Splint Type for Colles Fracture
For Colles fractures, rigid immobilization with a cast is recommended for displaced fractures, while removable splints are appropriate for minimally displaced fractures. 1, 2
Immobilization Options Based on Fracture Type
Displaced Distal Radius Fractures
- Rigid immobilization (casting) is preferred over removable splints for displaced distal radius fractures 1
- The cast should immobilize the fracture while allowing for finger motion to prevent stiffness 1
- Splinting in the position found is recommended unless straightening is necessary for safe transport 1
Minimally Displaced or Buckle Fractures
- Removable splints are an appropriate option for minimally displaced distal radius fractures 1, 2
- This approach provides adequate stabilization while offering economic and resource savings for healthcare systems 3
Positioning Considerations
- Traditional positioning has been with the elbow in flexion, forearm in pronation, and wrist in volar flexion and ulnar deviation 4
- However, some evidence suggests that immobilization in supination may result in less displacement than pronation, particularly for unstable fractures 5
- This is because the brachioradialis muscle, which attaches to the distal radius, can exert a deforming force when the forearm is in pronation 4
Duration of Immobilization
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal 2
- Regular monitoring is essential to detect any loss of reduction during the healing process 6
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 1
- Early wrist motion is not routinely necessary following stable fracture fixation 1
Emerging Options
- Newer splint designs such as integrated retainer pad splints have shown promising results with greater stability and less reduction loss compared to traditional splints 7
- When comparing different immobilization methods (circumferential casting, volar-dorsal splinting, and modified sugar-tong splinting), functional outcomes at 8 weeks and 6 months were not significantly different, suggesting that ease of application and familiarity should guide clinical decisions 6
Special Considerations
- If a fracture is associated with an open wound and severe bleeding, appropriate bleeding control measures should be implemented 1
- If a fractured extremity appears blue, purple, or pale, immediate medical attention is required as this may indicate poor perfusion 1
- For fractures with significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 2