From the Guidelines
The acute management of a Colles' fracture involves prompt immobilization, particularly when fracture fragments are small, nonarticular, or minimally displaced, as simple immobilization is often appropriate in these cases 1. The initial management should focus on immobilizing the wrist in a sugar-tong or volar splint with the wrist in slight flexion and ulnar deviation to maintain reduction.
- Key considerations include:
- Immobilization to prevent further injury and promote healing
- Pain management, which may include NSAIDs like ibuprofen 400-600mg every 6 hours or naproxen 500mg twice daily, combined with acetaminophen 1000mg every 6 hours
- The use of short-term opioids like hydrocodone/acetaminophen 5/325mg every 4-6 hours for more severe pain
- Application of ice for 15-20 minutes every 2-3 hours during the first 48 hours to reduce swelling
- Elevation of the affected extremity above heart level to minimize edema
- Regular assessment of neurovascular status is crucial, checking for sensation, capillary refill, and pulse to prevent complications. Orthopedic consultation should be obtained within a reasonable timeframe for definitive management, which may include closed reduction under local anesthesia or surgical intervention depending on fracture displacement, stability, and patient factors, as indicated by the american college of foot and ankle surgeons 1.
From the Research
Acute Management of Colles' Fracture
The acute management of a Colles' fracture typically involves reduction and immobilization to restore the anatomical position of the distal radius [(2,3,4,5)].
Reduction Techniques
- Closed manual reduction techniques, such as the handshake technique 2 or closed unassisted reduction 3, can be used to reduce the fracture.
- These techniques can be simple, easy, and reliable, and can be performed quickly by one physician without equipment 3.
Immobilization
- Plaster cast immobilization is commonly used to maintain the reduced position of the fracture [(2,4,5)].
- The goal of immobilization is to allow the fracture to heal in a stable position, restoring normal function to the wrist [(4,5)].
Challenges and Complications
- Reduction of Colles' fractures with axial compression can be challenging, and closed rereduction may not always be successful 6.
- Factors such as high age, dorsal comminution, and presence of axial compression can worsen the prognosis 6.
- Early involvement of patients in their rehabilitation process is essential to minimize the risk of complications, such as sympathetic reflex dystrophy 5.