Colles' fracture:
Dorsal splint or complete cast during the first 10 days?
By Tina Str0mdal Wik, and Ase T. Aurstad, Department of Orthopaedic Surgery, St. Olav's University Hospital, Norway, Vilhjalmur Finsen, Department of Orthopaedic Surgery, St. Olav's University Hospital, Norway, Department of Neuroscience, NTNU, Norway
Reprinted with permission from INJURY, Int. J. Care Injured. (2009) 40, 400-404.
Abstract
In a prospective randomized trial of conservatively treated Colles' fractures, we compared radiological outcomes and complication rates for two immobilization methods, either complete cast (34 cases) or dorsal splint (38 cases), during the first 10 days after reduction. Radiographs were evaluated for dorsal tilt, radial tilt and radial shortening: results were almost identical in the two groups. There was a mean difference of 3.4° in dorsal angulation in favour of dorsal splinting 10 days after reduction and mean difference of 1.6 mm in radial length in favour of complete casting at five weeks. There was no difference between the two treatment groups in reported pain or cast problems. Thus, individual preference may be followed in choice of immobilization method.
Introduction
Distal radial fractures account for approximately 20% of all fractures (Finsen & Benum, 1987; Sahlin, 1990), and Colles' fractures account for 87% of all radial fractures (Hove, Fjeldsgaard, Reitan, et al., 1995). Among women aged between 50 and 70 years, Colles' fractures account for more than 40% of all fractures (Finsen & Benum). However, radiological outcome for Colles' fracture is often less than satisfactory, and there is little hard evidence as to which treatment to select (Handoll & Madhok, 2002). Most cases are still treated conservatively in accident and emergency units with reduction and immobilization in a plaster cast or splint (Handoll & Madhok), yet redisplacement in plaster is all too common (Dixon, Allen, & Bannister, 2004; Gartland & Werley, 1951; Hove, Solheim, Skjeie, & Sorensen, 1994: Mtiller, Nazarian, Koch, et al., 1990; Soolgaard, 1986; S0rensen, 1986; Vang Hansen, Staunstrup & Mikkelsen. 1998), and re-reduction or surgery may be required.
At our hospital, all Colles' fractures deemed suitable for conservative treatment are reduced and immobilized with a plaster of Paris dorsal splint, which is converted to a complete cast after 10 days. According to individual factors such as age, general health and radiological results after 10 days, some patients with severe redisplacement are readmitted.
The main purpose of this study was to determine whether, during the first 10 days of immobilization, a complete plaster cast or dorsal plaster splint best retains the alignment of a reduced Colles' fracture. In addition, we aimed to compare the complication rates of the two methods.
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