conservative treatment. However, this deterioration was fairly mild and showed no significant association with functional outcome. Restricted ROM showed some association with PROms., Level of Evidence: IV.

Background: Colles' type fractures of the distal radius are one of the most commonly manipulated fractures in the ED. Local audit data suggest that a high proportion of these injuries undergo subsequent surgical fixation. If widespread, this could represent a potential burden on patients and the NHS worthy of further research. The aims of this study were to estimate the rate of surgical fixation of Colles' type distal radial fractures after ED fracture manipulation and explore variations in their management in UK EDs., Methods: We conducted a multicentre observational study in 16 EDs in the UK from 4 February 2019 to 31 March 2019. All adult patients with a Colles' fracture who underwent fracture manipulation in the ED were included. Patients who could not be followed up and those with volar displaced fractures were excluded. We measured the rate of wrist fracture surgery at 6 weeks, patient demographics and variations in anaesthetic technique used., Results: During the study period, 328 adult patients attended the participating EDs with a distal radial fracture. Of these, 83 patients underwent fracture manipulation in the ED and were eligible for the study. Their mean age (SD) was 65.3 (17.0) years, 84.3% were female and the most common method of anaesthesia used was haematoma block (38.6%). 34 (41.0%, 95 % CI 30.3 to 52.3) patients had subsequent surgical fixation of their fracture. Younger age was associated with higher rates of surgical fixation but ED anaesthetic technique did not affect the subsequent need for surgery in this sample., Conclusion: Subsequent surgical fixation was carried out in 41% of patients who underwent manipulation of Colles' type wrist fractures in this cohort. This merits further research and represents a potential target to rationalise repeat procedures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Dorsal displaced distal radius fracture (Colles' fracture) is very common and could occur from fragility in middle-aged and elderly people. Many Colles' fractures are still treated conservatively in clinics without hospitalization. Internal fixation using a palmar locking plate has been the standard treatment, but some complications have been reported. The aim of this study was to analyze changes in radiographic parameters over time in patients with conservatively treated Colles' fractures, and to establish whether the type of fracture influenced these changes. Prospective data collected included patient characteristics and radiological findings. The study was conducted at two private clinics and included 60 patients (13 men and 47 women; mean age, 72.5 years old; range, 55 to 96 years old) with a Colles' fracture (types of injury: intramedullary [n = 15], anatomical [n = 39], extramedullary [n = 2], and unknown [n = 4]) who were treated conservatively with manipulation and cast immobilization. Conservative, non-surgical treatment with manipulation was performed first, then, cast immobilization continued for 4 weeks. Loss of correction between the time of reduction and the final observation was defined by the following radiographic measurements: palmar tilt, radial inclination, and ulnar variance. The average final follow up period was 4.6 months (1.5-12 months). Immediately after reduction, 11 intramedullary fractures, 42 anatomical fractures and 7 extramedullary fractures were confirmed. Correction loss according to ulnar variance was significantly greater (P = 0.012) during the final observation for patients with an intramedullary injury at reduction than that for patients with extramedullary and anatomical injuries at reduction. We found that the correction loss for ulnar variance from immediately after reduction until the final observation was significantly greater in the intramedullary group, suggesting that an alternative to conservative treatment may be beneficial for patients with intramedullary fractures.

Distal forearm fractures are a common presentation in UK emergency departments (EDs). However, despite the frequency of this presentation there is considerable variation in management, which may reflect the lack of definitive evidence to support one method. This article provides a narrative review of the literature on these injuries and provides an evidence-based approach to how they can be managed by ED clinicians. The review was prompted by a case-based critical reflection and Driscoll's ( 2007 ) model what, so what, now what, is used to structure the article and learning., Competing Interests: None declared, (©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Objective: To analyze the clinical efficacy of over-elbow small splint fixation for the treatment of comminuted Colles fractures., Methods: From October 2013 to October 2015, 52 patients with comminuted Colles fracture were divided into two groups (the traditional splint fixation group and the over-elbow small splint fixation group) according to the treatment strategy. There were 26 patients in the over-elbow small splint fixation group including 7 males and 19 females with an average age of (64.615±11.475) years old ranging from 38 to 85 years old, and 26 patients in the traditional splint fixation group including 9 males and 17 females with an average age of (65.269±13.162) years old ranging 36 to 91 years old, respectively. In the over-elbow small splint fixation group, 3 cases were type A3 fractures, 9 cases were type C1, 7 cases were type C2 and 7 cases were type C3;in the traditional splint fixation group, 4 cases were type A3, 8 cases were type C1, 9 cases were type C2 and 5 cases were type C3. After manipulative reduction, the fractures in traditional splint fixation group were fixed with traditional small splint, and the fractures in over-elbow small splint fixation group were added with over-elbow right angle splint for the first three weeks, then continued fixing like the control group until clinical cicatrization. All patients in both groups were regularly taken X-ray examination and changed dressings to obtain the clinical healing. Patients were guided to do functional exercise after splints were taken off. The therapeutic effects were evaluated according to modified Green and O'Brein score system after 8 weeks' functional exercise., Results: All patients got clinical healing without severe complications in both groups. The shortened length of radius in traditional splint fixation group was more than that in over-elbow small splint fixation group (5.923±1.978) mm VS (2.962±1.248) mm( P <0.05). There was no significant difference in radial incline between two groups. There was a higher wrist score in over-elbow small splint fixation group compared with traditional splint fixation group 89.615±11.482 vs 80.385±13.485( P <0.05)., Conclusions: Over-elbow small splint fixation is better than traditional splint fixation for the treatment of comminuted Colles fracture because of reliable clinical result and excellent wrist functional recovery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To investigate the effect of U-shaped gypsum functional fixation after closed manipulative reduction for treatment of Colles' fractures., Methods: From January 2011 to April 2014,47 cases of Colles fracture were treated by closed reduction and U-shaped gypsum functional fixation including 12 males and 35 females with an average age of 54.8 years old ranging from 8 to 72 years old. The time from injury to treatment was 40 min to 3 d. The patients were closed fractures without neurovascular injury. After manual reduction and U-shaped gypsum functional fixation, the thumb of injury hand were traction by contralateral hand, and other fingers of injury hand were taken flexion to exercise grip function. According to the situation of fracture healing, plaster was removed at 4 to 8 weeks' fixation, the wrist joint functional exercise was strengthened after plaster removed., Results: All patients were followed up from 6 to 12 months with an average of 6.4 months, the fracture healing time was 4 to 8 weeks. According to the Cooney wrist function scoring: the result was excellent in 44 cases, good in 2 cases, 1 case., Conclusion: U-shape gypsum functional fixation for treatment of Colles fracture limits the activity of thumb and extensor tendon, can reduce shortening of radial by traction of the injury thumb with the contralateral hand; it is good for blood circulation of hand and wrist, and swelling.

Background: The most common fracture of the distal end of the radius is Colles' fracture. Treatment modalities available for use in hand rehabilitation after injury include massage. The aim of this study was to evaluate the effect of isometric massage on the recovery of hand function in patients with Colles fractures. For this purpose, the strength of the finger flexors was assessed as an objective criterion for the evaluation of hand function., Material and Methods: The study involved 40 patients, randomly divided into Group A of 20 patients and Group B of 20 patients. All patients received physical therapy and exercised individually with a physiotherapist. Isometric massage was additionally used in Group A. Global grip strength was assessed using a pneumatic force meter on the first and last day of therapy. Statistical analysis was performed using STATISTICA. Statistical significance was defined as a P value of less than 0.05., Results: In both groups, global grip strength increased significantly after the therapy. There was no statistically significant difference between the groups. The men and women in both groups equally improved grip strength. A statistically significant difference was demonstrated between younger and older patients, with younger patients achieving greater gains in global grip strength in both groups., Conclusion: The incorporation of isometric massage in the rehabilitation plan of patients after a distal radial fracture did not significantly contribute to faster recovery of hand function or improve their quality of life.

Objective: To explore guiding role of three-column theory in manipulative reduction, small splint fixation and early rehabilitative exercises of Colles fracture., Methods: From August 2011 to February 2012,47 patients with Colles fractures were treated by manipulative reduction small splinting fixation and early rehabilitative exercises under the guidance of three-column theory, including 21 males and 26 females aged from 40 to 76 years old with an average of (65.5 +/- 2.3). According to AO fracture classification, 27 patients were type A (including 18 cases with type A2 and 9 cases with type A3) and 20 patients were type C (including 10 cases with type C1, 6 cases with type C2 and 4 cases with type C3). Pain and recovery time of swelling, postoperative complications were observed and recorded, Gartland-Werley scoring system were applied for evaluate functional recovery and biomechanical analysis of wrist joint at 12 weeks after operation., Results: All patients were followed up for 3 to 9 months with average of 5 months. Pain relief time ranged from 5 to 15 d with average of (7.6 +/- 2.2) d,recovery time of swelling of opisthenar was for 6 to 13 d with an average of (8.9 +/- 1.9) d. Two patients occurred tension vesicle within 3 days after operation, but no other complications occurred. According to Gartland-Werley scoring system, 25 cases got excellent results, 18 cases good and 4 cases moderate at 12 weeks after operation., Conclusion: Under the guidance of three-column theory, treating Colles fracture by manipulative reduction, small splinting fixation and early rehabilitative exercises can reduce pain and swelling time, promote union of fracture, effectively rehabilitate wrist function, improve clinical efficacy, and fit for concept of biomechanics.

Purpose of the Study: Abraham Colles classified and described fractures of the distal epiphyseal radius. He recommended the arm should be immobilized in a cast that extends from the base of the fingers to above the elbow, while holding this joint at ninety degrees of flexion the forearm in pronation and the wrist in slight flexion and ulnar deviation. We identified the brachioradialis muscle as the main culprit in the frequently observed loss of reduction of the fracture. Since the brachioradialis is attached to the distal region of the radius and functions as a flexor of the elbow when the forearm is in pronation, its stimulation easily displaces a reduced fracture, particularly if its geometry suggests axial instability. We concluded that post-reduction stabilization in supination was more desirable than in pronation., Material and Methods: Prospective study of one hundred and fifty-six patients suffering from Colles' fractures who were treated with the functional method. Approximately one-half of the fractures were immobilized in pronation and the other half in supination. The median age of the patients was 49 years. After approximately eleven days of immobilization in an above-the-elbow cast that held the forearm in a relaxed attitude of supination and the wrist in slight flexion and ulnar deviation, a new cast or brace was applied. The appliance permitted flexion of the elbow and slightly limited extension. We utilized modified Lindstom criteria to assess radiological results, according to types of fractures and by groups treated in supination and pronation., Results: In the type I and III (non-displaced) fracture series there appeared to be no significant difference in the functional results between the pronation and supination treated groups. In the type II category, in the supinated fractures, there were 9 excellent, 4 good and no fair or poor results. In the pronated group 9 excellent, 8 good and one fair result. The functional results in type IV fractures treated in supination were excellent in 11 instances, good in 7 and fair in 2. In fractures treated in pronation there were 5 excellent, 10 good and 5 fair results. There were no poor results in either group. 85% of type II fractures and 85% of type IV fractures treated in supination had excellent or good results. In the pronation group, 67% had excellent or good results in type II and 40% in type IV classification. In combining the results for all types of braced Colles' fractures, (I-IV) 93% of the supination group and 87% of the pronation group achieved excellent or good functional results. In analyzing overall results regardless of type of fracture or position of immobilization, 90% of the patients had excellent or good results., Conclusion: We treated Colles' fractures in supination and compared the results with those obtained when treated in pronation. The results indicated a lower incidence of re-displacement in the supination group. We developed a forearm brace that permits flexion of the elbow, but prevented pronation of the forearm, and limited extension of the elbow in approximately the last fifteen degrees. It permits minimally limited flexion of the wrist but prevents wrist dorsiflexion. It makes impossible any radial deviation. The place of surgery in the management of Colles' fractures should be limited to those fractures that when treated by non-surgical means are not likely to render satisfactory functional and cosmetic results. There is not at this time a consensus as to when to use the surgical approach. The complication rate from the surgery have not clearly identify superiority of one over the other. Nonetheless, the surgical treatment has a definite place in the armamentarium of the orthopaedic surgeon. In a number of situations, it is the treatment of choice.

Distal radius fractures are frequently seen in the emergency room. Scaphoid fractures are frequently seen as well. However, coincidental occurrence of these two types of fracture is quite rare. A 66-year-old healthy man was taken to the emergency room after a fall. He had pain in his right wrist, and an X-ray examination revealed a Colles' fracture with a 30 degree dorsal angulation and an undislocated transverse fracture of the scaphoid bone. The case illustrates that special attention should be given to the examination of the wrist and the first finger beam to exclude associated injuries.

Background: Distal radial fractures occur very frequently. Most are dorsally displaced (Colles' fracture). In contrast to previously, approximately a quarter of these patients now undergo surgery. This is more than the number that is reduced and immobilised in a plaster cast. Volar plate osteosynthesis is now the most common type of surgery. There is great uncertainty regarding indications for surgery., Method: The article is based on own research, a search in PubMed and a review of reference lists to identify articles that compare radiological and clinical outcomes after Colles' fractures., Results: A number of national orthopaedic associations have reviewed the literature in an attempt to draw up guidelines for indications for performing surgery on distal radial fractures, without being able to arrive at definite recommendations based on randomised studies. Our review of the literature indicates a very uncertain correlation between radiological displacement and the final clinical outcome. This applies particularly to elderly patients (over 55-65), where by far the majority of the studies do not find any such correlation. Complications and reoperation are common among patients who have undergone volar plate surgery., Interpretation: There is surprisingly little correlation between the radiological and clinical outcome after Colles' fractures. A practice where a large proportion of patients undergo surgery is probably not justified. Elderly patients will very seldom benefit from surgery in the longer term.

Background: In light of the Norwegian Orthopaedic Association's wish to prepare guidelines for treatment of distal radius fractures, we have reviewed the knowledge base for the provision of such treatment., Method: The paper is based on systematic reviews of treatment of distal radius fractures from literature search in the following databases: the Cochrane Library, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE Cochrane), the Health Technology Assessment (HTA) database, PreMedline, Medline and Embase., Results: There is evidence for recommending percutaneous pinning of unstable, dorsally displaced distal radius fractures rather than conservative treatment, but which pinning method is best remains uncertain. There is also documentation to support the use of external fixation rather than conservative treatment. There is insufficient documentation available to draw conclusions regarding the relative efficacy of the various methods of external fixation, but external fixation in combination with adjuvant pinning of the fracture fragment enhances the result compared to external fixation alone. The evidence indicates that plates may enhance functional short-term results for unstable distal radius fractures compared to external fixation., Interpretation: There is evidence in support of differentiated treatment of distal radius fractures. However, many questions remain unanswered, and good prospective, randomised multi-centre trials are needed.

We reviewed 260 patients who had been treated non-operatively for a dorsally displaced distal radius fracture a mean 6.3 (range 2.5-12.7) years earlier, in an attempt to find the limits of displacement compatible with a good clinical outcome. We excluded patients with previous or later injuries to the same limb. Bivariate analysis revealed a highly statistically significant relationship between radiographic displacement at review and clinical outcome scores. Correlation coefficients varied between 0.14 and 0.30. However, multiple linear regression analysis using most factors commonly thought to be of importance in determining the clinical outcome as independent variables explained only 23% of the variability of the clinical outcome. Dorsal angulation, ulnar variance, and radial inclination together accounted for only 11% of the variability. We conclude that the final alignment of the distal radius as shown radiologically has only a minor influence on the clinical outcome of Colles' type distal radius fractures.

Introduction: Although Colles' fracture i.e. a dorsally displaced distal radius fracture (DRF) is one of the most common fractures, there is no enough evidence to determine the best form of rehabilitation., Objective: To assess whether the use of pulsed electromagnetic field (PEMF) therapy during cast immobilization of DRF provides beneficial effects on pain, edema, wrist range of motion and function, as well as on the frequency of complications immediately after cast removal., Methods: The prospective randomized controlled study included 60 women over the age of 55 years with extra-articular displaced DRF treated with reduction and cast immobilization. The patients were alternately allocated to either a PEMF group (n = 30, received 10 days of PEMF therapy during immobilization), or a control group (n = 30, without PEMF therapy). Pain, function, hand circumference, wrist and forearm range of motion and frequency of complications for each patient was evaluated within two to three days of cast removal., Results: Better mean values for the majority of examined parameters were recorded in the PEMF group than in the control group, but the difference was statistically significant just for edema (p < 0.001), flexion, extension and supination range (p < 0.01)., Conclusion: During immobilization PEMF therapy in DRF patients gave better results immediately after cast removal in terms of edema and wrist range of motion (ROM).

Background: The objective was to predict the late dorsal tilt angulation of distal articular surface of radius in Colles' type of fracture with radioulna index difference, age, sex of the patient and dorsal cortex comminution., Material and Method: Correlation between previously mentioned factors and the changing degree of dorsal tilt angulation of distal articular surface of radius were analyzed. Sixty three wrist radiographs of sixty two patients with Colles' type of fracture were evaluated for dorsal tilt angulation of distal articular surface, radioulna index before and after reduction and at the end of the immobilization, dorsal cortex comminution after reduction. The interobserver and intraobserver generalizability coefficients of the dorsal cortex comminution measurement method were analyzed., Results: Dorsal cortex comminution, age and sex of the patient were the predictors of the dorsal tilt angulation of distal articular surface of Colles' type of fracture at the end of the immobilization. Partial correlation coefficient for dorsal cortex comminution, age and sex were 0.177, 0.201 and -8.206 respectively. The generalizability coefficients were rated as substantial to excellent., Conclusion: The late dorsal tilt angulation of distal articular surface of radius at the end of the immobilization can be predicted from size of dorsal cortex comminution, age and sex of the patients.

Background: An alternative to general anesthesia was tested against hematoma block by a double-blind, randomized clinical trial in reduction of Colles fracture., Method: 96 patients more than 18 years old with displaced fractures of distal radius were selected from 2007-2009 on the basis of: 1) informed consent; 2) no contraindication to any method of analgesia; 3) no associated injury. Patients were randomized into 2 equal groups. The A group received Propofol intravenously, whereas the B group received 10 ml of 2% Lidocaine Hydrochloride into the fracture hematoma. Fractures are reduced under acceptable criteria. Pain measured by Visual Analogue Scale (VAS) was recorded before, during, and after reduction. Time to Emergency department, to manipulation and to hospital discharge is measured. In radiographic before, after reduction and a week later the radial tilt, ulnar migration and dorsal tilt are measured. Loss of these parameters were study statistically data analysis by KW statistics., Results: 96 patients with displaced fractures of distal radius at mean age 54.3 (19-84) years old, M/F rate 37/59, left/right hand 37/58., from 2005-2008. VAS during reduction was 0 in group A and 0.97 +/- 0.7 in group B and VAS after reduction was 2.72 +/- 0.7 in group A and 2.25 +/- 0.2 in group B. Time to reduction was 2.63 +/- 0.96 hr in A and 0.90 +/- 0.47 hr in B After a week, 21 fractures lose reduction in group A and 22 in group B., Conclusion: Hematoma block by local anesthetic is a safe and effective alternative to intravenous general anesthesia in reduction of Colles fracture.

Colles' fractures (fractures of the distal radius) are extremely common in the elderly. These fractures tend to result in displacement in elderly people because they have osteoporotic bone. Fracture displacement in the elderly, however, does not necessarily result in functional impairment. This review looks at the current literature on distal radius fractures in the elderly and the treatment options for stabilization of these fractures. These include conservative management with cast immobilization or surgical options: internal fixation, external fixation, percutaneous pinning, and bone substitutes.

Objective: Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar-dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess longterm functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions., Methods: We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3-4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months., Results: Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%-28.9%) of participants in the VDS group, 20% (95% CI 7.6%-32.4%) in the CC group and 30% (95% CI 13.6%-46.4%) in the MST splinting group (p = 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p = 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p > 0.25)., Conclusion: Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.

Purpose: The aim of this study was to compare the functional and radiographic outcomes of dorsally displaced distal radius fractures treated by closed reduction plaster cast fixation (CRPCF) and external fixation (EF) in patients 65 years and older., Methods: This retrospective and nonrandomized study comprised 46 consecutive patients older than 65 years who had distal radial fractures. Patients were divided into 2 groups according to treatment: a CRPCF group and an EF group. All the fractures were dorsally displaced and AO/ASIF type A or C, without articular stepoff or gap. Cases were evaluated based on the criteria of Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, wrist range of motion, and radiologic results., Results: The mean follow-up period was 25.1 months. Union was achieved in all cases. Although it was not a statistically significant difference, posttreatment complications were more common in the CRPCF group (10 patients) than in the EF group (7 patients). In the CRPCF group, most complications were discomfort from the cast, whereas in the EF group, most were pin site infections. The average wrist extension and ulnar deviation (clinically) and palmar tilt and radial height (radiologically) were statistically better in the EF group at the final follow-up. The mean DASH scores were 20.3 in the CRPCF group and 21.9 in the EF group. There was no statistically significant difference in the DASH scores; in wrist flexion, radial deviation, pronation, supination, grip strength, or pinch strength (clinically); or in ulnar variance or radial inclination (radiologically). There was no correlation between the DASH scores and palmar tilt and ulnar variance., Conclusions: We concluded that both CRPCF and EF are useful methods for distal radius fractures in elderly patients. The results showed significant differences in wrist extension and ulnar deviation., (Copyright 2010. Published by Elsevier Inc.)

Introduction: Evidence of the disability and quality of life after a distal radius fracture reported by the patients themselves is lacking, since previous studies focussed on radiological assessment and objective clinical parameters., Aim: To describe the pain and disability and how they change during 6 months of recovery in patients with distal radius fracture., Material and Methods: This is a prospective randomized study of 42 patients with a distal radius fracture. They were assessed three times: baseline visit (7-10 day), three and six months after injury. At each visit patients completed the PRWE (Patient -rated wrist evaluation) questionnaire with 15 items: 5 - Pain; 6 - Specific activities and 4 - Usual activities subscale., Results: At baseline patients experience moderate pain (minimal at rest, mild during repeated movement, severe when lifting), there is very severe disability in performing specific and usual activities. After three months the pain diminishes to mild (none at rest, mild when lifting), as well the disability that is mild (professional activity is affected most). Six months after injury there is only minimal pain and functional difficulties. The domains of specific activities remained more impaired at each phase, compared to usual activities (personal care and household work)., Conclusion: The results of this study describe the normal course of recovery after a distal radius fracture. Three months after the injury significant improvement is expected, and after six months there should be only minimal disability. Atypical recovery may suggest the appearance of a complication or a need to change the treatment protocol.

PURPOSE OF THE STUDY To present the method of functional treatment of distal radius fractures, and to evaluate its results in a group of 57 patients. MATERIAL The method described here was used to treat a Colles fracture in 57 patients between 2001 and 2005. The average age of patients at the time of injury was 62 years (range, 19 to 82). The minimal interval between the end of treatment and the evaluation of the patient group was one year. METHODS The presented method is based on the principles of functional treatment of wrist fractures, as advocated by Sarmiento et al. When the patient has been indicated for this treatment, the arm is immobilised in a classic rigid cast. This cast is changed three weeks after application for a cast permitting full palmar flexion and full ulnar deviation. The cast is removed when callus formation is detected and the fracture site is free of pain. During this treatment, much attention is paid to skin condition, with an emphasis on preventing the development of Sudecks algoneurodystrophy. RESULTS This method of functional treatment resulted in complete fracture healing in all patients. None of them required hospitalization. The total period of immobilization was on average 45 days, ranging from 41 to 57 days. On subjective evaluation the patients regarded both the course and the result of treatment as good. DISCUSSION In this paper the authors address the permanent conflict between concepts of surgical and conservative therapy. Their results fully support the fact that the freedom of motion of all joints for a greater part of treatment is necessary for healing as well as prevention of a subsequent restriction of the range of motion. They also provide evidence that this modified method facilitates healing without complications. The patients were satisfied with the outcome of treatment; there was no poor result reported. CONCLUSIONS The method of functional treatment for distal radius fractures is an effective procedure allowing for good bone healing with a minimum of complications. In addition, the treatment can almost exclusively be carried out in an out-patient department. The mechanism promoting the process of osteogenesis in its course is not known yet. However, it has to be mentioned that the method is time-consuming for both the physician and the patient. Key words: distal radius fracture, functional treatment, Sarmientos method.

Objectives: To compare final functional and radiographic outcomes of closed reduction and casting (CAST) with open reduction and internal fixation (ORIF) with palmar locking plate for unstable Colles type distal radius fractures (DRFs) in low-demand patients older than 70 years., Design: Retrospective, clinical study., Setting: Level 1 university trauma center., Patients: Over a mean period of 4 years and 7 months, 130 consecutive patients older than 70 years were treated for an unstable dorsally displaced DRF of which 114 or 87% were followed for 1 year or longer., Intervention: ORIF (n = 53) using volar locking plate or closed reduction and casting (n = 61)., Main Outcome Measurements: Objective and subjective functional results (active range of motion; grip strength; disabilities of the arm, shoulder and hand (DASH) score; patient-rated wrist evaluation (PRWE) score; visual analog scale; and Green and O'Brien score) and radiographic assessment (dorsal tilt, radial inclination, radial shortening, fracture union, and posttraumatic arthritis) were assessed., Results: At final follow-up, there was no significant difference between the 2 groups for mean ranges of motion, grip strength, DASH score, PRWE score, and Green and O'Brien score. Pain level was significantly less for the patients in the CAST group. An obvious clinical deformity was present in 77% of cast group and none in the ORIF group. At final follow-up, in the ORIF group, there was a mean loss of dorsal tilt of 1.3 degrees, radial inclination of 0.3 degrees, and radial length of 0.5 mm compared with the postoperative measurements. No primary acceptable reduction was achieved in 44% of the CAST group. At final follow-up, in the CAST group, dorsal tilt, radial inclination, and radial shortening averaged -24.4 +/- 12 degrees, 19.2 +/- 6.5 degrees, and +3.9 +/- 2.7 mm, respectively. Malunion occurred in 89% primarily reduced fractures. Dorsal tilt, radial inclination, and radial shortening were significantly better in the ORIF group., Conclusions: Radiographic results (dorsal tilt, radial inclination, and radial shortening) after unstable dorsally displaced DRFs are significantly better in patients treated by ORIF using a volar fixed-angle plate rather than those treated by cast immobilization (P < 0.05). At a mean follow-up time of 4 years and 7 months, the clinical outcomes of active range of motion, the PRWE, DASH, and Green and O'Brien scores do not differ between the 2 methods of treatment. The pain level was significantly less in the CAST group (P < 0.05), and this group experienced no complications. There was no difference between the subjective and functional outcomes for the surgical and the nonsurgical treatments in a cohort of patients older than 70 years. Unsatisfactory radiographic outcome in older patients does not necessarily translate into unsatisfactory functional outcome. Nonoperative treatment may be the preferred method of treatment in this age group.

We report a case of a 77-year-old female patient who died 4 days after a closed colles-fracture of the right wrist because of secondary emerged necrotising fasciitis. At the time of visiting our emergency department, the patient reports about untypical pain and progressive swelling of the entire right arm 3 days following a fall onto the outstretched hand where she sustained a closed distal radius fracture. Within 6 h, the patient developed hypotension and fever leading to cardiac and respiratory failure. The emergent-induced diagnostic presented a severe septic situation in the laboratory examination of the blood samples, an apparent before unknown diabetes mellitus and an unknown bronchial carcinoma with part of post-stenosis pneumonia of the right lung. After initial CPR and stabilisation, the patient underwent an urgent and aggressive surgical debridement with fasciotomies of the muscle compartments of the entire right upper extremity. The microbiological investigation of the intraoperative taken specimens presented plentiful group-A-beta-haemolytic streptococcus. Despite a broad spectrum intravenous antibiotic therapy, intensive care support and a second look operation 12 h later with exarticulation of the right arm in the shoulder joint, the patient died of septic shock and multiorgan failure 34 h after admission.

The distal radius is one of the most commonly fractured long bone. Colles' fracture results from a fall on the dorsiflexed and pronated hand. The dinner-fork deformity is the typical deformity of the Colles' fracture. For patients with no or a little displacement, conservative treatment is applied. The non-bridge type external fixator is applied for patients without an intra articular fracture. For patients with a comminuted fracture, the locking plate (volar approach) is recommended. During the healing period, shoulder, elbow and finger exercise should be insisted.

Introduction: Colles'fractures are the most common fractures of the human skeleton, especially in winter and in menopausal women., Objective: The objective of the paper was to provide an overview of the potential uses of the Gartland-Werley (G-W) scoring system, that is, of its elements (residual deformities, subjective discomfort, objective discomfort and complications) in assessing the results of the Colles' fractures treatment; as well as to determine which of these elements--and to what extent--have an impact on the final result of the scoring system and what correlations exist within the G-W scoring system itself., Method: Our paper included 102 patients suffering from Colles' fractures treated non-operatively with a minimum follow-up period of one year.The Gartland-Werley scoring system was used to assess the results of the non-operative treatment., Results: The results, when applying the G-W score, were excellent in 40, good in 46, satisfactory in 14, and poor in 2 patients at the end of the assessment. The G-W score elements had the following percentages in the scoring results: residual deformities 15.38%, subjective discomfort 15.38%, objective discomfort (functional results) 43.58%, and complications 25.64%. The correlation analysis showed a statistically significant correlation of the residual deformities and the total G-W score (p < 0.01) at the level of subjective discomfort and total G-W score (p < 0.01), and between objective discomfort and total G-W score at the same level., Conclusion: Colles'fractures, as the most common fractures in humans, require a special approach and adequate assessment of final treatment results, because inadequate treatment results in the reduction of patients'daily activities and their ability to work.

Many people "slip and fall", especially in the icy areas of the winter season. To prevent an injury to the head, most people put their hand out to hit the ground first, so the wrist usually gets injured. The most frequent injury from this type of "intervention" is a fracture to the distal radius and/or ulna, which is frequently called a "Colles' fracture."

Tracking of anatomical and functional results obtained after non-surgical treatment of the distal radius included 115 patients in total, of whom 51 cases were available to be analysed and processed within this work. Tracking of the results was based upon Anatomical Score System and Gartland-Werley Score System. The final numerical results obtained through Anatomical Score were the following:excellent in 12 cases (23.52%), good in 30 cases (58.82%), satisfactory in 8 cases (15.68%), dissatisfactory in 1 case (1.96%). According to the Gartland-Werley Score System, the final results included: excellent in 19 cases (37.25%), good in 24 cases (47.00%), satisfactory in 7 cases (13.72%), dissatisfactory in 1 case (1.96%). This work also presents correlation between Residual Deformity score, Subjective Hardship score and Objective dysfunction, with the results obtained by Anatomical score and Gartland-Werley total score. The possibility of dissatisfactory results obtained by radiological screening followed by dissatisfactory outcome is described in literature; however, dissatisfactory screening results could be found in up to 31.7% of cases with satisfactory clinical findings. Our work records 15.7% of the latter cases. We might say that non-surgical treatment is not to be accepted as the only and exclusive approach to distal radius fracture. Thus, proper evaluation is mandatory.

Context and Objective: Although Colles' fracture is a common clinical situation for the orthopedist, we did not find any information in the literature that would allow safe decision-making on the best treatment for each fracture type. The aim of the present study was to investigate Brazilian orthopedists' opinions regarding the main aspects of treatments for Colles' fracture., Design and Setting: Cross-sectional study conducted during the 34th Brazilian Congress of Orthopedics and Traumatology., Methods: Five hundred questionnaires containing 12 items were randomly distributed to orthopedists who were attending the congress; 439 were filled out correctly and were considered in this study., Results: The main factors in making decisions on interventions in fracture cases were whether the fracture was intra-articular, the existence of shortening of the distal radius and the patient's age. The classification method most used was Frykmann. The closed reduction method most used was manual reduction. The principal surgical interventions were percutaneous pinning (39%), external fixation (27%) and volar plate (19%). Most of the interviewees only used bone grafts for osseous gaps in special cases. The most frequent complications were impairment of joint mobility and residual pain., Conclusions: Brazilian orthopedists have concordant opinions regarding conservative treatment methods and the use of bone grafts. There were conflicting opinions regarding surgical treatment methods, classification types and complications.