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Functional Classification of Joints
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Colles' fractures: functional treatment in supination.

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|June 20, 2014
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Treating Colles' fractures in supination reduces re-displacement compared to pronation. This study found supination immobilization yielded better outcomes for specific fracture types, suggesting it as a preferred method for distal radius fractures.

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Biomechanics

Background:

  • Abraham Colles described distal radius fractures, with traditional immobilization in pronation.
  • The brachioradialis muscle's pull can cause re-displacement in reduced Colles' fractures, especially with axial instability.
  • Post-reduction stabilization in supination is hypothesized to be more effective than pronation.

Purpose of the Study:

  • To compare the efficacy of immobilizing Colles' fractures in supination versus pronation.
  • To identify the optimal forearm position for reducing re-displacement and improving functional outcomes.
  • To evaluate the role of the brachioradialis muscle in fracture instability.

Main Methods:

  • A prospective study of 156 patients with Colles' fractures treated functionally.
  • Fractures were immobilized in either pronation or supination for approximately 11 days.
  • Radiological results were assessed using modified Lindstrom criteria, comparing supination and pronation groups.

Main Results:

  • No significant difference in functional results for non-displaced (Type I and III) fractures between groups.
  • Supination yielded superior results for displaced fractures (Type II and IV) compared to pronation.
  • Excellent or good functional results were achieved in 93% of the supination group versus 87% of the pronation group for all fracture types.

Conclusions:

  • Immobilization in supination leads to a lower incidence of re-displacement for Colles' fractures.
  • A novel forearm brace was developed to maintain supination and limit wrist/elbow motion.
  • Non-surgical treatment is preferred for most Colles' fractures, with surgery reserved for specific cases.