Sarmiento A, Latta L L
Department of Orthopedic and Rehabilitation University of Miami, Florida, USA.
Acta Chir Orthop Traumatol Cech. 2014;81(3):197-202.
Abraham Colles classified and described fractures of the distal epiphyseal radius. He recommended the arm should be immobilized in a cast that extends from the base of the fingers to above the elbow, while holding this joint at ninety degrees of flexion the forearm in pronation and the wrist in slight flexion and ulnar deviation. We identified the brachioradialis muscle as the main culprit in the frequently observed loss of reduction of the fracture. Since the brachioradialis is attached to the distal region of the radius and functions as a flexor of the elbow when the forearm is in pronation, its stimulation easily displaces a reduced fracture, particularly if its geometry suggests axial instability. We concluded that post-reduction stabilization in supination was more desirable than in pronation.
Prospective study of one hundred and fifty-six patients suffering from Colles' fractures who were treated with the functional method. Approximately one-half of the fractures were immobilized in pronation and the other half in supination. The median age of the patients was 49 years. After approximately eleven days of immobilization in an above-the-elbow cast that held the forearm in a relaxed attitude of supination and the wrist in slight flexion and ulnar deviation, a new cast or brace was applied. The appliance permitted flexion of the elbow and slightly limited extension. We utilized modified Lindstom criteria to assess radiological results, according to types of fractures and by groups treated in supination and pronation.
In the type I and III (non-displaced) fracture series there appeared to be no significant difference in the functional results between the pronation and supination treated groups. In the type II category, in the supinated fractures, there were 9 excellent, 4 good and no fair or poor results. In the pronated group 9 excellent, 8 good and one fair result. The functional results in type IV fractures treated in supination were excellent in 11 instances, good in 7 and fair in 2. In fractures treated in pronation there were 5 excellent, 10 good and 5 fair results. There were no poor results in either group. 85% of type II fractures and 85% of type IV fractures treated in supination had excellent or good results. In the pronation group, 67% had excellent or good results in type II and 40% in type IV classification. In combining the results for all types of braced Colles' fractures, (I-IV) 93% of the supination group and 87% of the pronation group achieved excellent or good functional results. In analyzing overall results regardless of type of fracture or position of immobilization, 90% of the patients had excellent or good results.
We treated Colles' fractures in supination and compared the results with those obtained when treated in pronation. The results indicated a lower incidence of re-displacement in the supination group. We developed a forearm brace that permits flexion of the elbow, but prevented pronation of the forearm, and limited extension of the elbow in approximately the last fifteen degrees. It permits minimally limited flexion of the wrist but prevents wrist dorsiflexion. It makes impossible any radial deviation. The place of surgery in the management of Colles' fractures should be limited to those fractures that when treated by non-surgical means are not likely to render satisfactory functional and cosmetic results. There is not at this time a consensus as to when to use the surgical approach. The complication rate from the surgery have not clearly identify superiority of one over the other. Nonetheless, the surgical treatment has a definite place in the armamentarium of the orthopaedic surgeon. In a number of situations, it is the treatment of choice.
亚伯拉罕·科利斯对桡骨远端骨骺骨折进行了分类和描述。他建议将手臂固定在一个从手指根部延伸至肘部上方的石膏中，同时将该关节保持在90度屈曲位，前臂旋前，腕关节轻度屈曲和尺侧偏斜。我们确定肱桡肌是骨折复位经常丢失的主要原因。由于肱桡肌附着于桡骨远端区域，在前臂旋前时作为肘关节的屈肌起作用，其刺激很容易使复位的骨折移位，特别是如果骨折的几何形状提示轴向不稳定。我们得出结论，旋后位复位后的稳定比旋前位更可取。
对156例采用功能疗法治疗的科利斯骨折患者进行前瞻性研究。大约一半的骨折固定在旋前位，另一半固定在旋后位。患者的中位年龄为49岁。在将前臂保持在旋后放松位、腕关节轻度屈曲和尺侧偏斜的肘上石膏中固定约11天后，应用新的石膏或支具。该器具允许肘关节屈曲，伸展略有受限。我们根据骨折类型以及旋后位和旋前位治疗组，采用改良的林德斯顿标准评估放射学结果。
在I型和III型（无移位）骨折系列中，旋前位和旋后位治疗组的功能结果似乎没有显著差异。在II型骨折中，旋后位骨折有9例优、4例良，无尚可或差的结果。旋前位组有9例优、8例良和1例尚可的结果。旋后位治疗的IV型骨折功能结果11例优、7例良、2例尚可。旋前位治疗的骨折有5例优、10例良和5例尚可的结果。两组均无差的结果。旋后位治疗II型骨折的85%和IV型骨折的85%有优或良的结果。在旋前位组，II型骨折67%有优或良的结果，IV型分类中为40%。综合所有类型支具固定的科利斯骨折（I-IV型）的结果，旋后位组93%、旋前位组87%获得优或良的功能结果。在分析总体结果时，无论骨折类型或固定位置如何，90%的患者有优或良的结果。
我们对科利斯骨折进行旋后位治疗，并将结果与旋前位治疗的结果进行比较。结果表明旋后位组再移位的发生率较低。我们研制了一种前臂支具，它允许肘关节屈曲，但防止前臂旋前，并在大约最后15度限制肘关节伸展。它允许腕关节有最小限度的屈曲，但防止腕关节背伸。它使任何桡侧偏斜都不可能发生。科利斯骨折治疗中手术的应用应限于那些采用非手术方法治疗不太可能获得满意功能和美容效果的骨折。目前对于何时采用手术方法尚无共识。手术的并发症发生率尚未明确显示出一种方法优于另一种方法。尽管如此，手术治疗在骨科医生的治疗手段中占有一定地位。在许多情况下，它是首选的治疗方法。
