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
Colles fracture.Conservative (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.
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.
In elderly people with osteoporosis, it is sometimes better not to attempt a reposition due to further possible disruption.
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;
