312 THE JOURNAL OF BONE AND JOINT SURGERY THE TREATMENT OF COLLES ’ FRACTURE IMMOBILISATION WITH THE WRIST DORSIFLEXED

In a prospective study, 204 consecutive patients with displaced Colles ’ fractures had closed reduction then plaster immobilisation. Three different positions ofthe wrist in plaster were randomly allocated: palmar flexion, neutral and dorsiflexion. The results in the three groups were compared. Fractures immobilised with the wrist in dorsiflexion showed the lowest incidence of redisplacement, especially of dorsal tilt, and had the best early functional results. Immobilisation of the wrist in palmar flexion has a detrimental effect on hand function; it is suggested that it is also one of the main causes for redisplacement of the fracture. This is discussed in relation to the functional anatomy of the wrist and the mechanics of plaster fixation. Colles ’ fracture is a very common injury, but there is no agreement on the best way of treatment. A wide variety ofmethods have been described, including reduction and immobilisation of the wrist and forearm in various positions, percutaneous pinning, external fixation and open reduction with internal fixation. Although a Colles ’ fracture can usually be reduced quite easily, it is difficult to maintain the reduction, especially where there is comminution or intra-articular extension. Gartland and Werley (1951)reported that 60% oftheir patients healed in an unreduced position. When the wrist is immobilised in palmar flexion, there is a risk ofstiffness ofthe fingers, and especially the metacarpophalangeal joints. This is a common compli-cation (Gartland and Werley 1951; Bacorn and Kurtzke 1953). Dorsiflexion is the best functional position for the hand, so it was decided to evaluate and compare the results of immobilisation of Colles ’ fractures in three different positions of the wrist joint: palmar flexion, neutral and dorsiflexion. PATIENTS AND METHODS A prospective study was made of204 consecutive patients with displaced Colles ’ fractures at LNJP Hospital, New Delhi from June to November 1986. Of these, 60 wer