What is the recommended management and rehabilitation approach for a Colles fracture?

Management and Rehabilitation of Colles Fracture

Acute Management

After casting or surgery for distal radius fracture, early finger motion must begin immediately to prevent edema and stiffness, followed by aggressive finger and hand motion once immobilization is discontinued. 1

Treatment Options

The choice between operative and non-operative management requires careful consideration:

• Cast immobilization or operative methods (locking plates, Kirschner wires, or external fixation) are both acceptable options 1
• Recent RCTs have not identified clear superiority of one method over another in elderly populations 1
• Percutaneous crossed-pin fixation followed by casting in functional position produces significantly better anatomical and functional outcomes compared to casting alone 2
• For cast immobilization, wrist dorsiflexion position shows the lowest incidence of redisplacement and best early functional results, while palmar flexion has detrimental effects on hand function and increases redisplacement risk 3

Immobilization Duration

• Early mobilization (less than 6 weeks) in elderly patients produces less pain, stronger grip, and no greater loss of reduction compared to 6-week immobilization 4
• Either complete cast or dorsal splint during the first 10 days produces nearly identical radiological outcomes 5

Rehabilitation Protocol

An appropriate rehabilitation programme must consist of early postfracture introduction of physical training and muscle strengthening, followed by long-term continuation of balance training and multidimensional fall prevention. 1

Immediate Post-Immobilization Phase

• Aggressive finger and hand motion exercises are essential immediately after cast removal to achieve optimal outcomes 1
• Early identification of individual goals and needs is critical before developing the rehabilitation plan 1
• The primary aim is restoring pre-fracture mobility and independence 1

Exercise Components

• Physical training and muscle strengthening should begin early in the postfracture period 1
• Balance training must continue long-term to prevent future falls 1
• Exercise programs improve bone mineral density and muscle strength while reducing fall frequency 1

Critical Caveat

Avoid overly aggressive physical therapy, as it may increase the risk of fixation failure in the postoperative period 1

Secondary Fracture Prevention

Risk Assessment

Every patient aged 50 years and over with a Colles fracture must be systematically evaluated for subsequent fracture risk. 1

This evaluation includes:

• Review of clinical risk factors 1
• DXA scanning of spine and hip 1
• Spine imaging for vertebral fractures 1
• Falls risk evaluation 1
• Identification of secondary osteoporosis 1

Non-Pharmacological Interventions

Adequate calcium intake (1000-1200 mg/day) combined with vitamin D supplementation (800 IU/day) is essential. 1

Additional measures include:

• Smoking cessation 1
• Alcohol limitation 1
• Vitamin D 800 IU/day reduces non-vertebral fractures by 15-20% and falls by 20% 1
• Avoid high-pulse dosages of vitamin D, as they increase fall risk 1

Pharmacological Treatment

For patients at high risk of subsequent fractures, pharmacological treatment should use drugs proven to reduce vertebral, non-vertebral, and hip fractures. 1

• First-line agents: Alendronate or risedronate (well-tolerated, low cost, extensive experience) 1
• Alternative agents: Zoledronic acid (IV) or denosumab (subcutaneous) for patients with oral intolerance, dementia, malabsorption, or non-compliance 1
• Treatment duration is typically 3-5 years, longer if high risk persists 1
• Regular monitoring for tolerance and adherence is mandatory 1

Multidisciplinary Coordination

Implementation requires a local responsible lead coordinating secondary fracture prevention between surgeons, rheumatologists/endocrinologists, and general practitioners. 1

• Patient education about disease burden, risk factors, follow-up, and treatment duration is essential 1
• Systematic follow-up improves long-term adherence, which is typically poor 1

Technologies to Avoid

Do not use low-intensity pulsed ultrasound (LIPUS) bone growth stimulation, as it has little or no impact on healing time, pain, or functional outcomes, while being cumbersome and potentially not covered by insurance 6