Commentary & Perspective on
"Closed Reduction of Colles Fractures: Comparison of Manual Manipulation and Finger-Trap Traction. A Prospective, Randomized Study"
By S.A. Earnshaw, DM, FRCS, et al.

Commentary & Perspective by
John G. Seiler III, MD*,
Georgia Hand and Microsurgery, Atlanta, GA

In this prospective, randomized study, the authors compared radiographically the results of two methods of closed reduction in the treatment of fractures of the distal part of the radius: manual manipulation and finger-trap traction. While the authors collected a large study cohort, and while the treatment groups seem to be similar in terms of fracture classification at the time of presentation, it would be useful to know more about the patient demographics.

Earnshaw et al. concluded that both methods of reduction, when combined with immobilization with use of a below-the-elbow Colles-type plaster-of-Paris cast are associated with a substantial rate of radiographic failure. Unfortunately, the authors did not expand the scope of this study to include the real clinical issue: What is the functional outcome that is associated with these treatment methods and these radiographic results?

Currently, there is no widely accepted standard for satisfactory radiographic parameters following a closed reduction of Colles fractures. In terms of outcome assessment, what is considered radiographically acceptable may not be indicative of acceptability in terms of a number of other factors that include the functional needs and psychological characteristics of the patient. Additionally, complications related to soft-tissue injury , not mentioned in this study, account for a substantial percentage of poor outcomes following treatment of fractures of the distal part of the radius.

The authors reported that, at five weeks, 25% of the fractures underwent open surgical treatment because of failed closed treatment and only 29% had united in a satisfactory position. Thus, 46% of the fractures healed in an unsatisfactory alignment. Are we to assume that the only patients who fared well with closed treatment are those whose fractures healed in a satisfactory alignment (29% of those studied)?

A major finding of this study is that two common methods of closed reduction in combination with immobilization (with use of a below-the-elbow Colles-type plaster-of-Paris cast) were associated with a high rate of fracture redisplacement. This provocative report should invite future investigations that compare other methods of treatment of Colles fracture and the functional outcomes relative to less than optimal radiographic results.

*The author did not receive grants or outside funding in support of the research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.