Colles Fracture

Treatment of Colles fractures will depend on:
• The type of Colles fracture present

• The age
• activity level of the patient
• the surgeon’s preference
• the patient’ s desires regarding immobilization and return to activity.
As Colles fractures are so common, many methods of treatment have
been developed to stabilize the fractures and allow the bone to heal.
The ultimate goal is to return the wrist to its prior level of
functioning.
• Management of a Colle's fracture depends on the severity of the fracture. An undisplaced fracture may be
treated conservatively with a cast alone. The cast is applied with the distal fragment in palmar flexion and
ulnar deviation.
• Surgical options can include: external fixation, internal fixation, percutaneous pinning, and bone substitutes.
• A fracture with mild angulation and displacement may require closed reduction. Significant angulation and
deformity may require an open reduction and internal fixation or external fixation. The volar forearm splint is
best for temporary immobilization of forearm, wrist and hand fractures, including Colles fracture.
• A higher amount of instability criteria increases the likelihood of operative treatment.
• The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands
of the patient will all be considered when determininmg the best treatment option
Management of Colles’ fracture
• Undisplaced fracture
- Treated conservatively with a cast alone
- The cast is applied with the distal fragment in palmar flexion and ulnar deviation.
• Fracture with mild angulation and displacement
- Closed reduction
- The manipulation of the bone fragments without surgical exposure of the fragments
• Significant angulation and deformity
- Open reduction and internal fixation or external fixation.
Open reduction is where the fracture fragments are exposed

surgically by dissecting the tissues.
Closed reduction is the manipulation of the bone fragments
without surgical exposure of the fragments.
MANAGEMENT OF COLLES’
FRACTURE
Undisplaced fracture
• A plaster cast or a splint is likely to be applied until the bones have healed.
• A splint is more commonly used in older people and those who are not very
active, and when the pain is minimal.
• A cast is more commonly used in younger and more active individuals.
• A cast is a device that completely encircles and encases a limb. This is to
keep the limb perfectly immobile after the bones are placed in the
correct alignment. This is to ensure that the break heals correctly.
Materials that are used to make a cast are usually fiberglass and plaster.
• It used in orthopedics to hold a limb completely still while a broken
bone or injured limb is healing. A splint can be adjusted accordingly if
the limb starts to swell.
• In some cases a splint can allow some degree of movement. In the field
an emergency medical technician (EMT) will often place a splint
temporarily o
Displaced fracture/ Fracture with mild angulation and
displacement:
• Closed reduction- The manipulation of the bone fragments without
surgical exposure of the fragments.
• A cast will then be placed on the arm
Significant angulation and deformity
• Open reduction (fracture fragments are exposed surgically by

dissecting the tissues) and internal fixation or external fixation
Comminuted fracture
• A break or splinter of the bone into more than two fragments.
• Percutaneous K-wire fixation along with plaster immobilization. It
then remove after weeks.
Physiotherapy treatment
During reduction plaster cast:
• Uninvolved joint range of motion
• Wrist joint passive supination and pronation
• Isometric hand muscle exercise
After removal of cast:
• Wrist and forearm strengthening exercises
• Wrist range of movement
• Handgrip exercise
Pain management
Analgesics
Classification:
• Narcotic analgesics- opioid analgesic
• Non-narcotic analgesics- Nonsteroidal anti-inflammatory
drugs (NSAIDS)
Analgesic efficacy
1. Low efficacy agent ( for mild and moderate pain):
• Codeine
• Dihydrocodeine
• Pentazocine
2. High efficacy agent (for severe pain):
• Nalbuphine
• Methadone
• Morphine
• Diamorphine
• Pethidine
• Tramadol
Mechanism of action of opioid analgesic
By acting on opioid receptors:
- Inhibit release of excitatory neurotransmitters
- Decrease synaptic transmission
NSAIDs
Mechanism of action
17
COX-1 and COX-2
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General unwanted effects of NSAIDs
• 'Analgesic-associated nephropathy'. This can occur
following long-continued high doses of NSAIDs (e.g.
paracetamol) and is often irreversible.
• Liver disorders, bone marrow depression.
• Bronchospasm. Seen in 'aspirin-sensitive' asthmatics.
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Paracetamol
Also known as acetaminophen or Panadol
It has excellent analgesic and antipyretic activity, which can
be traced to inhibition of CNS prostaglandin synthesis.
Unwanted effects:
• Allergic skin reactions
• kidney damage
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Colles Fracture

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Treatment of Colles fractures will depend on:

• The type of Colles fracture present

• A higher amount of instability criteria increases the likelihood of operative treatment.

Open reduction is where the fracture fragments are exposed

• Open reduction (fracture fragments are exposed surgically by

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