The treatment of Colles’ fracture remains controversial. Non-operative and operative measures have been recommended. This study almost takes a step backward and looks at a randomized prospective multi-center trial comparing a conventional plaster cast versus a pre-fabricated functional brace (Aberdeen Colles’ fracture brace). The brace maintains reduction by 3-point fixation, as described by Charnley. It consists of a pre-fabricated construct, including two pieces of plastic connected by Velcro straps. The brace is applied over a layer of stockinette and “plaster wool.” The Velcro straps are tightened, which provides 3-point loading. Five different trauma centers participated in the study. Only patients over 18 years of age, with a unilateral Colles’ fracture, were included. A total of 151 patients had minimally displaced fractures, which did not require manipulation, and 188 patients had displaced which needed manipulation. Displacement was defined as dorsal angulation greater than neutral, greater than 3mm of shortening, and loss of more than 4° of radial inclination. A total of 170 patients were treated by conventional cast and a total of 169 patients were treated by the Aberdeen brace. In the displaced group, radiographs were taken 7-10 days after injury. If the reduction was satisfactory, then treatment was continued. If the reduction was unsatisfactory, then manipulation was performed and the initial method of treatment was still followed. The cast or brace was removed 5-6 weeks after injury, and independent assessment was made consisting of both radiologic measures and functional assessment similar to a modified Gartland and Werley scoring system. Only ten patients were excluded from follow-up measurements.
In general, young patients, and those with less initial displacement, had better results. Gender and hand dominance played no relationship in the functional outcome. Patients who underwent manipulation had a lower grip strength than those that did not require manipulation. Patients treated with the brace, in both the manipulated and non-manipulated groups, had higher grip strength than those treated by cast early on in the treatment regimen and at both 5 and 8 week follow-ups. At 12 weeks, their grip strength was the same in both treatment groups. Most importantly, there is no difference between the groups treated with a plaster cast and the group treated with the brace, with reference to mean functional scores and mean anatomic scores at follow-up.
This article presents support for “less is better” with regards to treatment of Colles’ fractures. The pre-fabricated fracture brace applies 3-point load that aims to maintain the fracture reduction, prevent swelling of the hand by avoiding circumferential pressure, and allow movement of the wrist. There was little difference between the groups treated with plaster immobilization compared to the group treated with a fracture brace. In general, good outcome was accomplished in all groups, similar to the adage of Abraham Colles. A major flaw of the study is a failure to indicate the severity of intraarticular involvement of the fractures, which may be a confounding factor. Certainly, intraarticular step-off may lead to an acceptable early post-operative outcome, but years down the road may lead to traumatic arthritis. Nonetheless, this article provides an interesting twist in the treatment of distal radius fractures.
J Bone Joint Surg