Case 25 2026: Closed Reduction of a Distal Radius Fracture in the Emergency Department

Maria Lerche Mortensen and Philip Månsson

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Case 25 2026: Closed Reduction of a Distal Radius Fracture in the Emergency Department · JPBRS

Rapport de cas

Case 25 2026: Closed Reduction of a Distal Radius Fracture in the Emergency Department

Maria Lerche Mortensen and Philip Månsson¹

¹Department of Orthopedic Surgery, SUH Nykøbing Falster, Denmark

Publié 28 mai 2026163 vues9 min de lecture

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Résumé

A 62-year-old female presented to the emergency department after a fall from standing position, attempting to break the fall with her left hand. She presented with pain, swelling, and a visible deformity of the wrist. A distal radius fracture of Colles’ type was diagnosed. She was treated in the emergency department in accordance with local guidelines, with closed reduction using both Chinese finger traps and manual reduction with a hematoma block for analgesia. Finally, a dorsal below-elbow cast was applied, and the patient was referred for follow-up after 10-12 days. Patient medical history This patient was active and employed, able to take care of herself, her family and household. She had no past fractures, no relevant medication, and no known allergies. Before and After Patient examination Patient history was obtained, involving circumstances of the trauma, including reasons to suspect underlying disease or other injuries. She fell while walking on a slippery surface, described the trauma as “just bad luck”, she reported no other complaints of pain, had intact memory, and had no cardiac symptoms prior to fall. The clinical examination included inspection, palpation, and function. Inspection: A bayonet deformity was observed, with significant swelling over the radial styloid. There were no wounds or discoloration. Palpation: There was a palpable step-off, and pain over the distal radius. Elbow, hand and fingers were palpated without pain. Therefore, there was no suspicion of other injuries. Function: Neurological and vascular integrity were intact. The motor function was tested: n. ulnaris – finger abduction with intact strength; n. radialis – extension of the MCP-joints; n. medianus – opposition of the first digit. The

Points clés à retenir

Conseils pratiques

-tAssess activities of daily living, as it affects the choice of treatment
-tCheck for associated injuries
-tAssess neurovascular status before and after reduction, document findings thoroughly
-tPrint the AP radiograph; it may be easier to visualize the fracture site when comparing the clinical and radiological findings
-tWhen performing manual reduction, the distal fragment should be pulled even more dorsal, so impacted segments or entrapped structures can be released before pulling the fragment volarly to establish anatomical alignment
-tConsider osteoporosis assessment.

Écueils

-tOverlooking associated injuries or underlying diseases that caused the fall
-tGripping too tight on fragile skin can result in skin tears. If at risk, hold on to the fingers only
-tInjection site too distal, can result in difficulty finding the fracture site
-tInadequate analgesia leading to pain and incomplete reduction
-tNot allowing the cast to set. Traction should be maintained until the sides of the cast can no longer be manipulated.

Patient history

This patient was active and employed, able to take care of herself, her family and household. She had no past fractures, no relevant medication, and no known allergies.

Examination

Patient history was obtained, involving circumstances of the trauma, including reasons to suspect underlying disease or other injuries. She fell while walking on a slippery surface, described the trauma as “just bad luck”, she reported no other complaints of pain, had intact memory, and had no cardiac symptoms prior to fall.
The clinical examination included inspection, palpation, and function.

Inspection: A bayonet deformity was observed, with significant swelling over the radial styloid. There were no wounds or discoloration.
Palpation: There was a palpable step-off, and pain over the distal radius. Elbow, hand and fingers were palpated without pain. Therefore, there was no suspicion of other injuries.
Function: Neurological and vascular integrity were intact. The motor function was tested: n. ulnaris – finger abduction with intact strength; n. radialis – extension of the MCP-joints; n. medianus – opposition of the first digit. The sensory function was tested: n. ulnaris – sensation of the ulnar 1 ½ digits; n. radialis – sensation of the dorsal aspect of the radial 3 ½ digits; n. medianus – sensation of the volar aspect of the radial 3 ½ digits.
The suspected diagnosis was confirmed by conventional radiographs in anteroposterior (AP) and lateral views.

Pre-operative considerations

A Colles’ fracture can be managed in different ways, depending on the patient’s age, activities of daily living, fracture morphology, and local clinical guidelines.
Treatment options include: Conservative treatment with a cast; closed reduction followed by cast immobilization; closed reduction and percutaneous Kirschner wire fixation; open reduction and internal fixation (ORIF).
In this case, the patient was active and had high functional demands for her wrist function. The fracture position was not acceptable for conservative treatment alone.
The patient was offered closed reduction in the ED, considering the general preference to minimize surgical intervention, reduce complications, and limit hospital stay. The patient was informed that the procedure might be unsuccessful, or reduction could be lost at follow-up, necessitating subsequent surgical intervention.

Étape 1 — Radiographic assessment of dorsal angulation

Références

Closed reduction of distal radius fractures: a systematic review and meta-analysis, Hjalte Søsborg-Würtz, Sükriye Corap Gellert, Julie Ladeby Erichsen, and Bjarke Viberg. DOI: 10.1302/2058-5241.3.170063
Distal radius fractures: an evidence-based approach to assessment and management, Kalpesh R Vaghela, Diana VelazquezPimentel, Aashish K Ahluwalia, Anika Choraria, Alistair Hunter. DOI: 10.12968/hmed.2020.0006
Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis, Marjolein A. M. Mulders, Robin Detering, Daniel A. Rikli, Melvin P. Rosenwasser, J. Carel Goslings, Niels W. L. Schep. DOI: 10.1016/j.jhsa.2018.05.003

Post-operative plan

In this case, closed reduction was successful. Post-reduction radiograph showed an improved position, although not perfect. The angulation was 7 degrees dorsally, the length had improved, with the ulna now at -1. The inclination remained unchanged.
The position was regarded as acceptable. The patient was discharged and was prescribed paracetamol and ibuprofen for pain management.
The patient was referred for a follow-up in 7-10 days at which time the radiographic alignment will be reassessed. If the fracture remains in position, conservative treatment is continued; otherwise, operative treatment is indicated. In conservative management, the cast is maintained for five weeks. The patient should be introduced to edema prophylaxis and finger mobilization to prevent stiffness. Some patients may require physiotherapy after cast removal. The patient can expect improvement of wrist function over the first 6 months after cast removal; some patients may continue to improve function up to a year after removal.
Due to a low-energy trauma resulting in a wrist fracture, the patient should be referred for an osteoporosis workup.

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Case 25 2026: Closed Reduction of a Distal Radius Fracture in the Emergency Department

Résumé

Points clés à retenir

Patient history

Examination

Pre-operative considerations

Étape 1 — Radiographic assessment of dorsal angulation

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Étape 2 — Radiographic assessment of radial inclination

Étape 3 — Radiographic assessment of ulnar length

Étape 4 — Preparation for hematoma block

Étape 5 — Identifying injection site

Étape 6 — Preparing the injection site

Étape 7 — Needle insertion

Étape 8 — Advancing the needle to the fracture site

Étape 9 — Administration of local anesthetic

Étape 10 — Chinese finger traps

Étape 11 — Preparation for manual reduction

Étape 12 — Applying dorsal pull

Étape 13 — Applying volar pull to reestablish anatomy

Étape 14 — Application of cast

Étape 15 — Post-casting care

Post-operative plan

Pearls

Pitfalls