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Colles’ Fracture


- See:  Distal Radius Frx Menu / Intra-Articular Fractures of the Distal Radius

- General Discussion:
    - frx was described by Abraham Colles in 1814, originally described as low energy extra articular frx of distal radius occuring in elderly individuals;
-
frx is typically dorsally displaced and angulated;
- mechanism:
- fracture is also caused by a forced dorsiflexion of the wrist;
- occurs in pts > 50 years of age who fall on out stretched hand;
- dorsal surface undergoes compression while volar surface undergoes tension;
- incidence:
- Incidence of Colles' Fracture in a North American Community
- Incidence of distal forearm fracture in British men and women.
- Fracture risk in the U.S. Medicare population.
- Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong?
    - classification:
          - Frykman Classification
- Melone Classification
- Universal Classification
    - associated injuries:
          - ulnar styloid frx
- Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study.
- Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture
                 - Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures.

- TFCC tear
- according to the report by Richards, et al (1997), TFCC tears occurred in 53% of extra-articular distal radius fractures vs
35% of intra-articular fractures;
- scapholunate dissociation:
- Intercarpal Ligament Injuries Associated with Fractures of the Distal Part of the Radius

- Physical Exam and Evaluation

- Radiographic Findings:
    - x-ray appearance is that of a dorsally angulated fracture of distal radial metaphysis  (2-3 cm proximal to wrist joint),
w/ or w/o associated frx of ulnar styloid;
- initial frx line is almost always on volar side & is single line;
    - determination of stability:
           - intra-articular component
- radial shortening
- dorsal angulation
- radial inclination
- distal radioulnar subluxation and/or ulnar styloid frx
- in stable extra-articular fractures, there will often be frx extension into the DRUJ, which is the most likely source of symptoms;
- scapholunate dissociation:
- ref: Scapho-Lunate Diastasis: A Component of Fractures of the Distal Radius.
           - comminution:
                 - dorsal surface is frequently comminuted;
- if comminution extends volar to midaxial plane of radius, then cast immobilization will frequently fail;
- expect increase in comminution w/ incr in amount of dorsiflexion;
- high-loading angles, (70-90 deg), have much more comminution than low loading angles of 20 to 40 deg;
- as noted in the study by Trumble, et al (1998), external fixation provided clear advantages in specific situations;
- in older patients, pain relief, grip strength, and ROM were significantly better when external fixation was used;
- in younger patients, external fixation provided consistently better results when there was comminution in 2 or more cortices;
- references:
- An effective treatment of comminuted fractures of the distal radius.
- Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation.

- Treatment:
     - Non Operative Treatment /  colles fracture reduction
- Percutaneous Pinning
- External Fixators for Distal Radius Fractures
- ORIF of Intra-Articular Distal Radius Fractures

- Late Complications:
     - extensor pollicis longus rupture
- RSD
- often RSD following colles fractures will result from over distraction of an external fixator;
- in the presentation by Stoffelen D and Broos PL (15th Annual Meeting of the Orthopaedic Trauma Association 1999), the
authors found  use of calcitonin to be helpful in treating this disorder;
- vitamin C:
- Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?
- Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture

- loss of reduction and secondary deformity;
- median nerve compression;
- Predictors of Acute Carpal Tunnel Syndrome Associated With Fracture of the Distal Radius
- malunion
- distal radioulnar joint injury;
- extension of Colles frx into the RU joint has a worse prognosis;
- in stable extra-articular fractures, there will often be frx extension into the DRUJ, which is the most likely source of symptoms;
- patients may note:
- weak grip;
- localized pain;
- loss of supination;
- ref:  The Distal Radio-Ulnar Joint in Colle's Fracture.

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References