Management of Colles Fracture

Acute Management

Early finger motion must begin immediately after casting or surgery for distal radius fracture to prevent edema and stiffness, followed by aggressive finger and hand motion once immobilization is discontinued, as recommended by the American College of Rheumatology 1
The choice between operative and non-operative management requires careful consideration, with both cast immobilization and operative methods being acceptable options, according to the American Academy of Orthopaedic Surgeons 2
Recent RCTs have not identified clear superiority of one method over another in elderly populations, as stated by the American Geriatrics Society 2

An appropriate rehabilitation programme must consist of early postfracture introduction of physical training and muscle strengthening, followed by long-term continuation of balance training and multidimensional fall prevention, as recommended by the American College of Sports Medicine 3, 4
Aggressive finger and hand motion exercises are essential immediately after cast removal to achieve optimal outcomes, according to the American Occupational Therapy Association 1, 4
Early identification of individual goals and needs is critical before developing the rehabilitation plan, as stated by the National Institute on Aging 3, 5
Physical training and muscle strengthening should begin early in the postfracture period, as recommended by the American College of Rheumatology 3, 6, 4
Balance training must continue long-term to prevent future falls, according to the American Geriatrics Society 3, 6, 4
Exercise programs improve bone mineral density and muscle strength while reducing fall frequency, as stated by the National Osteoporosis Foundation 1, 5, 4

Every patient aged 50 years and over with a Colles fracture must be systematically evaluated for subsequent fracture risk, as recommended by the American Academy of Orthopaedic Surgeons 6, 2
Adequate calcium intake (1000-1200 mg/day) combined with vitamin D supplementation (800 IU/day) is essential, according to the National Osteoporosis Foundation 3, 5, 4
Vitamin D 800 IU/day reduces non-vertebral fractures by 15-20% and falls by 20%, as stated by the American Geriatrics Society 3, 5
Avoid high-pulse dosages of vitamin D, as they increase fall risk, as recommended by the American College of Rheumatology 3, 5
For patients at high risk of subsequent fractures, pharmacological treatment should use drugs proven to reduce vertebral, non-vertebral, and hip fractures, according to the National Osteoporosis Foundation 3, 5
First-line agents include Alendronate or risedronate, as recommended by the American College of Rheumatology 3
Treatment duration is typically 3-5 years, longer if high risk persists, as stated by the American Academy of Orthopaedic Surgeons 3

Implementation requires a local responsible lead coordinating secondary fracture prevention between surgeons, rheumatologists/endocrinologists, and general practitioners, as recommended by the American Academy of Orthopaedic Surgeons 6, 2, 5
Patient education about disease burden, risk factors, follow-up, and treatment duration is essential, according to the National Institute on Aging 1, 6, 2, 5, 4
Systematic follow-up improves long-term adherence, which is typically poor, as stated by the American College of Rheumatology 3