If the pain is severe or the wrist looks deformed (the bone is sticking out or you think it might have fractured in more than one place) you should go to the hospital immediately. Do not eat or drink anything (even water) if your wrist is malformed and likely to need to be put back into place (closed reduction). In that case, anesthesia will need to be administered and you might experience nausea that would cause you to vomit during or right after the reduction.
If there is paleness or lack of mobility of the fingers, the fracture will require a visit to the doctor. Those with Colles fractures also usually have a history of a fall, usually in which they used an outstretched hand to brace themselves for the fall. This may include high impact trauma in a younger patient or lower impact trauma in an older osteoporotic adult.
For example, if a ruler runs the length of your hand, wrist, and most of your forearm, use a ruler as a splint. A folded length of newspaper that runs past your elbow and to the middle joints of your fingers works as well. The general rule for splinting is that the joint above the fracture (ie: the elbow) and all the joints below (fingers and thumb) need to be immobilized to protect the fracture. Bear this in mind when splinting.
Pad the hollow areas between your arm, wrist, fingers etc and the splint to make sure the fracture is supported and not deformed by the wrapping.
If you don’t have gauze or an Ace bandage on hand, you can use a scarf or bandanna to keep your wrist in place against the splint. Work from above the break down. Check the circulation in your fingertips after wrapping by pressing on the fingernail. If the color does not return promptly, loosen the bandage and re-wrap.
Don’t place ice directly on the skin. You should already have your wrist wrapped, so this shouldn’t be an issue. You can leave the ice pack on your wrist for up to 10 minutes, then give your skin a chance to return to its normal temperature.
Do not do this, however, if your wrist is malformed and likely to need to be put back into place (closed reduction). In that case, anesthesia will need to be administered and having pain medication in your system can interfere with that. If you choose to take pain medication anyway, be sure to inform your doctor.
You can also make a sling out of a scarf or other piece of clothing.
There are several classifications of Colles fractures, depending on the severity of the injury. Colles fractures are referred to as: Type I: extra articular and non-displaced, Type II: extra articular and displaced, Type III: intra articular and non-displaced, and Type IV: Intra articular and displaced. [10] X Research source Clifford Wheeless MD. , The Wheeless Textbook of Orthopaedics: Colles Fractures , last updated Dec 12 2012 The criteria that define a break as a Colles fracture include: transverse fracture of the radius, the fracture occurs within 2. 5 cm proximal to the radio-carpal or wrist joint, and dorsal or posterior displacement and dorsal angulation with a radial tilt. [11] X Research source Sanjay Meena MD, Sharma Pankaj MD, Ashok Dawar MD, Fractures of the Distal Radius: An Overview, Journal of Family Medicine and Primary Care 2014 Oct-Dec 3 (4) 325-332)
You will be given anesthesia if you have to have the bones in your wrist repositioned. However, keep in mind that this procedure doesn’t require surgery. Your doctor is essentially just popping your wrist back into place. You might have to wear a splint for a couple of days to deal with the swelling in your wrist before getting a proper cast. There are some newer casting technologies which allow for the structural integrity and durability of a cast, while still allowing for a degree of airiness and the and ability to bathe normally. Closed reduction would be appropriate for Types I, II fractures certainly, and may be appropriate for Type III fractures. ( Diaz-Garcia, 2012). In recent studies, there are few differences in comparison of non-operative and operative management of Colles fractures. [14] X Research source Rohit Arora MD, Markus Gabl MD, Martin Gschwentner MD, A Comparative Study of Clinical and Radiographic Outcomes of Unstable Colles Fractures in Patients older than 70 years: Nonoperative versus Volar Locking Plating, Journal of Orthopaedic Trauma, April 2009, Vol 23 issue 4 p 237-242). In elderly patients with distal radius fractures, those who received treatment with closed reduction (moving the bone back into place manually) with casting alone had equal functional status scores and significantly decreased pain scores. In patients who reported excellent functional status, 77% had a notable visual deformity the “dinner fork deformity” often seen in this fracture. This deformity did not correspond with poor functional outcome, or patient dissatisfaction. Persistent pain was correlated with patient dissatisfaction and surgical treatment.
This will occur if a closed reduction does not result in satisfactory use of the wrist, there is a “shortening” of the radius of greater than 5 mm, or it is a comminuted fracture with greater than 3 fracture fragments of the radius. With surgery, the fracture is placed back together with tiny plates and screws to achieve an anatomically superior result. The extremity will still be placed in a splint or cast and monitored sequentially during the 6 week healing period. This approach would be typically considered more favorable in younger patients. A superior radiographic outcome is not always correlated with a superior functional outcome, but it is always the goal, set out upon when repairing these fractures. During the operation, you will be asleep (under general anesthesia) and your bones will be straightened, placed correctly and held together with pins, plates and/or screws specifically designed for use in bone. After surgery your wrist will be placed in a splint or cast to prevent it from moving. [15] X Research source Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin. 2005; 21:279. Complications are not dependent on treatment method selected, but due to the trauma sustained. Specific complications include: the presence of a cosmetic “dinner fork” deformity, median nerve palsy or weakness also called post traumatic carpal tunnel syndrome, or Reflex Sympathetic Dystrophy (RSD) or Chronic Regional Pain Syndrome. This occurs as a result of injury to the median nerve from compression due to swelling, or lack of blood flow, secondary to a compartment like syndrome. [16] X Research source Sanjay Meena MD, Sharma Pankaj MD, Ashok Dawar MD, Fractures of the Distal Radius: An Overview, Journal of Family Medicine and Primary Care 2014 Oct-Dec 3 (4) 325-332).
You can do this by sitting in a chair and propping your wrist up with pillows. Reclining chairs work the best, but any chair or sofa will do.
Some doctors advise placing a towel over the plastic bag as an extra precaution. You may want to ask a family member or friend to help you bathe or shower.
As an added protection, always wear your sling when you go out in public because it will keep it from moving when you walk and will alert others to the fact that you have an injury and they should make an effort not to bump into you.
The therapist will also give you exercises that you can perform at home on your own. The more you practice the exercises as directed by your therapist, the faster you will regain function of your wrist.
