COLLE’S FRACTURE
COLLE’S FRACTURE
- Defined as transverse fracture of the distal radius.
- Just above the wrist at the level of cortico-cancellous junction, with dorsal displacement of distal fragment.
- Mechanism of injury : fall on out-stretch hand
- It is the most common osteoporotic-related fracture in the upper limb.
- Hence, it is common among post-menopausal women.
Clinical features
- Pain, swelling, deformity.
- Palpation over distal radius : tenderness and irregularity.
- Dinner fork deformity.
- Radial styloid being leveled or situated proximal to the ulnar styloid.
Complications
1) Joint stiffness
- Involving the fingers, wrist, elbow and shoulder.
2) Mal-union
- Occurs usually unnoticed within the immobilisation cast.
3) Subluxation of the distal radio-ulnar joint
- Resulting shortening of the radius, which made the ulnar styloid more prominent.
- Hence, any movement of the wrist joint involving pronation/supination or ulnar deviation is restricted or is painful.
4) Carpal tunnel syndrome
5) Ruptured tendon of extensor policis longus
6) Sudeck’s osteodystrophy
- Colles’ fracture is the commonest cause of this condition in the upper limb.
- Characterised by pain, swelling of wrist, hand and fingers, and deformity.
- There’s diffuse tenderness, and the skin over it appears glazed, stretched.
- Treated by physiotherapy.
Treatment
1) Undisplaced
- Cast immobilisation for 6 weeks, applied below elbow towards the neck of metacarpals.
- Hand is immobilised in functional position, with slight palmar flexion and ulnar deviation.
2) Displaced (with dinner fork deformity)
- First, close manipulative reduction is done under anesthesia.
- Ask your assistant to apply traction over the wrist joint by holding the patient’s hand, and counter traction at the elbow joint.
- Press over the dorsal aspect of deformity, at the same time try palmar-flexing, ulnar deviation, and pronating the hand.
- After reduction, confirm that it’s properly done by X ray.
- Apply colles’ cast.
3) Comminuted
- Requires open reduction and internal fixation.
Exam Important
- Colles fracture best describes the patient’s wrist fracture.
- Colles fracture is fracture at cortico-cancellous junction of the distal end of the radius with dorsal tilt.
- Deformities present in colles fracture is Dorsalt tilt.
- Colles fracture is common in women because of postmenopausal osteoporosis.
- Colles fracture is common in old age.
- Dinner fork deformity is the characteristic of colles fracture.
- Proximal impaction , Lateral rotation & Dorsal angulation is seen in colles fracture.
- Carpal tunnel syndrome, Reflex sympathetic dystrophy (RSD), Frozen hand shoulder syndrome are the complications of Malunited Colles fracture.
- Stiffness of wrist, Stiffness of shoulder & Carpal tunnel syndrome are complication of colles fracture.
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