Colles Fracture

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

• radius breaks 2-3 cm proximal to the wrist joint,
• The distal fragment is dislocated 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 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

• 
  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.
• 
  Operational':
  • 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.

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;
• rupture of the extensor pollicis longus tendon;
• carpal tunnel syndrome.

Links

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

Source

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

• ZEMAN, Miroslav. Special Surgery. 2. edition. Prague : Galen, 2006. 575 pp. ISBN 80-7262-260-9.