[Bandaging of Colles' fracture with plaster of Paris. Low dorsal bracing versus high circular plaster of Paris]. Colles' fracture. How should its displacement be measured and how should it be immobilized? A comparison of 3 and 5 weeks immobilization for older type 1 and 2 Colles' fractures. Distal radius fractures: a prospective randomized comparison of fibreglass tape with QuickCast. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial. Early results after Colles' fracture: functional bracing in supination vs dorsal plaster immobilization. On immediate functional bracing of Colles' fracture. Fixation not needed for undisplaced Colles' fracture. Brace treatment of Colles' fracture. Functional treatment of Colles fracture. Is manipulation of moderately displaced Colles' fracture worthwhile? A prospective randomized trial. [A comparison of 2 methods of plastic cast fixation in treatment of loco classico radius fracture. A prospective, randomized study]. A new functional brace for the treatment of Colles' fractures. Focused rigidity casting: a prospective randomised study. Minimally displaced distal radius fractures: do they need plaster treatment? Early mobilisation of Colles' fractures. A prospective trial. The value of early mobilisation in the treatment of Colles' fractures. Colles' fractures treated by plaster and polyurethane braces: a controlled clinical study. Early mobilization in the treatment of Colles' fracture: a 3 year prospective study. Length of immobilisation after fractures of the distal radius. Colles' fracture. Immobilisation in pronation or supination? Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts. Treatment of Colles' fracture. A prospective comparison of three different positions of immobilization. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis. A new thermoplastic casting material. A comparison between plaster of Paris and Hexelite.
nan In a study of 250 consecutive cases of Colles' fracture, analysis of various radiographic criteria for displacement showed that only the measurements for dorsal displacement and radial displacement were independent of each other. These measurements suffice for the comparison of series. The fractures randomly were divided into five equal groups, immobilized according to five different techniques. The technique of immobilization was found to be of subordinate importance for the final results, which are determined by the original displacement and the success of reduction. In a prospective study of Colles' fractures, 100 patients with Older type 1 and 2 fractures were randomized in two groups. One group was immobilized for 3 weeks and the other one for 5 weeks. Both groups were immobilized with a below-elbow plaster splint. At 1 year follow-up, there were 73 patients with 74 fractures. Dorsal angulation, radial length, wrist motion, grip strength and pain were measured. There was no significant difference in the measured parameters in the two groups. We found that 3 weeks of immobilization is a satisfactory treatment for Older type 1 and 2 Colles' fractures. Cast immobilization remains the most commonly employed method in the treatment of distal radius fractures. In an effort to test a new shrinkable polymer-coated casting material (QuickCast), a prospective randomized study was performed on 30 consecutive distal radius fractures. Fractures were divided into three groups based on the severity of fracture and treated with either a conventional short-arm fibreglass tape cast or a QuickCast. Results showed no significant differences in minor cast complications or maintenance of fracture reduction between conventional fibreglass tape and the QuickCast material. The shrinkable QuickCast, however, resulted in an average of one less cast change in all groups. This reduction in time and labour must be weighed against the slightly increased cost of the QuickCast immobilizer. We carried out a randomised, prospective, multicentre clinical trial of the treatment of Colles' fractures. A total of 339 patients was placed into two groups, those with minimally displaced fractures not requiring manipulation (151 patients) and those with displaced fractures which needed manipulation (188 patients). Treatment was by either a conventional Colles' plaster cast (a control group) or with a prefabricated functional brace (the Aberdeen Colles' fracture brace). Similar results were obtained in both groups with regard to the reduction and to pain scores but the brace provided better grip strength in the early stages of treatment. This was statistically significant after five weeks for both manipulated and non-manipulated fractures. At the tenth day the results were statistically significant only in manipulated fractures. There was no significant difference in the functional outcome between the two treatment groups. However, younger patients and those with less initial displacement had better functional results. A randomized clinical study of functional bracing in supination (FUSU) versus dorsal plaster immobilization (DPI) was conducted in 145 patients with Colles' fracture. A dynamic wrist unit was developed and used in 68 patients allocated for FUSU. The anatomical end result after FUSU was excellent or good in 80% of the patients versus 64% after DPI (P less than 0.05), in particular due to less dorsal angulation (P less than 0.001) and less radial shortening. The functional recovery was equal after 7 weeks and 3 months. At 6 months, 92% satisfactory results were achieved after FUSU versus 86% after DPI (P less than 0.05). Both anatomical and functional benefits were recorded in Frykman type V, VI, and VIII fractures and in the group of displaced intra-articular fractures. The functional benefit from FUSU is suggested primarily to be secondary to decreased fracture redislocation. A prospective randomized trial was carried out in 60 consecutive patients with Colles' fractures requiring manipulation. They were treated by either a standard Colles' plaster (control group) or in a functional plaster brace applied immediately after reduction of the fracture. The brace extended from the proximal radius and ulna to the level of the radial styloid and allowed a full range of movement at the radiocarpal joint. Both groups comprised 30 patients and were matched for age, sex and dominance of hand. There was no significant difference in initial severity of fracture or the quality of reduction. Radiological results on cast removal (35-42 days) were significantly better in the brace group compared with those treated with a below-elbow cast (P less than 0.05). Wrist function was also significantly better in the brace treated group at 12 weeks after fracture (P less than 0.05). This brace has a number of advantages over standard plaster treatment, but requires a degree of skill and experience in its application. A prefabricated brace has now been developed with a similar 'built in' three-point loading which will be easier for inexperienced staff to apply. A series of 68 undisplaced or minimally displaced Colles' fractures was randomized into two groups undergoing treatment with either a plaster cast or an elastic bandage. Pain, function, grip strength, and range of motion were evaluated 1 year later. There was a difference in the functional outcome in favor of the patients treated with an elastic bandage, who did not have more fracture redislocations than those treated with a plaster cast. Twenty patients with Colles' fractures were treated with a functional brace that allows wrist motion. The result was compared with a similar group of patients treated with a plaster cast. Dorsal displacement of the fracture was less and wrist function was better in the brace group. Swelling of the hand during the early stages was observed in the brace group; and because this may necessitate brace adjustment, increased medical supervision is necessary for this period. nan Thirty elderly patients with moderately displaced Colles' fractures were randomly assigned to manipulation under Bier's block or plaster immobilization alone. Moderately displaced was defined as 10 degrees to 30 degrees of dorsal angulation and less than 5 mm of radial shortening compared with the uninjured side. The groups were well matched for age, sex, fracture type and displacement; immobilization time and rehabilitation were standardized. The outcome measures were: radiological position at union, the functional score of Gartland and Werley, grip strength, cosmesis and algodystrophy assessment. There was no detectable difference between the groups in any of the outcome measures. Two-thirds of the correction of dorsal angulation achieved by manipulation was lost by 5 weeks. We conclude that up to 30 degrees of dorsal angulation and 5 mm of radial shortening may be accepted in selected elderly patients. The purpose of this study was to compare the functional and radiological result of two different positions of the wrist in a plaster cast following Colles' fracture. For this prospective study, each of 50 patients with type A 2.2, A 3.3, C 1.2 or C 2.2 (AO classification) fractures of the radius was randomly assigned to one of two groups. Both groups were treated in the same way as far as anaesthesia and reduction were concerned. The only difference in treatment lay in the position of fixation in plaster. In group 1 the wrist was immobilized in neutral flexion-extension. In group 2 the wrist was dorsiflexed 20 degrees, while the carpus was pushed in a volar direction by an impression in the plaster cast. At review 2-7 years after the accidents, the two groups were compared with reference to symptoms, range of motion at the wrist, power of first closure and radiographic appearance. In group 1 there were 5 patients with significant disability, compared with only 1 in group 2. A significant difference was found in the range of movement between the two groups for flexion and ulnar abduction (p < 0.01). The loss of power of first clenching (difference between injured and healthy hand) was 6.2 mmHg for group 1 and 3.8 mmHg for group 2 (not significant). The radiographic examination showed significant differences both in sagittal inclination (p < 0.001) and in radial shortening (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) A new prefabricated brace for the functional treatment of Colles' fractures has been developed. It is applied at fracture reduction and maintains fracture position by the application of three-point loading. In a prospective randomized clinical trial treating 85 displaced Colles' fractures, with blind independent follow-up, the brace gave better functional results than conventional plaster treatment. The improved function was apparent up to 6 months after injury. Finger function and pinch strength were also better in the brace-treated patients. Anatomical results were similar in the two groups. Focused rigidity casting was compared with standard casting in a randomised prospective study. Two hundred consecutive patients attending a fracture clinic were assigned to have either a standard cast consisting of synthetic or plaster of paris, or a focused rigidity cast of synthetic material. Patients were assessed using a specially developed scoring system termed the Bradford Plaster Index. In patients with fractures of the base of fifth metatarsal, focused rigidity casting proved superior to traditional techniques for ability score (p=0.0001), satisfaction score (p=0.0023), overall impairment of function (p=0.019), limitation of movement following cast removal (p=0.024) and in limitation of muscle strength following cast removal (p=0.001). In fractures of the distal radius, focused rigidity casting was superior for ability score (p=0.0002) and satisfaction score (p=0.00009). Patients with scaphoid fractures were better for satisfaction score (p=0.0483). Compared with the standard technique, focused rigidity casting has been shown to be superior to traditional methods with regard to satisfaction and functional scores without any detriment to clinical results. In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups: those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. No statistical differences could be found in functional outcome between the groups at any time during the evaluation. Although patients did not allow immediate functional treatment in the presence of a fracture, we could not find any differences between 1 week or 3 weeks of plaster treatment. No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows. The results of a prospective controlled trial of early mobilisation of Colles' fractures in the elderly are presented. Early mobilisation produced less pain and a stronger grip. It did not lead to any greater loss of reduction of the fracture. However, there was no significant improvement in the final range of movement of the wrist. Immobilisation of the wrist for six weeks in plaster is extremely inconvenient for the elderly living alone and the patients greatly appreciated the reduction of this period of time to a minimum. Unilateral Colles' fractures in 187 patients over the age of 55 years were studied in a randomised prospective trial: 97 fractures were minimally displaced and were treated either conventionally or in a crêpe bandage; 90 displaced Colles' fractures were reduced and of these 47 were treated conventionally while 43 were encouraged to mobilise the wrist in a cast which restricted extension. Early wrist movement hastened functional recovery and led to earlier resolution of wrist swelling. Discomfort was no greater than in patients who were treated conventionally. The bony deformity, which recurred irrespective of the method of treatment, was not adversely affected by early mobilisation. In a prospective randomized controlled trial polyurethane casts and traditional plaster-of-Paris braces were compared in 46 cases of Colles' fractures of the forearm. Secondary fracture dislocation, subjective inconveniences, and the need for secondary adjustment of the cast were recorded. No significant difference was observed in the two groups. In comparison with plaster the synthetic bandage is lighter, water repellent, and hardens faster, and as far as circular bandages are concerned, they have zippers. It is concluded that polyurethane braces are a good supplement to plaster-of-Paris bandage in such fractures and recommended in selected cases. Ninety consecutive women with unilateral Colles' fractures were randomized into two different treatment groups. The control group was treated for 5 weeks in conventional short-arm, below the elbow plaster of Paris casts. The other group (N = 45) was treated similarly in plaster casts for 3 weeks and then had flexible casting applied for the remaining 2 weeks which allowed for early joint mobilization. Functional recovery was assessed by measuring grip strength and joint mobility at intervals over the 3 years. Radiographic and overall assessments were also made during 3 year course of study. Virtually all patients reported greater comfort after switching to the flexible casting. Mean grip scores and joint mobilities were higher at all time points with early mobilization, reaching levels of statistical significance at 6 months for grip score and at 3 months for joint mobility. By 3 years most differences between treatment groups had resolved. We found no evidence that early mobilization was detrimental to recovery. We conclude that early mobilization is a satisfactory treatment option for Colles' fracture, and may, in fact, hasten functional recovery. Thirty-three patients with undisplaced fractures of the distal radius were included in a clinical controlled trial with the purpose of evaluating whether it was safe to reduce the time of immobilisation in a plaster splint from 5 to 3 weeks. We did not find any difference in radiological healing at 3 months or in the functional scores after 3 and 9 months. nan The use of Orthoplast cast-bracing to allow early hand function in the treatment of displaced Colles' fractures was investigated in 243 patients. They were randomly allocated into three groups: in the first a conventional Colles' type plaster was used; in the second an above-elbow cast-brace with the forearm in supination; and in the third a below-elbow cast-brace. Radiographic measurements were made at each stage of treatment, and the final anatomical result was scored using Sarmiento's (1975) criteria. Function was assessed at three months and at six months. The anatomical result was not influenced by the method of immobilisation but was related to the efficacy of reduction. Loss of position in the braces was no greater than in plaster. The functional result at three months also was uninfluenced by the method of immobilisation; it was, however, related to the severity of the initial displacement, and (to a lesser degree) to the anatomical result, an effect which was lost at six months. Early hand function and the supinated position advocated by Sarmiento were found to confer no anatomical or functional advantage; we could see no reason to change from the use of conventional plaster casts in the treatment of uncomplicated Colles' fractures. The usual treatment of Colles' fracture, i.e. fracture of the distal radius with dorsal angulation of the distal fragment, is closed reduction and immobilization in a plaster cast. The position of the forearm in the cast varies, according to the reports of various authors. Forty-two extra-articular-fractures of the distal radius have been randomly divided into three groups. All were reduced, and the forearms were then immobilized in three different positions of rotation according to the grouping. The study indicates that the position of the forearm during immobilization is of importance as regards redislocation. After application of a plaster cast with the forearm in pronation there seems to be less likelihood of redislocation occurring than when the forearm is immobilized in supination (P less than 0.05). A controlled prospective trial of early exercise of slightly displaced fractures of the distal radial metaphysis has been performed. Twenty-eight fractures were enclosed in a tubigrip support 7-13 days after injury and 28 fractures were splinted in below-elbow plaster for 4 weeks. It was found that early movement of the wrist produced a superior functional result at 5 and 7 weeks (P less than 0.05) and allowed an earlier recovery of domestic skills (P less than 0.05). Early exercise did not improve recovery of strength of grip and did not produce a higher incidence of malunion. Patients treated in tubigrip experienced no more pain in weeks 4 and 6 and apart from one failure, no patient actively disliked this form of treatment and 22 were totally satisfied. Plaster of Paris and Hexelite, a new thermoplastic bandage, were compared in the treatment of 183 patients with malleolar fractures, Colles' fractures or distortions of the finger joints. There were no statistically significant differences between the two types of bandages taking into account the strength of the bandage, the amount of skin damage and the patient's opinion of the bandage. Hexelite is seven times more expensive than plaster of Paris, and, in addition, is more difficult to handle. Hence its use has been discontinued.
There remains insufficient evidence from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Patient preferences and circumstances, and the risk of complications should also be considered.
Prioritising research questions to clarify the most appropriate conservative treatment for this common fracture is warranted. Researchers should differentiate between extra-articular and intra-articular, and non-displaced and displaced fractures, ascertain patient preferences, and agree a core outcome data set.