What is the recommended treatment for a Colles fracture, including immobilization and pain management?

Treatment of Colles Fracture: Immobilization and Pain Management

For Colles fractures, a removable splint is recommended as the appropriate treatment option for minimally displaced fractures, while surgical management should be considered for significantly displaced fractures. 1

Initial Assessment and Immobilization

• Splinting of a fractured extremity is useful to reduce pain, reduce risk for further injury, and facilitate transport to a medical facility 2
• For minimally displaced distal radius fractures (buckle fractures), removable splints are an appropriate treatment option 1
• If there is significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 1
• For displaced fractures requiring reduction, rigid immobilization (casting) is preferred over removable splints 1

Splint Position and Technique

• Traditional immobilization in pronation with the wrist in volar flexion and ulnar deviation may contribute to loss of reduction due to the deforming force of the brachioradialis muscle 3, 4
• Immobilization in supination may result in a lower incidence of re-displacement compared to pronation, particularly for unstable fracture patterns 4
• It may be reasonable to treat a deformed fractured extremity in the position found unless straightening is necessary for safe transport 2
• For stable fractures following reduction, a below-elbow cast or splint is typically sufficient 5

Duration of Immobilization

• For stable Colles fractures (Older type 1 and 2), 3 weeks of immobilization has been shown to be as effective as 5 weeks of immobilization 6
• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
• Patients do not need to begin early wrist motion routinely following stable fracture fixation 2

Pain Management

• The American Academy of Orthopaedic Surgeons recommends consideration of multimodal and opioid-sparing protocols when possible 2
• Pain management options include:
  • Pharmacologic: local anesthetics, nonsteroidal anti-inflammatory drugs, acetaminophen 2
  • Nonpharmacologic: ice, elevation, compression 2
• Ultrasound and/or ice are options for adjuvant treatment of distal radius fractures 2
• Vitamin C supplementation is suggested for the prevention of disproportionate pain 2

Rehabilitation Considerations

• Active finger motion exercises should be performed following diagnosis to prevent stiffness 1
• Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
• Monitor for potential complications such as skin irritation or muscle atrophy during immobilization 1

Special Considerations

• If a fracture is associated with an open wound and severe bleeding, appropriate bleeding control measures should be implemented 2
• If a fractured extremity is blue, purple, or pale, emergency medical services should be activated immediately 2
• Covering open wounds associated with a suspected fracture with a clean dressing may lower the risk for further contamination and infection 2