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By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Colles’ fracture
• Fracture at distal end of radius at its cortico-
cancellous junction (2 cm from the distal
articular surface).
• Displacement is usual.
• Common in in people above forty years of age
especially in women due to postmenopausal
osteoporosis
• FOOSH injury
Pathoanatomy
• Fracture line runs transversely at the cortico
cancellous junction.
• Common displacement
• AP view :- Proximal shift, Radial shift, Radial
tilt
• Lateral view :- Proximal shift, Dorsal shift,
Dorsal tilt
• Some amount of comminution can happen.
• Some of associated injuries are
– Fracture of styloid process of ulna
– Rupture of ulnar collateral ligament, triangular
cartilage of ulna
– Subluxation of radio ulnar joint due to rupture of
interosseous radio-ulnar ligament
Diagnosis
• Pain, swelling deformity at wrist
• Tenderness and irregularity of the lower end
of radius is found
• “Dinner fork deformity”
• Radial styloid process lies at same level or at
higher level then ulnar styloid process
• Important to differentiate from smith and
bartons fracture
Treatment
• Undisplace fracture:- immobilization in below
elbow plaster cast
• Displaced :- Closed reduction and
immobilization
• 6 week immobilization
• Chances of redisplacement is higher in
comminuted fracture
• Adult with dominant hand, surgery is
recommended
• Percutaneous K wire fixation is done.
• External fixation can also be used in case of
comminuted fracture. Fracture fragments are
kept in distraction so that stretched soft
tissues will keep fragments in alignment
• LCP (Locking compression plate)
Complications
1. Stiffness of joints
2. Malunion
3. Subluxation of inferior radio ulnar joint
– Minor degree of displacement is acceptable
– Treatment is ulna head excision
4. Carpal Tunnel Syndrome
– Treatment is decompression of carpal tunnel
5. Sudecks osteodystrophy
– Commonest cause of sudecks dystrophy
– Noticed after removal of plaster cast
– Patient complaints of pain, stiffness and swelling
of the hand.
– Overlying skin appears stretched and glossy
– Treatment is physiotherapy.
6. Rupture of extensor pollices longus tendon
– May be due to blood circulation rupture or due to
friction at sharp edge of malunited fracture
By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Smith’s fracture
• It is reverse of colles’ fracture
• Seen in adult and in elderly patient
• Distal fragment displaces ventrally and tilts
ventrally
• Treatment is closed reduction and plaster cast
immobilization
• Complications are same as colles’ fracture
By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Barton’s fracture
• Intra-articular fracture
• Fracture extends from articular surface of the
radius to either anterior or posterior direction
• Distal fragment gets displaced
• Types :- Volar or Dorsal
• Closed manipulation and a plaster cast
• ORIF may required
Thank you
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9. Forearm lower end fractures

  • 1. By :- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University Colles’ fracture
  • 2. • Fracture at distal end of radius at its cortico- cancellous junction (2 cm from the distal articular surface). • Displacement is usual. • Common in in people above forty years of age especially in women due to postmenopausal osteoporosis • FOOSH injury
  • 3. Pathoanatomy • Fracture line runs transversely at the cortico cancellous junction. • Common displacement • AP view :- Proximal shift, Radial shift, Radial tilt • Lateral view :- Proximal shift, Dorsal shift, Dorsal tilt
  • 4. • Some amount of comminution can happen. • Some of associated injuries are – Fracture of styloid process of ulna – Rupture of ulnar collateral ligament, triangular cartilage of ulna – Subluxation of radio ulnar joint due to rupture of interosseous radio-ulnar ligament
  • 5. Diagnosis • Pain, swelling deformity at wrist • Tenderness and irregularity of the lower end of radius is found • “Dinner fork deformity” • Radial styloid process lies at same level or at higher level then ulnar styloid process • Important to differentiate from smith and bartons fracture
  • 6.
  • 7. Treatment • Undisplace fracture:- immobilization in below elbow plaster cast • Displaced :- Closed reduction and immobilization • 6 week immobilization • Chances of redisplacement is higher in comminuted fracture • Adult with dominant hand, surgery is recommended
  • 8. • Percutaneous K wire fixation is done. • External fixation can also be used in case of comminuted fracture. Fracture fragments are kept in distraction so that stretched soft tissues will keep fragments in alignment • LCP (Locking compression plate)
  • 9.
  • 10. Complications 1. Stiffness of joints 2. Malunion 3. Subluxation of inferior radio ulnar joint – Minor degree of displacement is acceptable – Treatment is ulna head excision 4. Carpal Tunnel Syndrome – Treatment is decompression of carpal tunnel
  • 11. 5. Sudecks osteodystrophy – Commonest cause of sudecks dystrophy – Noticed after removal of plaster cast – Patient complaints of pain, stiffness and swelling of the hand. – Overlying skin appears stretched and glossy – Treatment is physiotherapy.
  • 12. 6. Rupture of extensor pollices longus tendon – May be due to blood circulation rupture or due to friction at sharp edge of malunited fracture
  • 13. By :- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University Smith’s fracture
  • 14.
  • 15. • It is reverse of colles’ fracture • Seen in adult and in elderly patient • Distal fragment displaces ventrally and tilts ventrally • Treatment is closed reduction and plaster cast immobilization • Complications are same as colles’ fracture
  • 16. By :- Dr. Bindesh D. Patel, PT Deputy Registrar P P Savani University Barton’s fracture
  • 17. • Intra-articular fracture • Fracture extends from articular surface of the radius to either anterior or posterior direction • Distal fragment gets displaced • Types :- Volar or Dorsal
  • 18. • Closed manipulation and a plaster cast • ORIF may required
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