The classic position of immobilization of Colles' fractures with the
elbow in flexion, the forearm in pronation, and the wrist in volar flexion
and ulnar deviation is probably the main reason for the common and rapid
recurrence of the original deformity. Such a position places the
brachioradialis muscle, a strong flexor of the elbow and the only muscle
attached to the distal fracture fragment, in an ideal physiological
position to exert a deforming force on the fracture fragments. Based on
this assumption, further supported by electromyographic studies, a method
of treatment was developed which calls for the initial immobilization of
the arm in an above-the-elbow cast with the elbow in flexion, the forearm
in supination, and the wrist inmoderate ulnar and volar flexion. This cast
is changed a few days after application for an Orthoplast brace that
permits motion of the elbow and volar flexion of the wrist while preventing
pronation and supination of the forearm and dorsiflexion of the wrist. The
proposed method did not prevent collapse of the fragments in all instances.
However, the degree of collapse was minimum. The position of supination of
the forearm and the freedom of motion of all joints seemed to reduce the
swelling, stiffness, and incapacitation frequently found during active
treatment of these fractures.