Published: 2017-12-22

A comparative study of management of Colles fracture by closed reduction with cast versus closed reduction with internal fixation (K-wires/4 mm CC screws)

Vamshi Varenya Nimmagadda, Bhanu Prabha T., Johorul Islam Tapadar


Background: Distal radius fracture is extremely common and represents 16% of fractures treated by orthopaedic surgeons. Near anatomical reduction with restoration of radial length, radial tilt and ulnar variances are important for good functional results. A variety of treatment options have been proposed for distal radius fracture closed reduction and immbolization in cast has been the main stay of treatment, but because it invariably results in malunion, poor functional outcome and cosmetic outcome, other modality of treatment were brought into practice like percutaneous intrafocal pinning, transulnar percutaneous pinning, external fixation, plating etc. This comparative study was to compare the clinical outcomes of closed reduction with cast and closed reduction with Percutaneous Kirschner wiring (PKW)/canullated cancellous screws (CC screws 4 mm)for the management of Colles fractures in patients between 20 and 70 years old. In this study we did an prospective study in 40 patients with extra articular distal radius fracture treated by both closed reduction with cast and closed reduction internal fixation (PKW/CC screws).

Methods: There were 20 patients with Colles fractures treated by closed reduction with cast and 20 patients treated with closed reduction internal fixation (PKW/CC screws). We compared both the managements together. All patients were followed up in the orthopaedic department prospectively for at least 12 months between June 2015-June 2016 The functional outcomes and radiological results were compared between the two groups.

Results: The study included 40 patients, aged between 20 to 69 yrs. Average follow up was 12 months. Using the demerit scoring system of Gartland and Werley we had excellent to good results of 60% in closed reduction internal fixation compared to closed reduction with casting excellent to good was 10%.

Conclusions: The percutaneous pinning/cc screws and immobilization in neutral position for 3 weeks followed by physiotherapy proved to be better and simple procedure for extra articular non comminuted distal radius fractures. 


Fracture radius distal 1/3rd, Cast, Pinning, CC screws, Immobilization

Full Text:



Papyrus E. The book of medical knowledge of 16th century BC, egyptinshallamnmikolajczak. Archieve, History filooz med. 2004;67(1):5-48.

Grammaticos PC, Diamantis A. Useful known and unknown views of the fracture of modern medicine. Hell J Nucl Med. 2008;11(1):2-4.

David L, Helfet MD, Norbert P. AO Philosopy and principles of Fracture Management, Its Evolution and Evaluation. J Bone Joint Surgery. 2003;85(6):1156-60.

Simic PM, Wieland AJ. Fractures of the distal aspect of the radius, Changes in treatment over the past two decades. J Bone Joint Surg (Am). 2003;85:552-64.

Wayne M, Weil MD, Thomas E. Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization. Hand Clinic, 2005;21:317-28.

Nana AD, Joshi A. Plating of the distal radius. JAM Acad Orthop Surg. 2005;13:159-71.

Norikar U, Ota MD, Thoshiyasu Nakamure MD. Radiographyic parameter analysis on modified Sauve Kapandji Procedure. J Wrist Surg. 2013;2(1):19-26.

Aita MA, Ferreira CHV, Ibanez DS, Marquez RS, Ikeuti DH, Mota RT. Randomized clinical trail of percutaneous osteosynthesis and Minimally invasive Surgery. Evaluation of the distal end of radius fractures. Rev Bras Orthop. 2014;49(3):218-22

Nalbantoglu U, Gereli A, Kocaoglu B, Turkmen M. Percutaneous Cannulated Screw Fixation in the treatment of distal radius fractures. Arch Orthop Trauma Surg. 2012;132:1335-41.

Green DP, O’Brien ET. Open reduction of carpal dislocations: indications and operative techniques. J Hand Surg Am. 1978;3:250–65.

Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles’ fractures, functional bracing in supination. J Bone Joint Surg Am. 1975;57:311–7.

Gartland JJ, Jr, Werley CW. Evaluation of healed Colles’ fracture. J Bone Joint Surg Am. 1951;33:895–907.

Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–59.

Trumble TE, Schmitt SR, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg Am. 1994;19:325–40.

Jupiter JB, Ring D, Weitzel PP. Surgical treatment of redisplaced fracture of the distal radius in patients older than 60 years. J Hand Surg Am. 2002;27:714–23.

Chan BK, Leong LC, Low CO, See HF. The use of external fixators in treatment of intra articular fractures of the distal radius. Singapore Med J. 1999;40:420–4.

Gausepohl T, Pennig D, Mader K. Principles of external fixation and supplementary technique in distal radius fractures. Injury. 2000;31:56–70.

Sanders RA, Keppel FL, Waldrop JI. External fixation of distal radial fractures: Results and complications. J Hand Surg Am. 1991;16:385–91.

Ruch DS, Ginn TA. Open reduction and internal fixation of distal radius fractures. Op Tech Orthop. 2000;13:138–43.

Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: Arthoscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am. 1999;81:1093–110.

Gereli A, Turkmen M, Kocaaglu B. Comparative study of closed reduction percutaneous cannulated screw fixation and open reduction palmar locking plate fixation in the treatment of AO Type 2 distal radius fractures. Arch Orthop Trauma Surg. 2013;134:121-9.

Green DP. Pins and plaster treatment of communited fractures of distal end radius. J Bone Joint Surg Am. 1975;57:304–10.

Field J, Atkins RM. Algodystrophy is an early feature after Colles’ fracture.What are the implications? J Hand Surg Br. 1997;22:178–82.

Atkins RM, Duckworth T, Kanis JA. Features of Algodystrophy after Colles’ fracture. J Bone Joint Surg Br. 1990;72:105–10.