Distal Radius Fracture (Colle's Fracture)


MECHANISM

DIAGNOSIS

TREATMENT

COMPLICATIONS

  Initial Treatment
Splint type & position Double sugar-tong splint
Wrist in slight flexion and ulnar deviation, forearm in neutral position, elbow at 90 degrees
Initial follow-up visit Nondisplaced: 3 to 5 days
Displaced, reduced: 2 to 3 days
Pt instructions Icing, elevation, ROM of fingers and shoulder
  Follow-up Care
Cast or Splint type & position Nondisplaced: SAC, wrist in neutral position
Reduced: LAC, wrist in slight flexion and ulnar deviation, forearm in neutral position, elbow at 90 degrees
Length of immobilization Nondisplaced: 4 to 6 weeks
LAC for 3 to 4 weeks followed by SAC until healed (total, 6 to 8 weeks)
Elderly: LAC for 2 to 3 weeks followed by SAC until healed
Healing time Nondisplaced: 6 to 8 weeks
Reduced: 8 to 12 weeks
Follow-up visit interval Nondisplaced: Every 2 to 3 weeks
Reduced: Weekly until fracture stability ensured, then every 2 weeks until healed
Repeat radiography interval Nondisplaced: At first follow-up visit, at 2 weeks, at 4 to 6 weeks
Reduced: weekly for 3 weeks; then every 2 weeks if stable
Pt instruction Finger and shoulder ROM exercises while immobilized
Aggressive hand, wrist, and elbow rehabilitation after immobilization, especially in elderly adults
Indications for Ortho consult Open Fracture
Intraarticular extension
Severe comminution
Inability to maintain reduction (younger patients and high-demand patients)
Progressive symptoms of median nerve injury
Early symptoms of reflex sympathetic dystrophy

WITHIN 30-60 min:
Open fractures, acute neuropathy, tenting of the skin, compartment syndrome, or vascular compromise require emergent orthopedic referral
WITHIN 24-48 hr:
If the fracture is displaced and the physician is uncomfortable performing the necessary reduction, the patient should be referred and have reduction performed within 24 hours (preferably).
 

LAC = long-arm cast; SAC = short-arm cast

Pediatric Consideration

Indications for Orthopedic Referral Emergent Referral (Within 30 to 60 Minutes):
  • As with adults, patients with open fractures, acute neuropathy, tenting of the skin, compartment syndrome, or vascular compromise require emergent orthopedic referral.
  • If specialist care is not promptly available, tenting or neurovascular compromise associated with a displaced fracture can generally be corrected by immediate closed reduction after adequate analgesia or local anaesthesia is achieved.

Nonemergent Referral (24 to 48 Hours):

  • Operative repair of distal radius fractures in children is seldom indicated because the outcomes from nonoperative management are so good.
  • Conditions that should prompt an orthopedic referral include displaced fractures that the physician is not comfortable reducing, Salter-Harris type III to V fractures, displaced Salter-Harris type I and II fractures, and severe local soft tissue injury.
  • Patients with unstable greenstick fractures or complete fractures that are not amenable to closed reduction should also be referred.
  • Failure to achieve an adequate reduction by closed methods should also prompt referral.

Complete Fractures

  • Complete fractures of the distal radius in children are nearly always angulated and have some degree of distraction of the fracture fragments.
  • They have a higher chance of losing position during treatment and refracture after treatment.
  • In general, these fractures should be immobilized in a sugar-tong splint with the elbow at 90 degrees, and the patient should be referred to an orthopedic surgeon for closed reduction and definitive care.

Complications

  • The most common bony complication is residual angulation.
  • Most fractures remodel to produce an acceptable functional and cosmetic result.
  • Some loss of forearm rotation may occur.
  • Complications that are common in adult distal radius fractures (loss of wrist motion and distal radial joint dysfunction) are almost unheard of in pediatric fractures.
  • Other complications include concomitant fractures (supracondylar or carpal, particularly the scaphoid), median nerve injury (from improper immobilization or too-vigorous reduction and manipulation), compartment syndrome and refracture after premature discontinuation of protection.






Reduction: