Treatment

A displaced fracture should be reduced under appropriate anaesthesia such as:

• Bier's block
• axillary block
• general anaesthesia

Disimpaction is achieved by pulling the hand distally and hyperextending the wrist. Once the fracture has been reduced, the wrist is manipulated into a position of palmar flexion, ulnar deviation and pronation.

• a plaster is applied which extends from elbow to the metacarpophalangeal joints, which lie in the line of the proximal skin crease in the palm and not at the base of the fingers. This arrangement permits thumb and finger movements as well as elbow flexion.

The patient is given a sling with instructions to actively exercise the fingers, elbow and shoulder.

The fracture should be inspected the following day to check that the plaster is not too tight. A further appointment should be made in 7-10 days. Re-displacement is not uncommon and requires re-reduction.

The fracture should have united by about 6 weeks.

Undisplaced or minimally displaced fractures may be treated directly with a Colles' backslab.

Severely comminuted and unstable fractures may require external fixation. Designs such as the Pennig fixator incorporate a jointed body so permitting early movement.