Sarmiento A, Pratt G W, Berry N C, Sinclair W F
J Bone Joint Surg Am. 1975 Apr;57(3):311-7.
The classic position of immobilization of Colles' fractures with the elbow in flexion, the forearm in pronation, and the wrist in volar flexion and ulnar deviation is probably the main reason for the common and rapid recurrence of the original deformity. Such a position places the brachioradialis muscle, a strong flexor of the elbow and the only muscle attached to the distal fracture fragment, in an ideal physiological position to exert a deforming force on the fracture fragments. Based on this assumption, further supported by electromyographic studies, a method of treatment was developed which calls for the initial immobilization of the arm in an above-the-elbow cast with the elbow in flexion, the forearm in supination, and the wrist inmoderate ulnar and volar flexion. This cast is changed a few days after application for an Orthoplast brace that permits motion of the elbow and volar flexion of the wrist while preventing pronation and supination of the forearm and dorsiflexion of the wrist. The proposed method did not prevent collapse of the fragments in all instances. However, the degree of collapse was minimum. The position of supination of the forearm and the freedom of motion of all joints seemed to reduce the swelling, stiffness, and incapacitation frequently found during active treatment of these fractures.
科莱斯骨折经典的固定姿势是肘部屈曲、前臂旋前、腕关节掌屈和尺偏，这可能是原始畸形常见且迅速复发的主要原因。这种姿势使肱桡肌（一种强大的肘部屈肌，也是附着于远端骨折碎片的唯一肌肉）处于对骨折碎片施加变形力的理想生理位置。基于这一假设，并得到肌电图研究的进一步支持，开发了一种治疗方法，该方法要求最初将手臂固定在上臂石膏中，肘部屈曲、前臂旋后、腕关节适度尺偏和掌屈。应用几天后，更换为Orthoplast支具，该支具允许肘部活动和腕关节掌屈，同时防止前臂旋前和旋后以及腕关节背屈。所提出的方法并非在所有情况下都能防止骨折碎片塌陷。然而，塌陷程度最小。前臂旋后的姿势以及所有关节的活动自由度似乎减少了这些骨折积极治疗期间常见的肿胀、僵硬和功能丧失。
