A Study of Conservative Treatment for Colles’ Fractures Using the Novel Classification by Lateral Radiographic View

Abstract

Objective: The objective of this study is to elucidate the changes in radiographic parameters over time in conservative treatment of Colles’ fractures. Participants and Methods: The participants were 60 patients with Colles’ fractures (60 wrists) that were treated conservatively. They were l3 males and 47 females with a mean age of 72.5 years (range, 55-96 years). Based on the AO Foundation and Orthopaedic Trauma Association (AO/OTA) fracture and dislocation classification, the numbers of patients with type A2, A3, Cl, C2, and C3 fractures were 33, 5, 5, l2, and 5, respectively. The cause of injury was limited to a fall from eye height, and we excluded patients with a concurrent fracture of the distal ulnar metaphysis and patients with comminution of the palmar cortex. All the patients underwent manipulative reduction immediately after diagnosis. We focused on the palmar cortex in lateral radiographic views to classify the fractures into the intramedullary type, the anatomical type, and the extramedullary type, and measured the palmar tilt (PT), radial inclination (RI), and ulnar variance (UV) at the time of injury, immediately after reduction, and in final observation. Statistical Analysis: We analyzed the correction loss of PT, RI, and UV by Tukey-Kramer after one-way analysis of variance (ANOVA). Results: The fracture types immediately after reduction were the intramedullary type in 11 patients, the anatomical type in 42 patients, and the extramedullary type in 7 patients. The correction loss in PT and in RI was negative in each group, with no significant differences among the 3 groups, whereas UV was positive in each group. The correction loss was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group. Conclusion: We analyzed radiographic parameter changes over time associated with reduced position in the conservative treatment of Colles’ fractures. The correction loss in UV immediately after reduction until the final observation was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group.