Distal Radial Fractures

Distal radial (Colles') fractures are among the most common fractures in the elderly. They occur when the dorsal trabecular bone of the distal radius collapses inward, resulting in angulation and shortening. The cause is usually a fall on an outstretched hand. Patients present with pain, tenderness, and swelling of the wrist.

Prognosis and Treatment

The severity of the fracture and need for reduction are assessed on x-ray. The prognosis is better when the radial styloid has been shortened < 0.5 cm (< 0.2 inches) compared with the ulna on the anteroposterior view and when dorsal tilting of the distal radius articular surface does not exceed neutral on the lateral view.

Active, fully independent patients should receive aggressive treatment for optimal results. Generally, for less active patients living in an assisted care setting, the fracture is immobilized for a few weeks, after which patients are encouraged to use their hand in daily activities.

Patients who have minimally displaced distal radial fractures or few functional demands are treated with a short arm cast or splint. When a fracture requires closed reduction, anesthesia is necessary. A local injection of lidocaine with hematoma aspiration may be sufficient, but regional (axillary block) or IV general anesthesia is better for relaxation and analgesia. Fractures with significant shortening or intra-articular comminution may require external fixation. The cast is usually worn for 3 to 8 weeks, depending on the fracture's stability and the patient's functional status.

Pain, stiffness, and weakness gradually diminish for 6 to 12 months after the fracture. Moving the fingers, elbow, and shoulder prevents stiffness of the fingers and shoulder, the most common complications. Elevating the hand above heart level minimizes swelling. Symptoms of carpal tunnel syndrome may develop. Physical therapy can help speed recovery.