A comparative study of management of Colles fracture by closed reduction with cast versus closed reduction with internal fixation (K-wires/4 mm CC screws)

Background: Distal radius fracture is extremely common and represents 16% of fractures treated by orthopaedic surgeons. Near anatomical reduction with restoration of radial length, radial tilt and ulnar variances are important for good functional results. A variety of treatment options have been proposed for distal radius fracture closed reduction and immbolization in cast has been the main stay of treatment, but because it invariably results in malunion, poor functional outcome and cosmetic outcome, other modality of treatment were brought into practice like percutaneous intrafocal pinning, transulnar percutaneous pinning, external fixation, plating etc. This comparative study was to compare the clinical outcomes of closed reduction with cast and closed reduction with Percutaneous Kirschner wiring (PKW)/canullated cancellous screws (CC screws 4 mm)for the management of Colles fractures in patients between 20 and 70 years old. In this study we did an prospective study in 40 patients with extra articular distal radius fracture treated by both closed reduction with cast and closed reduction internal fixation (PKW/CC screws).Methods: There were 20 patients with Colles fractures treated by closed reduction with cast and 20 patients treated with closed reduction internal fixation (PKW/CC screws). We compared both the managements together. All patients were followed up in the orthopaedic department prospectively for at least 12 months between June 2015-June 2016 The functional outcomes and radiological results were compared between the two groups.Results: The study included 40 patients, aged between 20 to 69 yrs. Average follow up was 12 months. Using the demerit scoring system of Gartland and Werley we had excellent to good results of 60% in closed reduction internal fixation compared to closed reduction with casting excellent to good was 10%.Conclusions: The percutaneous pinning/cc screws and immobilization in neutral position for 3 weeks followed by physiotherapy proved to be better and simple procedure for extra articular non comminuted distal radius fractures.