Colles Fracture: Definition, X-ray, Treatment, Complication

Colles Fracture

Definition (Expert Homeopathy: Dr. Anutosh Chakraborty)

Fracture of lower end of the radius within 3/4" (2cm) proximal both and distal articular surface of the radius.
There is always an associated injury to the inferior radio-ulnar joint with or without articulation of the ulnar styloid process and ulnar collateral ligament of the wrist. The fracture is an impacted one.


Mechanism

It is the commonest of all fractures and is due to a supination force. The patient often an elderly woman, falls on the dorsiflexed hand(outstretched) breaking the radius transversely joint above the wrist. The momentum of the body imposes a supination force and the lower radius with the hand is twisted and tilled backward and radially.


Clinical features

The patient commonly an elderly female complained of pain and swelling of the wrist after a fall on her outstretched hand. The DINNER-FORK deformity is seen only with gross displacement.
The normal slight concavity on the back of the wrist is obliterated and depression is seen in the front of the lower radius. The lower end of the radius and the tip of the ulnar styloid process are prominent and tender. The tip of the radial styloid process is raised at a higher level or it is at the same level as that of the ulnar styloid process. Normally it is situated about 1/2" lower than that of the ulnar styloid process. Wrist movements are restricted and painful.


X-Ray

There is a transverse fracture(#) of the radius less the one inch from the wrist and often the ulnar styloid process is broken
The radial fragment is
a) Shifted and tilted backward
b) Shifted and tilled radially
c) Impacted


Treatment / Surgery

Reduction: Under anesthesia, the fracture (#) is reduced

  1. Disimpaction: It is achieved by pulling on hand. If it fails, the backward tilt is temporarily increased and the traction resumed.
  2. Pronation: The patients' wrist is palmer-flexed and the forearm strongly pronated
  3. Pressure: To ensure that reduction is complete. The surgeon presses the lower radius firmly forward and towards the ulna.

Immobilization

  1. Following reduction, the forearm is still held pronated and the wrist slightly palmar flexed, and a plaster slab is applied. It extends from just below the elbow to the metacarpal necks (knuckle) and two-thirds of the circumference of the wrist.
  2. The plaster is completed by encircling the plaster bandage.
  3. After plastering the hand is kept elevated, left on a calf and color sling.

Check X-ray done after 7days.
Immobilization for 6 weeks, after the plaster is discarded, crepe bandage is applied.
Early movements of fingers and shoulder are advised.


Complications

Mal-union
Delayed union and non-union rarely
Stiffness and sundeck's atrophy may persist for months
Tendon rupture - Delayed rupture of the long extensor tendon may rarely occur.


What is a Smith fracture? 

This fracture happened at the distal part of the radius. In the forearm, the radius is the larger of the two bones in the arm. It's the end of the beam in the direction of the brush, it is referred to as the distal end. Smith's fracture, is also associated with the so-called palmar presence of a distal fragment. This means that the damaged part of the bone is moved back into the palm of your hand. 

Usually, Smith's fractures are extra-articular. So the fracture does not impact the wrist joint. These are, usually, the task of disruption, which means that the fracture occurs at right angles to the bone. Smith's fracture, is well-known, under several different names such as the Big break-through, and Kolles Reverse the Damage. 

In the forearm, the radius is the most commonly broken bone in the arm. But, in fact, Smith's fractures are relatively rare. Their share is less than three percent of all fractures of the radius. The majority of frequently, they are likely to occur in younger men and older women.

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