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Colles # Colles # Presentation Transcript

  • Colles' fracture From Wikipedia, the free encyclopedia Jump to: navigation, search Colles' fracture Classification and external resources An X-ray image of a fractured radius showing the characteristic Colles' fracture with displacement and angulation of the distal end of the radius. ICD-10 S52.5 (ICD10-CA S52.500-S52.501[1] ) ICD-9 813.41 DiseasesDB 2959 MedlinePlus 000002 eMedicine radio/822 MeSH D003100 See also: Distal radius fracture A Colles' fracture, also Colles fracture, is a fracture of the distal radius in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm. Colles' fractures are often seen in people with osteoporosis. Contents [hide] 1 Terminology 2 Causes 3 Diagnosis 4 Treatment 5 Eponym 6 In older and younger people 7 References 8 External links
  • Terminology[edit] The term Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, now the term tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”.[2] The classic Colles fracture has the following characteristics:[3] Transverse fracture of the radius 2.5 cm (0.98 inches) proximal to the radio-carpal joint dorsal displacement and dorsal angulation Causes[edit] The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched arms - falling with wrists flexed would lead to a Smith's fracture. It can also be caused by overuse. Originally it was described in elderly and/or post- menopausal women. It usually occurs about three to five centimetres proximal to the radio- carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles' fracture is a common fracture in people with osteoporosis, second only to vertebral fractures. Diagnosis[edit] Colles' fracture
  • Colles fracture on X-ray. A severe Colles fracture may assume a bayonet-like displacement. Dorsal tilt Radial shortening Loss of ulnar inclination Radial angulation of the wrist Dorsal displacement of the distal fragment Comminution at the fracture site Associated fracture of the ulnar styloid process in more than 60% of cases. Treatment[edit] Management depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. There is some evidence that immobilization with the wrist in dorsiflexion as opposed to palmarflexion results in less redisplacement and better functional status.[4] Significant angulation and deformity may require an open reduction and internal fixation or external fixation. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures, including Colles' fracture. There are several established instability criteria: dorsal tilt >20°, comminuted fracture, abruption of the ulnar styloid process, intraarticular displacement >1mm, loss of radial height >2mm. A higher amount of instability criteria increases the likelihood of operative treatment.
  • Treatment modalities differ in the elderly.[5] Eponym[edit] It is named after Abraham Colles (1773–1843), an Irish surgeon who first described it in 1814 by simply looking at the classical deformity before the advent of X-rays.[6] Ernest Amory Codman was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.[7][8] In older and younger people[edit] Colles fractures occur in all age groups, although certain patterns follow an age distribution. In the elderly, because of the weaker cortex, the fracture is more often extra-articular. Younger individuals tend to require a higher energy force to cause the fracture and tend to have more complex intra-articular fractures. In children with open epiphyses, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate. More common in women because of post-menopausal osteoporosis. Colles Fracture WRITTEN BY DR. STUART MYERS SATURDAY, 26 APRIL 2008 15:24 General: This is the commonest wrist fracture & often occurs in postmenopausal women. It usually results from a fall onto the
  • outstretched hand & leads to the Radius (larger forearm bone) crushing into itself & tilting backwards. A Colles fracture results in the radius shortening or conversely the ulna becomes too long and impacts against the wrist bones. Normally the radius is tilted forward approx. 10 degrees on a side view. On a front view of the wrist the radius and ulnar are approximately the same length.
  • Issues:
  • There are many issues to take into consideration in the management of this fracture. Any given Colles fracture may be well treated in several different ways. Age, Activity Level, General Health Non - Dominant Hand Dominant Hand Undisplaced Displaced Joint surface Involved - Step __---- - Gap ---- ---- Comminution (1 fragment or many fragments) Osteoporosis (Soft bones) Growth plate involved (children) Other injuries eg nerve, cartilage, ligaments Stable Unstable Acceptable Unacceptable Fixable to allow immediate movement Risks of Surgery Treatment: The aim is to hold the fractured bones in a satisfactory position until healing occurs (usually in a plaster cast for 6 weeks) and avoid complications along the way. If the fracture is displaced then a “Closed reduction” may be required (pulling on the bones under an anaesthetic to realign the fracture). If the fracture is very unstable additional measures may be required to stabilise the fracture (“ Open reduction”) eg. Plates Screws Wires External Fixateurs Bone graft from the hip Norian cement (derived from Coral)
  • Sometimes the best long-term functional result is achieved by accepting a degree of deformity and starting early movement once the fracture has healed. One has to balance the advantages versus the risks of an operation and this is a decision that requires considerable experience. Plaster: The arm should be comfortable in the cast. If it feels uncomfortable despite Panadol and elevation; or if the cast feels too tight then let your doctor know immediately. While in the cast it is important to exercise the fingers, elbow & shoulder to prevent stiffness. The arm may be X-Rayed regularly if the fracture is unstable to make sure that the fracture position does not change. The outer bandage around the half plaster slab needs to be tightened regularly so that the plaster feels snug but not too tight. After plaster removed: Your doctor will give you a Tubigrip bandage for comfort. This can be removed for showering or when no longer required for support.
  • Perform finger & wrist exercises & grip strengthening exercises squeezing putty or a squash ball. It is not uncommon to experience some discomfort for a few months in the wrist especially on the side away from the thumb. This usually settles with time. Do not do any heavy lifting or play sport for 6 weeks after the plaster is removed. Do not return to driving until you can turn the steering wheel in an emergency. Complications: 1. Swelling – plaster too tight 2. Malunion – angled, shortening 3. Complex Regional pain syndrome (CRPS) 4. Nerve entrapment eg Carpal Tunnel 5. Tendon rupture 6. Arthritis 7. Other Examples: A 27 year old snow boarder falls at high speed. The Xrays tend to understate the injury. There is not only a Colles fracture with an associated fracture at the base of the ulna styloid but also a Scaphoid fracture. The degree of joint surface disruption and degree of comminution ( multiple fragments) is best seen on the CT scan. Front view Xray Side View Xray
  • CT Scan reveals scaphoid fracture CT Scan side view Internal fixation of all fractures allows immediate movement of the wrist and no cast A removable brace is used in the early post-operative period for comfort.
  • At 8 weeks satisfactory movement after a significant wrist injury. At 5 months the movement was full. Example 2: Normal alignment Colles fracture with change in wrist alignment A Colles fracture alters the alignment of the small bones (within the wrist. This can result in arthritis throughout the wrist. Example 3:
  • A fracture involving the joint surface with a large step will result in rapid onset arthritis if left untreated. Revised 6 / 10 / 06 Broken Wrist Injury Explained A broken wrist is common following a fall on an outstretched hand. A Colles fracture is a fracture of the Radius bone of the forearm, just above the wrist (a Scaphoid fracture is the other common type of wrist fracture). Symptoms include a great deal of wrist pain, a "dinner fork" deformity, wrist swelling and an inability to use the wrist and hand. The term Colles fracture originated with the Dublin doctor Abraham Colles, who first described this common type of wrist fracture in 1814. Falls that cause wrist fractures are common during snowboarding. The natural response to a fall is to stretch out a hand to break the fall, and falls tend to occur more often in beginners. For this reason a broken wrist is a relatively common feature, with around 100,000 wrist fractures worldwide among snowboarders each year. Top of Page Broken Wrist Signs & Symptoms As you would imagine with a fracture, there is a great deal of wrist pain. The aforementioned 'dinner fork' deformity is usually present, together with wrist swelling and, as a result of the fracture, an inability to use the wrist and hand. In most Colles fractures the patient will hold the affected wrist towards their body in an effort to protect it. Diagnosis is confirmed by an x-ray. Top of Page
  • Broken Wrist Treatment What you can do Consult a sports injury expert Apply cold therapy to relieve pain Wear a removable wrist support for protection Regain dexterity with therapeutic putty Relieve wrist stiffness with hand therapy balls Improve hand & grip strength with resistance exercises Use a bone healing system to speed up broken bone healing If a fracture of the wrist is suspected, the patient should be taken to an accident and emergency department without delay. Ice Packs may be helpful to relieve pain. If a Colles fracture is confirmed on x-ray, the initial treatment will be supervised by the doctor in the emergency department. If the two fragments of broken bone are shown to be close together, and well aligned, the treatment is simply to immobilise the wrist in a cast for 6 weeks. For the first 72 hours after the injury the wrist should be elevated to reduce swelling. However, if the x-ray shows that the two fragments of bone are displaced away from each other, or not well aligned, then the emergency department doctor will have to manipulate the fragments back into position. This procedure is done under anaesthetic and once the bone has been repositioned, the forearm and wrist will be immobilised in a plaster for 6 weeks. The wrist should be x-rayed again after 2 weeks to make sure that the bone is still well aligned. Depending on the preference of the treating doctor it may be possible to use a Removable Cast from two or three weeks so long as the x-ray shows that the bone is healing well. Removable Wrist Supports provide the same degree of protection as a conventional plaster, but are much lighter and therefore more comfortable to wear. The fact that they can be removed allows washing of the wrist region, making it much more hygienic than a conventional plaster which allows the user to keep the skin in good condition. Rehabilitation begins immediately by maintaining the range of movement in the shoulder, fingers and thumb, on the side of the affected wrist. This prevents secondary stiffness in these areas and helps to resolve swelling in the wrist. Assuming that there are no complications with healing, the plaster can usually be removed after 6 weeks, if the doctor is satisfied that the bone has united and healed itself. At this stage more active rehabilitation can be undertaken. Exercises in warm water are helpful to improve the hydration of the skin if it was encased in a plaster of paris. These also encourage the patient to gently begin moving the wrist in all directions, relieving stiffness. Exercises using Therapeutic Putty, Hand Therapy Balls and Finger & Grip Strengtheners can add strength to the muscles around the wrist and resolve wrist swelling. In the
  • period following the removal of the plaster it may be helpful to wear a Wrist Support when not doing the exercises. Top of Page Broken Wrist Prevention Snowboarders should wear wrist guards as they significantly reduce the incidence of wrist injuries during falls. These are available from all good ski shops. Top of Page Colles Fracture) What is it? When someone breaks their wrist, they may break any of a number of bones. The most common types of wrist fractures are those involving one of the wrist bones, such as a scaphoid fracture, and those involving a break of the end of the forearm bones. A Colles fracture is a wrist fracture involving a break of the end of the radius bone of the forearm ("distal radius fracture"). Scaphoid Fracture Colles Fracture What caused it? Americ an Society for Surgery of the Hand assh.or g The Best Resourc e For Your Hands, Period.
  • Wrist fractures occur most often in a fall or in a motor vehicle accident, but any sufficiently strong force on the hand can break the wrist. The wrist can be broken from a sudden force pushing the hand backwards. A strong force pushing the hand into the forearm can also cause a Colles fracture, which often involves a break of the radius bone near its end. There is a natural weak spot in the radius where it widens. Because of the flare in the shape of the bone, the broken piece next to the hand is usually wider than the piece right next to it.
  • If the pieces don't lock back together like a jigsaw puzzle, the pull of the forearm muscles can pull the larger end over the smaller like a sleeve, and the bone can shorten like a collapsible drinking cup. Wrist arthritis may occur following a distal radius fracture. This can be the result of cartilage injury at the time of the break, or wear and tear from changes in the joint alignment after the bone is healed. Carpal tunnel syndrome, causing numbness and tingling in the fingertips may also develop when a wrist fracture narrows the path for the nerve and tendons in front of the bone. A common development after a Colles fracture is a change in the contour of the back of the wrist due to the bone healing in a tipped back position. This often looks worse than it feels. What can you do to help? Ice, elevation and rest - and check with your doctor. If the injury involved a cut, medical evaluation is particularly important - check whether or not a tetanus shot, antibiotics or other treatment is needed. What can a therapist do to help? Depending on the problem, a therapist can be very helpful in providing a protective splint and supervising special exercises to improve movement and strength. Wrist and finger stiffness is a very common problem after this injury, and therapy can be the step which makes all of the difference. What can a doctor do to help? Confirm that this is the problem. X-rays are usually needed to show exactly what the problem is. Treatment really depends on the type of break. Your doctor may recommend:
  • o moving the fingers and doing exercises right away o wearing a splint or a cast o having surgery to set the break, possibly using hardware (pins, screws, wires, etc.) to hold the pieces in place. There are many different types of surgery, and treatment must be tailored to fit not only the break but other factors which affect the healing process. How successful is treatment? Regardless of treatment, recovery takes a surprisingly long time - six to twelve months is typical. Pain, fatigability, and loss of grip strength are a nuisance in about half of people with this type of injury. Despite this, three out of four patients on the average have a satisfactory result following distal radius fracture. What happens if you have no treatment? It's a roll of the dice. You may luck out and wind up with a pretty good result. However, if the break really needs to be set, it's best to do it right away. If the bone heals in the wrong position, it can be rebroken and re-set later, but the results of this late intervention are not as reliable, and usually not as good. Click here to search the web for distal radius fracture HOME | FOR PATIENTS | IMAGES | NEW | SEARCH | CONTACT