CONSERVATIVE TREATMENT FOR DISPLACED FRAC TURES OF THE DISTAL END OF THE RADIUS ACCORDING TO JUDET - ANATOMICAL AND FUNCTIONAL RESULTS ON 280 CASES

Purpose of the study The authors evaluated the anatomical results and limits of the conservative treatment for displaced Colle's fracture. M aterial and Methods The anatomical results of 280 consecutive fracture s were retrospectively analysed. Conservative treatment was performed according to Judet. Stability of the reduction was assessed for grade 0, 1, 2 of Kapandji's classification. Radiographical mean follow-up fo r all patient was three months (2 months to 8 years), Results In 122 c ases (64 per cent) mat-union was observed. Mat-union was due in 93,5 p er cent of cases (114) to secondary displacement of the distal fragmen t and in 6,5 per cent (8 cases) to poor reduction. Secondary displacem ent was essentially posterior in the sagittal plane. The principal fac tors of instability were radial shortening superior to 3 mm (p = 0,005 ), patient age of 55 years or more (p = 0,004), metaphyseal comminutio n (p = 0,004) and degree of primary displacement in the frontal plane (p = 0,01). Stability after reduction was determined by crossing the d istal fragment in relation to the anterior cortex of the proximal frag ment. There were 10,5 per cent algodystrophies and 9 per cent median n erve paresthesiae which were avoided by 45 degrees of wrist flexion. D iscussion Judet's conservative treatment is indicated in extra-articul ar Colle's fractures (grade 0, 1 2 of Kapandji's classification), afte r evaluation of factors of instability, secondary displacement and mal -union. Minor mal-unions may be well tolerated, and do not seem to aff ect wrist function with 3 mm of radial shortening and 10 degrees of ra dial glenoid posterior angulation on the sagittal plane.