EVALUATION OF HEALED COLLESʼ FRACTURES

It has been shown that the type of Colles' fracture incurred bears a definite relationship to the end result obtained. A fairly high percentage of unsatisfactory end results was found in the two groups with comminuted fractures. In adidition, in a comminuted Colles' fracture the threat of traumatic arthritis is always present. The basic nature of the fracture must therefore be considered a factor in the prognosis. The study of the fracture components themselves has demonstrated that the original reduction in all cases has been inadequate. The importance of this factor in influencing end results is illustrated by the fact that those cases showing the most complete reductions have been listed among the excellent end results. Among the fracture components, residual dorsal tilt has a more direct influence on an unfavorable end result than either residual radial deviation, residual shortening, or loss of integrity of the distal radio-ulnar joint. The method of immobilization used in this series was inefficient and inadequate. Sixty per cent. of our cases, when re-examined eighteen months after injury, showed a fracture healed in a position typical of a fresh unreduced Colles' fracture. In spite of incomplete reduction and inadequate immobilization the functional results at the time of the follow-up examination were found to be surprisingly good. Satisfactory functional end results were obtained in 68.3 per cent. of cases in this series. The chief credit for this percentage must be given to the innate ability of the wrist joint to overcome and compensate for residual bony deformity, rather than to the original treatment. Studies of function have shown that a great deal of bony deformity must be present before any of the motions at the wrist are compromised. A total of 31.7 per cent. of unsatisfactory results, however, is much too high for a fracture which continues to he lightly regarded and for which treatment tends to follow a routine pattern. The fruits of this attitude are apparent when the entire course of the fracture is reviewed. We believe that, aside from tile specific type of fracture incurred, insufficient reduction and present inadequate methods of immobilization are the factors responsible for unsatisfactory functional end results in the healed Colles' fractures in this series.