Treatment of Colles Fracture
Both cast immobilization and operative methods (locking plates, Kirschner wires, or external fixation) are valid treatment options for Colles fractures, though recent evidence has not identified clear superiority of one method over another in elderly patients. 1
Initial Assessment and Treatment Selection
The choice between non-operative and operative management depends on fracture characteristics and patient factors:
Non-Operative Treatment (Cast Immobilization)
- Cast immobilization is appropriate for minimally displaced or stable fractures 1
- Immobilization duration should be 3-4 weeks for stable fractures 2
- Studies demonstrate no significant difference in outcomes between 3 weeks versus 5 weeks of immobilization for stable fracture patterns 2
- The wrist should be positioned in slight flexion and ulnar deviation 3
- Early wrist mobilization within the cast hastens functional recovery and reduces swelling without increasing deformity 4
Operative Treatment Indications
- Surgical fixation with locking plates, Kirschner wires (percutaneous crossed-pin fixation), or external fixation should be considered for displaced or unstable fractures 1
- Percutaneous crossed-pin fixation followed by cast immobilization produces significantly better anatomical and functional outcomes compared to cast alone in displaced fractures 5
- Operative methods include locking plates, Kirschner wires, or external fixation 1
Key Management Principles
Immobilization Strategy
- Active finger motion exercises should begin immediately after diagnosis to prevent stiffness, which is one of the most functionally disabling complications 6
- Below-elbow casting is sufficient for most stable fractures 2
- Forearm position in supination may reduce re-displacement risk compared to pronation, particularly in unstable fracture patterns 3
Follow-Up Protocol
- Radiographic evaluation should occur at initial presentation, at approximately 3 weeks to assess healing, and at time of immobilization removal 6
- Monitor for loss of reduction, particularly in the first 2 weeks 3
Critical Pitfalls to Avoid
- Prolonged immobilization beyond 4-5 weeks leads to stiffness and reduced function 6, 2
- Failure to initiate early finger motion exercises results in preventable joint stiffness 6, 4
- Inadequate follow-up imaging may miss delayed displacement requiring intervention 6
- Immobilization-related complications occur in approximately 14.7% of cases, including skin irritation and muscle atrophy 6
Secondary Fracture Prevention
All patients aged 50 years and older with a Colles fracture should be systematically evaluated for osteoporosis and risk of subsequent fractures 1. A Fracture Liaison Service with a dedicated coordinator is the most effective organizational structure for this evaluation and treatment initiation 1.