What is the management approach for a Colles' fracture?

Management of Colles' Fracture

Initial Assessment and Reduction

For displaced Colles' fractures, closed reduction with cast immobilization is the primary treatment approach, though both manual manipulation and finger-trap traction achieve similar reduction quality with high rates of subsequent displacement during cast treatment. 1

Reduction Technique Options

• Manual manipulation and finger-trap traction produce equivalent initial reduction success rates (87% satisfactory alignment) and similar failure rates, with no significant difference in fracture position at any time point 1
• The "handshake technique" represents a simple, reliable manual reduction method that can be employed 2
• Critical caveat: Regardless of reduction method, substantial redisplacement occurs during cast immobilization—only 50-57% maintain acceptable alignment at 1 week, and only 27-32% at 5 weeks 1

Immobilization Position

Immobilize the forearm in supination rather than pronation to minimize loss of reduction. 3

• The brachioradialis muscle is the primary deforming force causing loss of reduction when the forearm is pronated, as it attaches to the distal radius and displaces the fracture fragment 3
• For unstable fractures (Type II and IV): Supination positioning achieves 85% excellent/good results compared to only 40-67% in pronation 3
• Initial immobilization should be in an above-elbow cast holding the forearm in relaxed supination with the wrist in slight flexion and ulnar deviation for approximately 11 days 3
• After 11 days, transition to a forearm brace that permits elbow flexion but prevents pronation and limits terminal elbow extension 3

Operative vs Non-Operative Decision-Making

Most Colles' fractures can be successfully treated with closed reduction and cast immobilization. 4

• Non-displaced or minimally displaced fractures: Simple immobilization is appropriate 5
• Surgical intervention should be reserved for fractures unlikely to achieve satisfactory functional and cosmetic results with non-operative treatment 3
• The specific indications for surgery remain controversial, as complication rates have not clearly demonstrated superiority of surgical over non-surgical approaches 3

Postoperative/Post-Reduction Management

Appropriate pain management is essential throughout treatment. 6

• Close monitoring with follow-up imaging is necessary to ensure proper healing and detect loss of reduction 5
• Early mobilization and rehabilitation should begin once fracture stability allows 6

Rehabilitation Protocol

Implement a comprehensive rehabilitation program including early physical training, muscle strengthening, and long-term balance training. 6

• Begin rehabilitation early after fracture stability is achieved 6
• Continue balance training long-term for fall prevention 6

Secondary Fracture Prevention

All patients over 50 with a Colles' fracture require systematic evaluation for osteoporosis and subsequent fracture risk. 6

• Ensure adequate calcium and vitamin D intake 6
• Counsel patients to stop smoking and limit alcohol intake 6
• Consider pharmacological treatment with agents proven to reduce vertebral, non-vertebral, and hip fracture risk 6
• Educate patients about disease burden, risk factors, and treatment duration 6

Common Pitfalls

• Underestimating redisplacement risk: Even with successful initial reduction, the majority of fractures lose acceptable alignment during cast treatment 1
• Immobilizing in pronation: This position allows the brachioradialis to displace the fracture, particularly in unstable patterns 3
• Failing to address osteoporosis: Missing the opportunity for secondary prevention in fragility fractures leads to subsequent fractures 6