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Saturday, February 16, 2002

Colles' fracture treatments lead to long-term deformity

Traditional methods of treating distal radial (Colles') fractures may need to change, said the co-authors of scientific paper 269 on Friday, because they do not prevent loss of radial length and inclination. This conclusion is based on a radiologic study of the progressive changes seen in distal radial fractures in the first year after injury.

"The restoration of radial length, shift and inclination, and volar tilt are among the primary aims of treatment," said the authors. "There was a significant loss of radial length and inclination in almost all patients with a displaced Colles' fracture, which essentially represents a failure of treatment."

Traditional treatment for Colles' fractures involves either a below elbow cast or percutaneous wire fixation and casting. External splintage is rarely used beyond 6 weeks.

The study involved 100 consecutive patients (78 females and 22 males) with unilateral Colles' fractures. The mean age of patients was 72 years (range: 65 to 88 years). Patients were treated with either a below elbow cast or percutaneous wire fixation and a cast after acceptable reduction was obtained. All patients were evaluated with serial X-rays for one year after treatment. Radial length, shift and inclination, and volar tilt were recorded and compared to the position immediately after injury.

Some loss of fracture reduction was seen in 30 patients in the 6 weeks after injury. Of the patients who required manipulation, 80% showed a loss of radial length and inclination beyond the baseline position, and 43% showed progressive late regression of the radiologic deformity to the pre-treatment position. Only 15% of those patients who did not require a manipulative reduction showed any progression of deformity.

Researchers also questioned the role of remanipulation. "If a re-reduction is to be performed," they concluded, "it should perhaps not be considered unless a more definitive procedure such as bone grafting or a longer period of immobilization is used. Future treatment methods may need to hold fractures safely for periods longer than six weeks and may have to resist deforming forces beyond the initial treatment phase."

Paper co-authors included Fares S Haddad, FRCS (Orth), Jig Patel FRCS (Orth), and Lawrence James, FRCS, all of London, United Kingdom.

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Last modified 16/February/2002