Colles Fracture

• Colles Fractures:

  • distal radial fracture - 1 inch proximal to distal end of radius
  • distal fragment angled dorsally
  • dinner fork deformity
• Mechanism:

  • FOOSH
  • specifically pronated forearm + wrist extension
  • transfer of energy from proximal carpals dorsally and axially
• Mechanism of Colles Fracture:

  • distal radius is the most common upper limb fractures
  • risk factors = osteoporosis - seen more in older people and seen more in females
  • within the younger population, its usually caused by higher impact
• Radiologist Report:

  • key finding - dorsal angulation and transmission of the distal end of the radius (tilting and shifting backwards)
  • looking for:
  • degree of dorsal angulation
  • degree of impaction
  • degree + direction of displacement
  • location of the medial fracture line
  • presence for intra-articular fractures
• Management - Conservative vs Surgical:

  • depends on:
  • nature of fracture
  • age of pts
  • activity level
  • surgeons presence
• Conservative Management:

  1. analgesia - pain control
  2. realignment - the fractures are often angled, realigned using Bier block or haematoma block where there's an IV anaesthetic which provides numbing below the tourniquet in the upper arm and then realign the distal segment
  3. splint for 3 to 7 days
  4. cast for 6 weeks (changed at 2 to 3 weeks)
  5. 1 to 4 xrays taken
  6. cast removed at around 6 weeks
  7. rehabilitation commences
• Surgical Management:

  • surgical management is usually needed if its a less stable fracture or if there's greater displacement and they dont think the distal segment of bone will stay put with just immobilisation via a cast
  • 2 key types of fixation:
  • (open reduction internal fixation) ORIF
  • reducing the two ends of bone and put them in place
  • external fixation
  • pins placed through the skin at the distal and proximal segments to provide stability in the fracture
• Prognosis:

  • recovery lasts more than or equal to 12 months
  • often pain with vigorous activity
  • residual stiffness/ache lasts less than or equal to 2 years (sometimes permanently)
  • risk factors for permanent stiffness/ache:
  • high velocity injuries
  • older than 50 years of age
  • often do not gain full ROM
  • functional impact is often minor
• Complications:

  • Malunion resulting in dinner fork deformity
  • Median nerve palsy or post traumatic carpal tunnel syndrome
  • Reflex sympathetic dystrophy
  • Secondary osteoarthritis – can be caused by intra-articular fractures
  • Extensor pollicis longus tendon tear - requires surgical repair in order to regain proper function through them