Patient education and supervision can be provided by physiotherapists or by the treating physician.
In the majority of patients, DRF does not cause any limitations to daily activities and support, patient education, and supervision for active and passive mobilization exercises is sufficient in most cases. In the latest Cochrane review of the rehabilitation of DRF, the authors stated that the evidence is insufficient to draw any conclusions and that further RCTs are warranted.
Generally, the scientific evidence for rehabilitation protocols has been rated as very low quality, and thus most of the recommendations are based on expert opinions. The focus of DRF rehabilitation is to minimize the functional limitations caused by the fracture and treatment. These limit values are in accordance with the findings of previous studies for a good outcome. Joint gap or step-off less than 1 to 2 mm. Radial shortening less than 2 to 4 mm and According to the current literature, the suggested acceptable values during non-operative treatment in persons younger than 65 years are as follows: 48, 49 Periodical (every 1–2 weeks) radiographs have been used to check the fracture position.
Colles fracture splint position trial#
47 However, a recent randomized controlled trial (RCT) shows no difference in three versus five weeks of cast treatment after minimally displaced DRF, although another recent RCT contradicts these findings. Traditionally, non-operative treatment has comprised the reduction of the fracture near to the anatomical position, followed by immobilization with a functional position cast for four to five weeks. Unfortunately, the literature regarding non-operative treatment is both confusing and scarce. Regardless of the treatment method, some patients will still have pain and stiffness to some extent. The aim of treatment is to recover function to a level as close as possible to the level preceding the fracture. Wilcke and colleagues observed that when dorsal angulation was over 10° to 15°, radioulnar inclination was under 15° and the radius was shortened by more than 2 to 3 mm, the poor functional outcome was both statistically significant and clinically important in patients aged under 65 years when results were measured using Disabilities of Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Visual Analogue Scale (VAS). However, the role is not as clinically important as compared with the shortening of the radius. 39, 40 Possible dorsal angulation may also have an effect on functional outcome. In addition, over 2 mm step-off or gap may also cause similar problems in elderly patients. 40, 41 It seems, however, that over 1 mm step-off or gap on the joint line significantly increases the risk of secondary osteoarthritis and may cause prolonged pain and stiffness in younger patients. 36– 39 In younger patients, a shortening of the radius of more than 3 mm may cause functional deficit in terms of prolonged pain, reduced range of motion (ROM) and decreased grip strength. Shortening of the radius, articular step-off and gap in the joint line are the most significant radiological predictors of poor functional outcome. Radiological factors that predict functional outcome However, with Colles’ fracture, there is no classification to help in predicting instability. Smith’s and Barton’s fractures are generally considered to be unstable, warranting operative treatment in most cases.
These classifications can help to distinguish between different fracture patterns. In clinical practice, fractures are commonly classified as Colles’ fracture ( Fig. However, the utility of these in clinical practice is modest since patient characteristics, such as age, are not taken into account. Articular surface unity and fracture comminution are important factors in these classification systems. These classification systems are commonly based on radiographs, fracture pattern and injury mechanism. Several classification systems, such as the AO and Fernandez and Frykman classifications 20– 22 exist for DRFs. 15– 17 If injury of the carpal ligaments is suspected, CT or high-resolution magnetic resonance imaging may be beneficial before a final treatment decision is made. Soft tissue injuries have been shown to be present in approximately 31% of cases, 15 and they may have an effect on treatment decisions. 13, 14 The clinical examination of soft tissues in the wrist and hand is also important. However, computed tomography (CT) 13 may yield additional benefits in evaluating the articular surface and comminution of the fracture, which may be a risk factor for osteoarthritis of the radiocarpal joint. The gold standard in DFR diagnostics is anterior-posterior and lateral radiographs.
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