To reduce a fracture of the distal radius (Colles’ fracture), grasp the hand with one hand while holding the wrist with the other. Make countertraction as you apply traction on the hand, inclining it to the ulnar side and applying pressure upon the fragments. This combined traction, pressure, and ulnar flexion will quickly reduce the fracture. Proper reduction is crucial for preventing recurrence of deformity.
<Callout type="important" title="Critical Step">Proper reduction of Colles’ fractures requires bringing the head of the ulna back to rest in the sigmoid notch of the radius.</Callout>
Andrews emphasizes the necessity of general anesthesia and knowledge of anatomy for successful reduction. Early passive motion may cause irritation, but gentle massage is recommended after fixation.
Fractures of the olecranon are usually due to direct violence or muscular action. Treatment involves suturing if possible, followed by immediate massage without immobilization. If asepsis can be assured, suture is indicated for compound fractures. The bone is exposed and fragments are separated and cleansed before being secured with silver wires.
<Callout type="warning" title="Risk of Mistake">Thinking the fracture set when merely the lower fragment of the radius is in position is a common mistake that can lead to deformity after union.</Callout>
For fractures of the carpus and hand, reduction may be accomplished by patting the hand on ulnar flexion and making pressure on the fragments through the palm. Excision may be necessary if non-union occurs.
Fractures of fingers often require careful antisepsis due to a tendency towards displacement after reduction. Splinting is usually necessary for maintaining proper alignment, but modern techniques offer better control over deformity.
Key Takeaways
- Proper reduction of Colles’ fractures is crucial to prevent recurrence of deformity.
- General anesthesia and knowledge of anatomy are essential for successful reduction of complex fractures.
- Immediate massage without immobilization is recommended after suturing olecranon fractures.
Practical Tips
- Use gentle massage instead of passive motion immediately after reducing a Colles’ fracture to avoid irritation.
- Ensure proper alignment when treating finger fractures by using modern splinting techniques that provide better control over deformity.
Warnings & Risks
- Failing to properly reduce the head of the ulna in Colles’ fractures can result in permanent deformities such as dumping forward of the ulna and widening of the wrist.
- Thinking a fracture is set when only the lower fragment is aligned can lead to significant complications after union.
Modern Application
While some surgical techniques described here are outdated, the principles of proper reduction and immobilization remain crucial. Modern medical advancements have improved anesthesia and sterilization methods, but understanding historical approaches provides valuable context for emergency situations where advanced facilities may not be available.
Frequently Asked Questions
Q: What is the importance of bringing back the head of the ulna in Colles’ fractures?
Bringing the head of the ulna back to rest in the sigmoid notch of the radius ensures proper alignment and prevents deformities such as dumping forward of the ulna and widening of the wrist.
Q: Why is early massage recommended after reducing a Colles’ fracture?
Early gentle massage helps prevent irritation and promotes healing without causing unnecessary suffering or increasing callus formation, which can hinder recovery.
Q: What are the treatment options for fractures of the olecranon?
Treatment involves suturing if possible, followed by immediate massage without immobilization. If asepsis is assured, suture is indicated for compound fractures to ensure proper alignment and healing.