From the Guidelines
The proper procedure for reducing a Colles fracture involves applying adequate anesthesia, followed by manual traction and manipulation to restore radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments 1. To achieve this, the following steps can be taken:
- Administer appropriate analgesia such as a hematoma block with 5-10 mL of 1% lidocaine injected into the fracture site, or procedural sedation with medications like midazolam (1-2 mg IV) and fentanyl (50-100 mcg IV) to ensure adequate pain control.
- Apply longitudinal traction to the wrist with the elbow flexed at 90 degrees while an assistant provides counter-traction at the elbow.
- Accentuate the deformity by increasing the dorsal displacement and ulnar deviation, then apply volar-directed pressure on the distal fragment while simultaneously applying dorsal pressure on the proximal fragment.
- Correct any radial deviation by moving the hand ulnarly, and maintain the reduced position while applying a sugar-tong or volar-dorsal splint with the wrist in slight flexion and ulnar deviation. The goal of reduction is to achieve <2 mm of residual articular surface step-off to avoid long-term complications, such as osteoarthritis 1. Post-reduction radiographs should be obtained to confirm adequate alignment, and proper immobilization for 4-6 weeks is necessary to allow bone healing in the correct position. It is essential to note that the presence of a coronally oriented fracture line, die-punch depression, or more than three articular fracture fragments are common indications for operative reduction 1.
From the Research
Reducing a Colles Fracture: Procedure and Techniques
The proper procedure for reducing a Colles fracture involves several techniques, including:
- Closed reduction, which can be performed manually or using longitudinal traction 2, 3
- Closed unassisted reduction, which can be useful in acute settings where there is a shortage of assistance and tools 2
- Finger-trap traction, which has been compared to manual manipulation in a prospective, randomized study 3
- Regional anesthesia, which has been found to be preferable for Colles' fracture reduction, resulting in less pain and better grip strength 4, 5
Comparison of Reduction Techniques
Studies have compared different reduction techniques, including:
- Manual manipulation vs. finger-trap traction: no significant differences were found between the alignment of the fractures in the two treatment groups at any time 3
- Closed unassisted reduction: a reliable and simple technique that can be performed quickly by 1 physician without equipment 2
- Regional anesthesia vs. local anesthesia: patients treated with regional intravenous block had less pain and better grip strength at the 6-month follow-up 5
Key Considerations
When reducing a Colles fracture, key considerations include:
- Accurate reduction and adequate immobilization to achieve an optimal outcome 3, 6
- The use of proper anesthesia, such as regional anesthesia, to minimize pain and improve outcomes 4, 5
- The potential for redisplacement during the period of cast immobilization, which can occur with any reduction technique 3