Emergency Department management of Colles-type fractures: a prospective cohort study

OBJECTIVE: To assess radiographic outcomes from ED reduction of Colles-type fractures.

DESIGN: Prospective cohort.

SETTING: One tertiary hospital in Western Australia.

PARTICIPANTS: All patients (184) between ages 21-85 years, presenting to ED with Colles-type fractures between 1 April 2006 to 31 July 2008. Fractures were divided into two groups. Those with <or=15 degrees dorsal angulation were classified as 'minimally displaced' and those with >15 degrees dorsal angulation were classified as 'displaced'.

MAIN OUTCOME MEASURES: Radiographic analysis of the dorsal angle on post-reduction and 6 week post-fracture X-rays. A combined end-point of poor outcome, as defined by either poor radiological result and/or progression to surgery.

RESULTS: In the group of patients with displaced fractures, 69 of 114 (61%) went on to have an operation or a poor radiographic outcome versus 8 of 48 (17%) in the group with minimally displaced fractures, an absolute difference of 44% (95% CI 30-57%). Patients who had a minimally displaced fracture with an adequate reduction went on to have a satisfactory 6 week X-ray in 37 of 43 cases (86%; 95% CI 75-96%). Patients who had a displaced fracture and an adequate reduction had a satisfactory 6 week X-ray in 42 of 86 cases (49%; 95% CI 38-59%). Patients who had a displaced fracture and an inadequate reduction had a satisfactory 6 week X-ray in only 3 of 22 cases (14%; 95% CI 0-28%).

CONCLUSION: The study highlights the importance of the initial 'on arrival' and 'post-reduction' X-rays in the ED. Displaced fractures are more likely to go onto poor outcome, as are inadequately reduced fractures. Medical officers working in ED should be aware of the importance of measuring the dorsal angle. They should be referring patients with >15 degrees dorsal angulation to orthopaedics early. Reduction should not be accepted until the dorsal angle has been adequately corrected.