The handshake technique: proposal of a closed manual reduction technique for Colles’ wrist fracture

Salvi, Andrea Emilio

doi:10.1016/j.ajem.2009.09.033

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Initial treatment of the fracture is aimed at restoring anatomical alignment and maintaining this alignment until the fracture has healed. 14,18 Management of most Colles' fractures is commonly carried out in the form of closed reduction and plaster cast immobilisation. 19 Reduction of a fracture is a painful procedure which requires anaesthesia, of which many methods have been used in the past.…”

Section: Initial Managementmentioning

confidence: 99%

“…It involves similar manoeuvres to traditional manual manipulation, however it ensures that the wrist is not hyperflexed, which could endanger the median nerve as well as increasing the rate of redisplacement. 18 Once reduced, the fracture must be immobilised in this position. Traditionally, circumferential casting and splinting are the immobilisation of choice.…”

Section: Initial Managementmentioning

confidence: 99%

“…18 Wrist flexion locks the articulation at the wrist joint, ensuring that ulnar deviation occurs at the fracture site, maintaining alignment of the distal radial articular surface. 18 Several techniques for reduction have been attempted, ranging from the finger-trap method to manual manipulation. No one technique has been shown to be superior in terms of functional outcome at the end of treatment.…”

Section: Initial Managementmentioning

confidence: 99%

Section: Initial Managementmentioning

confidence: 99%

“…12 When satisfactory reduction and immobilisation has been performed, the patient should have a follow up in fracture clinic, 14,26 with advice to maintain a vertical position of the hand and active movement of the fingers to reduce swelling and stiffness. 18…”

Section: Initial Managementmentioning

confidence: 99%

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Evidence-based review of Colles’ fracture

Habeebullah

Vasiljevic

Abdulla

2015

Trauma

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Background: A Colles' fracture occurs as a transverse fracture of the metaphyseal region of the distal radius, approximately 25-40 mm proximal to the radio-carpal joint, and is associated with dorsal displacement and angulation of the distal fragment. Other features include radial shortening and palmar tilt. Key radiological measurements usually noted are that of radial length (normally 11 mm), dorsal angulation of the distal radius (normally 10 volar angulation) and radial inclination (normally 22 ). A Colles' fracture is one of the most common types of osteoporotic fractures seen, especially in females above the age of 50. Incidence of men vs. women over the age of 35 was 9/10,000 vs. 37/10,000, respectively. Management: Conservative management is commonly an option in stable or minimally displaced fractures which are described as 2 mm loss of radial height, 5 change in radial inclination and 10 of dorsal angulation. This can be managed in a plaster cast for five to six weeks. Furthermore, age of >60 years was found to be the most important factor in predicting whether a reduced unstable fracture would redisplace.Kirschner-wire fixation is a useful and simple operative method to help stabilise fragments that are not severely comminuted. This option was found to be better than plaster cast management alone, but was associated with surgical complications such as infection and nerve injuries.A more common management option utilised for unstable fractures today is open reduction and internal fixation using either dorsal or volar plates. Dorsal plates are less commonly used due to increased risk of volar collapse and tendon rupture with up to a 22% removal of implant rate due to tendon irritation. Volar plates are more popular as they allow a more stable fixation and thus early mobilisation with a better radiological outcome when compared against K-wire fixation. They are also associated with a lower incidence of tendon complications.External fixation management options may either be bridging or nonbridging in regards to the radio-carpal joint. Immobilising the wrist with a bridging external fixation device can be an option when managing a severely comminuted fracture without a large enough distal fragment to secure a distal pin. However, dorsal malunion was six times more likely when compared against a nonbridging option. Though studies showed external fixation devices provided better radiological outcomes when compared to conservative management, there is insufficient evidence to conclude that long-term functional outcomes are also improved. Prevention: Often a fracture of this nature is considered as one of the first signs of osteoporosis in a middle-aged adult. Hormone replacement therapies and use of bisphosphonate therapy have been proven to reduce the risk of osteoporotic fractures with alendronate being found to significantly reduce the risk of spine, hip and wrist fractures in postmenopausal women with a mean age of 70 years. Incorporation of other health care professionals such as physiotherapists and occu...

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Section: Initial Managementmentioning

confidence: 99%

Section: Initial Managementmentioning

confidence: 99%