Colles fracture

A Colles fracture is caused by a fall on a dorsiflexed and pronated arm :


 * the radius breaks 2–3 cm proximal to the carpal joint ,
 * the distal fragment dislocates dorsally and radially.

In half of the cases there is also a fracture of the ulna styloid process. Age-wise, it occurs in two peaks:


 * at a younger age is related to increased activity,
 * in old age, it is related to osteoporosis (along with femoral neck fractures and vertebral compression fractures).

Content

 * 1Clinical picture and diagnosis
 * 2Therapy
 * 3Complication
 * 4Links
 * 4.1related articles
 * 4.2Source

Clinical picture and diagnosis
Colles fracture.

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 * typical bayonet-like position when 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 assess 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 ,
 * luxation of the radio-ulnar joint ,
 * the fracture can also be comminuted (shattering).

Position of the wrist joint.

Therapy

 * Conservative (most are treated conservatively)
 * local anesthesia (10 ml of 1% mesocaine to the hematoma site),
 * reposition – pull for 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
 * apply a dorsal plaster cast from the elbow to the heads of the metacarpals in slight wrist flexion and ulnar duction,
 * should follow :
 * x-ray check,
 * finger blood flow control,
 * in 2 days check to finish the cast (with X-ray),
 * another X-ray check after 1 week and after 3 weeks,
 * immobilization 6 weeks – immobilization in ulnar duction and palmar flexion,
 * inadequate position after reduction:
 * 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.
 * Operating :
 * in these cases :
 * if repositioning fails ,
 * intra-articular fractures ,
 * open fractures,
 * options are:
 * percutaneous fixation with Kirschner wires during closed reduction,
 * external fixation,
 * mini-incision tension screws,
 * open reposition with a T-plate,
 * LCP (locking compression plate).
 * After surgery to stabilize the joint with an orthosis, full recovery in 10 weeks.

In elderly people with osteoporosis, it is sometimes better not to attempt a reduction due to further possible disruption.

Complication

 * shape changes in the wrist due to 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

 * Fractures of the forearm
 * 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

Source

 * PASTOR, Jan. Langenbeck's medical web page  [online]. [feeling. 2009]. < https://langenbeck.webs.com/ >.


 * ZEMAN, Miroslav, et al. Special surgery. 2nd edition. Prague: Galén, 2006. 575 pp.  ISBN 80-7262-260-9.