Colles Fracture

A Colles fracture is a distal radius fracture with dorsal displacement and angulation of the distal fragment, usually after a fall on an outstretched hand. Obtain wrist radiographs and assess whether the injury is extra-articular or extends into the radiocarpal or distal radioulnar joint; involvement of the sigmoid notch can alter distal radioulnar joint biomechanics and may lead to pain, instability, or restricted forearm rotation if healed with a step or gap. PubMed+1PubMedColles Fracture - StatPearls - NCBI BookshelfNatureEstablishment and preliminary evaluation of CT-based classification for distal radius fracture | Scientific Reports

Before and after any manipulation, record digital perfusion and a focused neurologic examination, particularly median nerve function. Open fracture, neurovascular deficit, marked displacement, and unstable fracture morphology are indications to move beyond routine outpatient cast management and consider operative stabilization. PubMedPubMedPerioperative management of distal radius fractures

Place an acutely displaced fracture on a reduction pathway when restoring alignment is feasible and subsequent treatment depends on post-reduction radiographs. Splint after reduction rather than applying a circumferential acute cast when swelling risk is material; excessive pain, finger paresthesias, or digit discoloration in immobilization requires immediate reassessment for a constrictive splint or cast. PubMedPubMedColles Fracture - StatPearls - NCBI Bookshelf

For non-geriatric adults, the AAOS/ASSH guideline supports operative treatment when post-reduction radial shortening exceeds 3 mm, dorsal tilt exceeds 10 degrees, or intra-articular displacement or step-off exceeds 2 mm. These thresholds are decision aids after reduction, not an indication to operate on every radiographic deformity without considering injury pattern and patient goals. PubMedPubMedAAOS/ASSH Clinical Practice Guideline Summary Management of Distal Radius Fractures

For patients 65 years and older, operative fixation does not improve long-term patient-reported outcomes compared with nonoperative treatment, despite better radiographic results. Casting has the least complications and comparable functional outcomes in elderly trial populations, whereas radiographic alignment after closed reduction and the patient's functional demand should determine whether operative stabilization is worthwhile. PubMed+1PubMedAAOS/ASSH Clinical Practice Guideline Summary Management of Distal Radius FracturesBMJEULAR/EFORT recommendations for management of ...

In an adult with a closed extra-articular Colles fracture, closed reduction and casting are generally reasonable when residual deformity is limited. One clinical reference uses no more than 5 mm shortening, 5-degree change in radial inclination, 2 mm articular step-off, and 5 degrees angulation as eligibility parameters for closed reduction as primary treatment; use this alongside the AAOS/ASSH thresholds and the patient's age and functional requirements. PubMed+1PubMedDistal Radius Fractures - StatPearls - NCBI BookshelfPubMedAAOS/ASSH Clinical Practice Guideline Summary Management of Distal Radius Fractures

Closed reduction and plaster immobilization remain the primary noninvasive approach for extra-articular distal radius fractures. Immobilization commonly lasts 3 to 6 weeks, but non- or minimally displaced fractures that did not require reduction may safely undergo only 1 week of plaster immobilization in selected patients; shorter immobilization may improve function and return to daily activities. ScienceDirect+1ScienceDirectThe past, present and future of the conservative treatment ...PubMedTreatment options in extra-articular distal radius fractures: a systematic review and meta-analysis - PMC

For a stable fracture, consider cast removal at 4 weeks to permit early mobilization. Do not obtain an x-ray solely at cast removal unless symptoms or examination create concern; routine repeat imaging is reserved for unstable patterns in which a changed position would lead to surgical intervention. PubMedPubMedPerioperative management of distal radius fractures

At each cast or splint assessment, ask specifically about escalating pain, numbness or tingling, and finger color change. These findings require immediate examination of the immobilization and neurovascular status rather than reassurance or delayed routine follow-up. PubMedPubMedColles Fracture - StatPearls - NCBI Bookshelf

When operative stabilization is selected, perform surgery within 72 hours for intra-articular distal radius fractures and within 1 week for extra-articular fractures. More displaced and unstable fractures generally warrant open reduction and internal fixation, while simpler patterns may be treated with percutaneous K-wires; external fixation is an additional option in selected patterns. PubMedPubMedPerioperative management of distal radius fractures

Volar locking plate fixation provides stable fixed-angle support, direct reduction, and permits early active wrist rehabilitation. It is particularly useful for comminuted fractures, osteopenic bone, and high-energy injuries, but its principal patient-centered advantage is earlier functional recovery in unstable or high-demand cohorts; longer-term outcomes may converge with nonoperative care. Wolters Kluwer+1Wolters KluwerVolar Fixed-Angle Plating of the Distal Radius : Journal of the American Academy of Orthopaedic SurgeonsScienceDirectAdults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication Prevention

Counsel specifically about plate-related complications before choosing volar fixation. Reported complications include flexor and extensor tendon injury, flexor pollicis longus rupture, carpal tunnel syndrome, complex regional pain syndrome, loss of reduction, and hardware failure. New pain, tendon dysfunction, median neuropathy, or concern for mechanical failure after fixation should trigger focused examination and radiographic assessment. Wolters KluwerWolters KluwerComplications of Volar Plate Fixation for... : Journal of the American Academy of Orthopaedic Surgeons

For nonoperative care, the highest-yield surveillance question is whether a fracture likely to redisplace remains acceptably aligned when a change would lead to fixation. Schedule the 1- to 2-week radiograph only in that circumstance; stable fractures can proceed toward early mobilization after cast removal without routine imaging. PubMedPubMedPerioperative management of distal radius fractures

After volar plating, evaluate new volar wrist pain, thumb-flexion weakness or loss, extensor dysfunction, paresthesias, disproportionate pain, and mechanical symptoms as possible tendon injury, flexor pollicis longus rupture, carpal tunnel syndrome, complex regional pain syndrome, or hardware failure. These complications are recognized risks of plate fixation and should prompt targeted surgical reassessment rather than routine observation. Wolters KluwerWolters KluwerComplications of Volar Plate Fixation for... : Journal of the American Academy of Orthopaedic Surgeons

Functional recovery should be assessed against the patient's hand-use requirements rather than radiographs alone. In older adults, a less anatomic radiographic result after casting may still yield function comparable to surgery, while a high-demand patient may reasonably value the earlier recovery permitted by stable operative fixation. BMJ+2BMJEULAR/EFORT recommendations for management of ...ScienceDirectAdults Closed Distal Radial Fractures: Current Concepts in Treatment Selection and Complication PreventionWolters KluwerVolar Fixed-Angle Plating of the Distal Radius : Journal of the American Academy of Orthopaedic Surgeons