Immediate Treatment of Dorsally Displaced Colles Fracture
For a dorsally displaced Colles fracture, immediate closed reduction under appropriate anesthesia followed by immobilization in a below-elbow cast is the standard initial treatment. 1
Initial Assessment and Reduction
- Perform closed reduction as soon as possible to restore anatomical alignment and prevent complications. 2
- The reduction can be accomplished manually without equipment using longitudinal traction and manipulation techniques, even by a single physician in under 10 minutes. 2
- Adequate analgesia or procedural sedation should be provided before attempting reduction. 3
Immobilization Technique
- Apply a below-elbow cast with the wrist positioned in 15 degrees of dorsiflexion after successful reduction. 4
- This dorsiflexion position prevents redisplacement of the fracture fragments and maintains reduction better than traditional palmar flexion positioning. 4
- Rigid immobilization is preferred over removable splints for displaced fractures to maintain reduction. 1
Post-Reduction Management
- Obtain immediate post-reduction radiographs to confirm acceptable alignment before cast application. 1
- Follow with serial radiographic evaluation at approximately 3 weeks and at cessation of immobilization to monitor for loss of reduction. 1
- Appropriate pain management should be provided throughout the treatment course. 1
Treatment Decision Algorithm
For elderly patients (>50 years):
- Cast immobilization remains a valid option alongside operative methods (locking plates, Kirschner wires, external fixation). 1
- Recent evidence has not identified clear superiority of operative versus non-operative treatment in this population. 1
- The decision should account for fracture displacement severity, patient functional demands, and comorbidities. 1
Common pitfall: Immobilizing in excessive palmar flexion (the traditional "Cotton-Loder" position) may actually increase redisplacement risk. The evidence supports dorsiflexion positioning instead. 4
Expected Outcomes
- 76% of patients achieve excellent to good functional outcomes with proper closed reduction and dorsiflexion immobilization. 4
- Functional outcome correlates with anatomical restoration, though radiographic alignment accounts for only 11% of outcome variability. 5
- Residual dorsal angulation <10 degrees, radial length loss <6mm, and radial angulation loss <9 degrees are associated with excellent to good results. 4