A rational approach for the recognition and treatment of Colles' fracture.

The approach to Colles' fracture, as recommended in this article, is derived from understanding the mechanism of injury. Fractures that are inherently unstable can be recognized by observing the depth of comminution presented on the lateral postreduction radiography. These unstable fractures demand a more vigorous approach to achieve the result our patients have come to demand. External fixators, percutaneous pinning, and bone grafting have all been successfully used to achieve a satisfactory result. Fortunately, the majority of Colles' fractures are stable and can be treated by accurate closed reduction and immobilization in plaster. If the fracture results in loss of containment of the carpus, a chronically weak and sometimes painful wrist will result. This event can be remedied surgically. The final emphasis I would like to impart is the prevention of sympathetic reflex dystrophy. Early involvement by the patients in their rehabilitation process is essential in minimizing this condition. Understanding and application of the principles I have presented will result in patients pleased with the result of their care and, consequently, with their physician.