[Method of functional treatment of distal radius fractures]

PURPOSE OF THE STUDY To present the method of functional treatment of distal radius fractures, and to evaluate its results in a group of 57 patients. MATERIAL The method described here was used to treat a Colles fracture in 57 patients between 2001 and 2005. The average age of patients at the time of injury was 62 years (range, 19 to 82). The minimal interval between the end of treatment and the evaluation of the patient group was one year. METHODS The presented method is based on the principles of functional treatment of wrist fractures, as advocated by Sarmiento et al. When the patient has been indicated for this treatment, the arm is immobilised in a classic rigid cast. This cast is changed three weeks after application for a cast permitting full palmar flexion and full ulnar deviation. The cast is removed when callus formation is detected and the fracture site is free of pain. During this treatment, much attention is paid to skin condition, with an emphasis on preventing the development of Sudecks algoneurodystrophy. RESULTS This method of functional treatment resulted in complete fracture healing in all patients. None of them required hospitalization. The total period of immobilization was on average 45 days, ranging from 41 to 57 days. On subjective evaluation the patients regarded both the course and the result of treatment as good. DISCUSSION In this paper the authors address the permanent conflict between concepts of surgical and conservative therapy. Their results fully support the fact that the freedom of motion of all joints for a greater part of treatment is necessary for healing as well as prevention of a subsequent restriction of the range of motion. They also provide evidence that this modified method facilitates healing without complications. The patients were satisfied with the outcome of treatment; there was no poor result reported. CONCLUSIONS The method of functional treatment for distal radius fractures is an effective procedure allowing for good bone healing with a minimum of complications. In addition, the treatment can almost exclusively be carried out in an out-patient department. The mechanism promoting the process of osteogenesis in its course is not known yet. However, it has to be mentioned that the method is time-consuming for both the physician and the patient. Key words: distal radius fracture, functional treatment, Sarmientos method.