Emergency Medicine

Orthopaedic Emergencies 289

INJURIES TO THE WRIST AND HAND

3 X-ray demonstrates the distal radial fracture, with an associated avulsion of
the ulnar styloid process in up to 60% of cases.

4 Delayed complications of Colles’ fracture include malunion, post-traumatic
ref lex sympathetic dystrophy (Sudeck’s atrophy), acute carpal tunnel
syndrome, shoulder stiffness or a ‘frozen shoulder’ and late rupture of the
extensor pollicis longus.

MANAGEMENT

1 Treat undisplaced or minimally displaced fractures, particularly in the
elderly, directly with a Colles’ backslab, without manipulation.

2 Displaced, angulated fractures with radial deviation require reduction to
promote optimal return of function and to reduce the delayed complica-
tions.

3 Options for reduction include procedural sedation, Bier’s block, axillary
nerve block, haematoma block or general anaesthesia, according to depart-
mental policy.

4 Bier’s block technique of intravenous regional anaesthesia (see p. 488).
(i) Rest the patient for at least 2 h after completion while regular
observations are made. Allow home with an accompanying adult
if the plaster is comfortable and the patient feels well.

5 Colles’ reduction and immobilization
(i) Prepare a 20 cm width plaster slab measured from the metacarpal
heads to the angle of the elbow. Cut a slot for the thumb and
remove a triangle to accommodate the final ulnar deviation (see
Fig. 9.2a, b).

Figure 9.2 Colles’ plaster of Paris backslab
(a) and (b) the backslab is prepared by trimming to permit thumb movements, full elbow
flexion and to allow for the final ulnar deviation of the wrist; (c) the backslab in position.

(a) (b) (c)