Name of the Procedure:

Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation. Common Name: Closed Reduction of Distal Radial Fracture

Summary

The closed treatment of a distal radial fracture involves realigning broken fragments of the radius bone near the wrist without the need for surgical incisions. This non-surgical procedure also addresses any associated fractures of the ulnar styloid by manually manipulating the bones back into their proper positions.

Purpose

This procedure is used to treat fractures in the distal part of the radius bone, commonly caused by falls or trauma. The goal is to realign the bone fragments, ensuring proper healing and restoring function to the wrist and forearm.

Indications

• Sudden wrist pain after a fall or direct trauma.
• Visible deformity or swelling around the wrist.
• Inability to move the wrist or severe tenderness.
• X-ray confirmation of a distal radial fracture, with or without ulnar styloid involvement.

Preparation

• Patients may need to avoid eating or drinking several hours before the procedure if sedation will be used.
• Discontinue certain medications as advised by the healthcare provider.
• Pre-procedure imaging, such as X-rays, to assess the fracture.

Procedure Description

1. The patient is made comfortable, possibly with anesthesia or sedation to minimize pain and anxiety.
2. The healthcare provider uses their hands to carefully manipulate and realign the bones of the distal radius and ulnar styloid into their correct positions.
3. Once the bones are properly aligned, the wrist is immobilized using a cast or splint to keep the bones in place during the healing process.
4. Follow-up X-rays are typically performed to ensure the bones remain in the correct alignment.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the complexity of the fracture.

Setting

The procedure is usually performed in an emergency room, outpatient clinic, or hospital setting.

Personnel

• Orthopedic surgeon or trained physician
• Nurses
• Radiologic technologist for imaging
• Anesthesiologist or nurse anesthetist, if sedation is required

Risks and Complications

• Pain and swelling post-procedure
• Risk of improper bone alignment or non-union
• Possibility of needing surgical intervention if closed reduction is unsuccessful
• Nerve or blood vessel injury
• Compartment syndrome, although rare

Benefits

• Non-surgical method reduces recovery time and infection risk
• Proper alignment of bones promotes optimal healing
• Preservation of wrist function and mobility

Recovery

• Immobilization in a cast or splint for several weeks
• Follow-up appointments to monitor healing with X-rays
• Gradual return to activities as advised by the healthcare provider
• Physical therapy may be recommended to restore strength and mobility

Alternatives

• Open reduction and internal fixation (surgical method)
• External fixation (using an external frame to hold the bones in place)
• Pros and cons: Closed reduction avoids surgical risks but may not be suitable for all fracture types.

Patient Experience

During the procedure, patients might experience discomfort despite pain management efforts. Post-procedure, patients typically feel relief from severe pain as the bones are stabilizing but might still experience moderate discomfort and swelling. Pain management will be provided, and instructions for care at home, including elevating the limb and managing discomfort, will be given.