Colles Fracture

A Colles fracture is caused by a fall on a dorsiflexed and pronated arm: In half of the cases there is also a fracture of the ulna styloid process. Age-wise, it occurs in two peaks:
 * radius breaks 2-3 cm proximal to the wrist joint,
 * The distal fragment is dislocated dorsally and radially.
 * at a younger age it is related to increased activity,
 * in old age it is related to osteoporosis (along with fractures of the neck of the femur and compression fractures of the vertebrae).

Clinical picture and diagnosis

 * typical bayonet-like positionwhen viewed from above, fork-like position when viewed from the side,
 * pain, swelling, disfigurement of the wrist, limited mobility in the wrist,
 * on the X-ray, we evaluate the inclination of the articular surface of the radius (30° in the antero-posterior projection, 15° in the lateral view – it decreases in the case of a fracture),
 * may be:
 * fracture of the processus styloideus radii,
 * rupture of the ulnar collateral ligament,
 * dislocation of the radio-ulnar joint,
 * a fracture can also be cominutive (shattering).

Treatment
In elderly people with osteoporosis, it is sometimes better not to attempt a reposition due to further possible disruption.
 * Collesfracture.jpgConservative (most are treated conservatively)
 * local anesthesia (10 ml of 1% mesocaine to the hematoma site),
 * reposition - pull the thumb in the axis of the joint, for the other fingers in the direction of ulnar duction with a flexed elbow for a counter pull (finger cups are suitable),
 * attach dorsal plaster splint from the elbow to the heads of the metacarpals in slight wrist flexion and ulnar duction,
 * should follow:
 * X-ray check,
 * finger blood circulation check,
 * in 2 days check to finish turn of the gypsum (with X-ray),
 * another X-ray check after 1 week and after 3 weeks,
 * immobilization for 6 weeks - immobilization in ulnar duction and palmar flexion,
 * unsuitable position' after repositioning:
 * shortening of the radius by more than 2 mm,
 * dorsal angulation above 5°,
 * volar angulation above 20°,
 * deficit on the articular surface of the radius above 1 mm.
 * Colles_Fractuur.jpgOperational':
 * in these cases''':
 * if repositioning fails,
 * intra-articular fractures,
 * open fractures,
 * The options are:
 * percutaneous fixation with Kirschner wires during closed reduction,
 * external fixation,
 * traction screws with mini incision,
 * open reposition with T-splint,
 * LCP (locking compression plate).
 * After the surgery stabilization of the joint with an orthosis, full recovery in 10 weeks.

Complications

 * shape changes in the wrist during secondary redislocation and permanent difficulties in joint movement, which sometimes need to be solved by osteotomy and shortening of the ulna;
 * rupture of the extensor pollicis longus tendon;
 * carpal tunnel syndrome.

Related Articles

 * Forearm Fractures
 * Compound fractures of the radius and ulna
 * Isolated fractures of the radius and ulna
 * Fractures of the proximal ulna
 * Monteggio Fracture
 * Galeazzi Fracture
 * Smith's Fracture
 * Radius
 * Ulna