Fractures of the distal
radius (Colles’ fracture) are common and are usually the result of a fall on an
open, dorsiflexed hand. This fracture is frequently seen in elderly women with
osteoporotic bones and weak soft tissues that do not dissipate the energy of
the fall. The patient presents with a deformed wrist, radial deviation, pain,
swelling, weakness, limited finger ROM, and numbness.
consists of closed reduction and immobili-zation with a short arm cast. For
fractures with extensive com-minution or impaction, open reduction and internal
fixation, arthroscopic percutaneous pinning, or external fixation is used to
achieve and maintain reduction and to allow for early functional
rehabilitation. The wrist and forearm are elevated for 48 hours after reduction
to control swelling.
Active motion of the fingers and shoulder should begin
promptly. The patient is taught to do the following exercises to reduce
swelling and prevent stiffness:
Hold the hand at the level of
Move the fingers from full
extension to flexion. Hold and release. (Repeat at least 10 times every hour
Use the hand in functional
Actively exercise the shoulder
and elbow, including com-plete ROM exercises of both joints.
The fingers may swell
due to diminished venous and lympha-tic return. The nurse assesses the sensory
function of the median nerve by pricking the distal aspect of the index finger.
The motor function is assessed by the patient’s ability to touch the thumb to
the little finger. Diminished circulation and nerve function must be treated
promptly by release of constricting bandages.