Colles' Fracture Treatment
A definition of Colles' Fracture (broken wrist)
A Colles'’ fracture, or a distal radius fracture of the wrist, often occurs when attempting to “catch yourself” during a fall and landing on the palm of the hand. Common symptoms include: wrist pain, swelling, and deformity of the wrist. To correct the damage to a bone, the wrist may need to be immobilized in a cast for a period of time, which eventually causes wrist stiffness and a limited range of motion. Rehabilitating the wrist takes time and often the patient can be left with limited movement as the bone and soft tissue repair. To restore full range of motion after a patient is cleared for passive range of motion therapy, the use of a dynamic splint 6-8 hours a day or night will speed recovery and provide a plastic, permanent stretch. If you have had a Colles’ fracture, you may want to consider wearing a wrist rehabilitation device like a Dynasplint® System to aid in the recovery process.
Colles' fractures are very common, often occurring following a fall when an individual attempts to “break” the fall by stretching their arms in front of them. The force of the fall on the outstretched arm often results in the radius being broken near its distal end (the end closer to the wrist). Car and bike accidents and skiing accidents are also common causes. Colles' fractures gained their common nickname from the surgeon who first described the fracture in 1814, Irish physician Abraham Colles.
Colles' fractures cause immediate pain following injury, as well as swelling, tenderness and eventual bruising. In some cases, the wrist may be bent in an odd way, or may appear to be positioned “unnaturally.”
In addition to physical examination, x-rays are used to determine whether or not a fracture exists, and to determine the overall extent of the fracture. In most cases, the fracture is located within an inch or so of the bone end; however, the break may occur in different ways. These variations help physicians classify the fracture, which in turn can help determine the best course of treatment. Most Colles' fractures can be divided into four categories:
- Extra-articular: a fracture that does not extend into the wrist joint
- Intra-articular: a fracture that extends into the wrist joint
- Open fracture: a fracture that pierces the skin
- Comminuted fracture: a fracture that results in more than two pieces of bone
Individuals with osteoporosis (lower bone density) are more likely to incur Colles' fractures, and can sustain fractures even from seemingly minor injuries.
Colles' Fracture Physical Therapy
Colles' fractures may be treated with or without surgery. Whether or not surgery is required will depend largely upon the type and extent of the fracture. X-rays can help the orthopedist determine which type of procedure offers the best option.
Many fractures may be successfully treated using a plaster cast or splint. When the bone ends are not properly aligned, the fracture will need to be realigned or “reduced.” Even when casting is used, often a splint is employed for several days after the injury to allow initial swelling to subside before the cast is put in place. As swelling decreases over the first several weeks, the cast may become loose and require changing.
X-rays may also be taken during the initial weeks of healing, especially in cases where the fracture was reduced, to ensure the bone is healing properly. Most casts are removed after six weeks and a splint or brace may be used following cast removal to provide additional support for the arm during healing and while Colle's Fracture physical therapy is under way.
In some cases, especially when the bone is so misaligned that a cast is not sufficient to result in proper healing, surgery may be required to realign the bone and position it properly for healing. Two primary surgical approaches are used when treating Colles' fractures: closed reduction and open reduction internal fixation. In closed reduction the fracture is realigned in the operating room without need for an incision. In an open reduction procedure, an incision is made so that the surgeon may access the area of the fracture and reposition the ends of the bone to ensure the best healing position possible. When necessary, the bones may be held in place using pins, a plate and screws, an external device called an external fixator; or a combination of these.
Following surgery, the arm may be placed in a cast or a splint or bracing device may be used to keep the arm stable during the first six or more weeks of healing. Physical therapy will help the arm to return to normal levels of flexibility and range of motion. A dynamic splint may be added to the recovery protocol to regain range of motion more quickly.