This document discusses Colles' fracture, which is a fracture of the distal radius near the wrist. It most commonly occurs in post-menopausal women after a fall on an outstretched hand. The fracture causes dorsal displacement of the distal radius fragment. Treatment involves closed manipulation and casting the forearm in pronation, palmar flexion, and ulnar deviation. Complications can include nerve injuries, complex regional pain syndrome, malunion from improper treatment, and secondary osteoarthritis in more severe fractures.

1. DR. BIPUL BORTHAKUR
PROFESSOR, DEPT OF ORTHOPAEDICS, SMCH

3.  Colle’s fracture
 Smith fracture
 Barton’s fracture
 Chauffeur’s fracture

4.  Described by Abraham Colles in 1814
 It’s the fracture at the corticocancellous junction of
the distal radius, 2.5 cm proximal to the distal
articular surface of the radius, with typical
displacement
 Commonly seen in elderly female patients: post-
menopausal osteoporosis
 Mechanism of injury – fall on the outstretched hand
with wrist in extension

5.  Displacements in Colles’ fracture
 Shifts – Dorsal and lateral
 Tilts – Dorsal and lateral
 Impaction or proximal shift
 Supination
 Associated injuries:
 Ulnar styloid fracture
 Rupture of ulnar collateral ligament
 Rupture TFCC (triangular fibrocartilage complex)
 Rupture of the interosseous radio-ulnar ligament – DRUJ subluxation

6.  CLINICAL FEATURES:
 Pain, swelling and external deformity
– DINNER FORK DEFORMITY
 Limited ROM of wrist, tenderness
 Radial styloid rides upward to lie at
the same level or a little higher than
the ulnar styloid process

7.  INVESTIGATIONS: Plain radiograph
of forearm with elbow & wrist – AP and
lateral view
 Dorsal tilt is the characteristic displacement –
in lateral view
 Lateral tilt – in AP view
 Both can be diagnosed in x-ray – articular
surface faces dorsally or neutral in lateral view,
faces laterally or horizontal in AP view.

8.  TREATMENT:
 Undisplaced fracture – below elbow cast immobilization without any
manipulation
 With typical displacement – closed manipulation and below elbow slab or
cast immobilization for 4 to 6 weeks.
 Traction and counter-traction: disimpaction
 Correction of dorsal tilt – palmar flexion
 Correction of radial tilt – ulnar deviation

9.  TREATMENT:
 Final position of Colles’ cast
 Pronation of forearm
 Palmar flexion
 Ulnar deviation
 Take a check x-ray after Colles’ cast application to confirm the reduction
 Repeat x-rays at 7, 14 and 21 days (fracture becomes sticky) to see for
redisplacement.

10.  TREATMENT:
 Patient advised to keep the limb elevated
 Shoulder, elbow and finger joint movements have to be emphasized
 Remove the cast immediately if signs of compartment syndrome develops
 Fracture heals by 6 weeks, following which physiotherapy has to be started

11.  Reverse Colles’ fracture – ventral tilt and shift
 Fall on the outstretched hand with wrist in flexion
 Volar tilt / shift instead of dorsal tilt / shift
 More unstable than Colles’ fracture
 Garden-spade deformity

12.  Plain x-ray of wrist confirms the diagnosis
 Treatment – closed manipulation + B/E slab
or cast for 6weeks
 Traction – supination – extension of the wrist
 Surgical fixation if fracture displaces again –
volar locking plates

13.  High energy injury
 Intra-articular fracture of distal radius
 Either with volar or dorsal displacement
 Highly unstable fracture
 Demands restoration of articular congruity, alignment and length.

14.  Plain x-ray AP, lateral and oblique
views; CT scans are useful
 Usually operative treatment
 CR or OR with percutaneous K-wires
 OR with volar locking plates
 Distractor application in highly
comminuted fractures

15.  It is an intra-articular fracture of radial
styloid process.
 It results due to fall on outstretched
hand.
 It can be managed conservatively.

16.  Early:
 Nerve injury – median nerve compression
 Complex regional pain syndrome (CRPS) or Sudeck’s osteodystrophy
 Ulnar corner pain and instability
 Associated injuries of the carpus
 Redisplacement

17.  Late:
 Malunion – due to improper reduction, improper fixation and redisplacement
 Delayed union and non-union – rare unless infected or severe bone loss with instability
 Tendon rupture – EPL, FPL
 Carpal instability – due to ligament injury
 Secondary osteoarthritis – in intra-articular fractures