Approach

• Describe fracture on X-ray (site, associated displacement, deviation, shortening)

1. Initiation
   • Same side of injury as patient
   • Explain fracture, need for reduction
   • Pain relief (NO, haematoma block)
2. Assistance
   • Counter-traction
3. Traction
   • Demonstrate traction - relax musculature around fracture site
4. Reduction
   • Reverse the dicetion in which the fragment is displaced at the time of injury
   • May be necessary to increase angulatory deformity to disimpact the fracture
5. Hold
   • Held post reduction
   • Place in backslab (as risk of swelling): stockinette, crepe, plaster
   • Broad arm sling

Follow up

1. Re-Xray
2. Fracture clinic 2-3 days time: check reduction complete once swelling has improved
3. X-ray 7-10 days as this is the most common time fracture redisplaces
4. Information leaflet about care and complications of casts
5. Would normally take 4-6 weeks to heal after which may need physiotherapy for any resulting stiffness

Colles Fracture

1. Fracture of distal radius within 2.5cm of the wrist
2. Commonest of all fractures (especially osteoporotic old women)
3. Characteristic displacements
   • Dorsal displacement
   • Dorsal tilt
   • Radial displacement
   • Radial tilt
   • Impaction
   • Rotational deformity
   • Disruption of ulnar styloid

Indications for reduction

1. Displaced ulnar styloid (indicates serious disruption of inferior radioulnar joint)
2. Dorsal tilt of 10' or more (except in old and frail)