The distal end of the barrel-shaped deformity fracture is displaced to the radial side along with the hand, and the axis of the middle finger is not in the same plane as the axis of the radius. It is a deformity specific to the Coles fracture and is one of the most frequent fractures in the human body, accounting for 10% of all fractures, with the elderly and adults accounting for the majority. The cause is mostly due to indirect violence. The fracture is usually caused by a fall on a flat surface, when the palm of the hand is supported on the ground, when the wrist is in dorsal extension or internal rotation of the forearm, and the violence is concentrated on the cancellous bone of the distal radius. In such a state, the distal end of the fracture must be displaced to the dorsal and radial side. In this case, the ulnar styloid process may be accompanied by a fracture and the triangular fibrocartilage disc may be torn. The treatment method is to fix the Coles fracture without displacement in a neutral position with a plaster brace for 4 weeks. In most of the cases with displacement, closed reduction and external fixation are used. 1. Anesthesia Local intrahematomal anesthesia is mostly used for repositioning, which is simple and easy to perform but attention should be paid to the aseptic operation, once infected, it will pass to the fracture end and can cause serious consequences. Brachial plexus anesthesia is ideal for muscle relaxation and is more suitable for patients with combined hypertension and coronary artery disease, as well as for external fixation frame treatment. 2.Restoration method The patient is lying or sitting with the elbow joint flexed at 90° and the forearm in neutral position. An assistant holds the upper arm and the operator holds the injured hand with both hands, with the two thumbs placed on the dorsal side of the distal fracture segment and the remaining fingers holding the palmar side of the injured wrist and hand. The assistant and the operator perform 2-3 min traction to distract the shortened and embedded fracture, and the operator presses the distal radius dorsally with both thumbs, rapidly palmar flexes, and ulnar deviates at the same time, and the fracture can be reset. 3.Fixation method Fixation with short arm anterior and posterior plaster brace, keep the wrist joint rotated forward, palmar flexion and mild ulnar deviation position for two weeks. After two weeks, replace the cast and fix the wrist joint in neutral position for two weeks, and then carry out functional exercise. For unstable comminuted or open fractures, Frykman’s V, VI, VII and VIII fractures, dorsal angulation of 25° or more, radial shortening of more than 10 mm, and intra-articular fractures with significant comminution, external fixation brace should be used to avoid re-displacement and facilitate local wound management, which is beneficial to the functional activities of the fingers.