Distal Radius Fractures

Colles' Fracture

This is the most common fracture in female older than 50 years old with osteoporosis.  It is an extra-articular fracture of the distal 1 cm of the metaphysis of the radius.  Female patients with this fracture should be considered for investigation and treatment for osteoporosis.  They are also at risk for hip fractures and other fragility fractures (see here).   The term Colles fracture is often used eponymously for distal fractures with dorsal angulation.  

This fracture occurs when patient tries to break a fall with an outstretch arm.  The thenar eminence impacts the groud and the wrist is forcibly extended.  The impact on the radial aspect of the palm explains why there is relatively more shortening on the radial side.

This is a transverse extra articular fracture of the distal 1 cm of the radius.  The radial impaction and dorsiflexion force cause the following displacement.

1.  Shortening

2. Dorsal displacement and dorsal tilt of the distal fragment

3. Loss of height on the radial side ( a radial tilt of the distal fragment) as a result of impaction at the thenar eminence.

A residual volar displacement is commonly referred to as a garden spade deformity since it has a similar curvature to a garden spade. A malunion may also lead to delayed carpal tunnel syndrome if the carpal tunnel becomes consistently narrowed.

4.  An associated avulsion of the ulnar styloid is often seen as a result of greater force on the radial side.  This avulsion fracture is of minor clinical importance.

The Colles fracture is defined as a distal radius fracture with dorsal comminution, dorsal angulation, dorsal displacement, radial shortening, and an associated fracture of the ulnar styloid.  The term Colles fracture is often used eponymously for distal fractures with dorsal angulation.  Dorsal angulation means the distal fragment is tilted dorsally.

Normal radius has a volar tilt????????
La Fontaine's classification?

disruption of gilula line?

Injury to radial artery

Regional Pain Syndrome rps?

Forced dorsiflexion injury with impact on the hyperthenar and possible injury to the median nerve.

Problem with this fracture

1. Non-union is not a problem but 

   1. malunion is a problem 

   2. Carpal tunnel syndrome

   3. Wrist and finger stiffness

   4. Regional pain syndrome

This fracture if left untreated will consolidate after 2 weeks because there is stable impaction of cancellous bone at the distal radius fracture.

Colles was the first physician to diagnose this injury as a fracture and not a sprain.  He made the diagnosis without the benefit of X-ray and thus this fracture is named after him.

Reduction Principles:

1.  Manipulation under regional anesthesia by hematoma block or Bier's block

2. Traction alone will no reduce fracture. (A), (B)

3. Reduce fracture by increase deformity followed by dorsal pressure and flexion. (C), (D)

4. The reduced fracture and be stably splinted wrist with a dorsal radial slap by 3 point fixation priciple.

Treatment:

1. Fracture are usually treated by closed reduction under regional anesthisia by the attenching physician in the emergency room.

2. Swelling and carpal tunnel sydrome are previaling problem.
   The fracture is usually splinted with a dorsal radial slap and not a full cast.
   Preferably the patient should be followed up in the orthpedic/hand clinic in 48 hours to be sure bandage is not too tight.

3. Because of dorsal communition, after reduction the distal radius fragment has a tendency to redisplaced in dorsiflexion.  Therefore a followup X-ray is recommended at 2 weeks.  It would not be possible to remanipulate for a repeat reduction after 2 weeks.