Description: OTA 2002 - Session 10 Session X - Upper Extremity Sun., 10/13/02 Upper Extremity, Paper #66, 10:35 AM The Aberdeen Colles-Fracture Brace: An Alternative Treatment for Colles
Fracture: A Prospective Randomized Multicenter Study Nezar S. Tumia, FRCS 1 ; Douglas Wardlaw, FRCS 1 ;
Jeffrey P. Hallett, FRCS 2 ; Robert Deutman, MD 3 ; Sten
A. Mattsson, MD 4 ; Bengt Sandén, MD 4 ; 1 Department
of Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; 2 Department
of Orthopaedics, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, England; 3 Department of Orthopaedics, Martini Hospital, Groningen, The
Netherlands; 4 Department of Orthopaedics, University Hospital,
Uppsala, Sweden Purpose: The morbidity associated with the Colles cast immobilization
in treating Colles fracture includes stiffness and reduced strength and
function of the hand and fingers, which has led to an increased interest
in an alternative treatment using a functional brace. The Aberdeen Colles
fracture brace (AFB) is a prefabricated brace that maintains fracture reduction
by applying three-point loading and at the same time allowing movement at
the wrist joint. We compared the outcome of the management of Colles fractures
with use of the AFB and with use of a conventional plaster of Paris (POP)
cast. Methods: A randomized prospective multicenter clinical trial was
carried out; 339 patients with Colles fractures were treated at five different
trauma centers. Patients were stratified into two groups: group 1, 151 patients
who had minimally displaced fractures not requiring manipulation, and group
2, 188 patients who had displaced fractures requiring manipulation. Both
groups were treated with either a conventional POP cast or the AFB. The functional and anatomical assessments were made using the modified
Gartland and Werley scoring system and the radiological displacement method
(Bunger et al., 1984), respectively. The relative grip strength of the injured
hand was calculated for each patient. Pain and discomfort assessment was
made according to pain scores: 0, no pain; 1, occasional pain on heavy activity;
2, often pain on heavy activity; 3, often pain on normal activity; and 4,
often pain at rest. Results: Both the AFB and POP treatment groups gave similar anatomical
scores and pain scores. Hand grip strength was better among patients in
the AFB group than in the POP cast group. However, there was no statistically
significant difference in the functional scores. Discussion: There was no significant difference in the anatomical
scores between either treatment. The AFB was as effective as the POP cast
in maintaining fracture reduction in treating both manipulated and non-manipulated
fractures. In addition, there was no significant difference overall in the
pain scores between treatments in both groups. The handgrip strength was
better in patients who used the AFB than in those who had a POP cast because
of the free movement at the wrist joint permitted by the AFB (P < 0.05
at week 5). Conclusion: The AFB can be used effectively in treating both manipulated
and non-manipulated Colles fractures. The AFB gave better handgrip strength,
perhaps due to the free movement at the wrist joint in the AFB. This feature
may play a role in early rehabilitation, especially in elderly patients.
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