This document summarizes several types of fractures that can occur in the forearm and wrist as a result of falling onto an outstretched hand. It describes Colles' fracture, which is the most common and involves a break in the radius near the wrist. It also discusses Smith's fracture, which is a reverse Colles' fracture with the distal fragment displaced anteriorly. Other fractures mentioned include Monteggia, Galeazzi, scaphoid, and supracondylar fractures of the humerus. For each type, the document outlines the mechanism of injury, clinical features, diagnosis using x-rays, and treatment approaches.

1. INJURIES DUE TO FALL
ON AN
OUTSTRETCHED HAND
SHAHID

2.  Colles’ fracture
 Smith’s fracture
 Galeazzi fracture
 Monteggia fracture
 Scaphoid fracture
 Supracondylar fracture of humerus
 Fracture of head of radius
 Clavicular fracture

3. COLLES’ FRACTURE
 First described by Abraham
colles.
 Colles fracture is the
fracture at the distal end of
radius, at its cortico
cancellous junction (about
2cm from distal articular
surface).
 Most common age group-
above 40 years, occuring
most common in female.

4. MECHANISM OF INJURY

5. PATHOANATOMY
 Displacement-The fracture line runs transversely
at cortico-cancellous junction.
In many cases one or more displacements may
occur as follows:
 Impaction of fragments
 Dorsal displacement
 Dorsal tilt
 Lateral displacement
 Lateral tilt
 Supination

6. CLINICAL FEATURES
 Pain
 Swelling
 Deformity-classical
‘dinner-fork
deformity’
 Radial styloid process
lies in the same level or
little higher than the
ulnar styloid process.

7. DIAGNOSIS
 Radiological
features:
It is important to
differentiate colles’
fracture from other
fractures occuring at
same time, such as
Smith’s fracture,
Barton’s fracture by
looking at the
displacements.

9. X-RAY
 Lateral view: Dorsal tilt- detected by looking
at the direction of distal articular surface of
radius.
 AP view: Lateral tilt- similarly it can be
detected by looking at articular surface if it
faces medially it is normal, if it becomes
horizontal or faces laterally, a lateral tilt is
present.

10. TREATMENT
 Conservative method:
For undisplaced fracture- immobilization in a
below-elbow plaster cast for 6 weeks.
For displaced fracture- Manipulative
reduction followed by immobilization

11. MANIPULATIVE REDUCTION
 Step 1- Disimpact the
fragments by firm longitudinal
traction against the counter-
traction by an assistant.
 Step 2- Press the distal
fragment into palmer flexion
and ulnar deviation by using
thumb of other hand.
 Step 3- Now hand is drawn in
pronation, palmer flexion and
ulnar deviation. A plaster cast is
applied extending from below
elbow to metacarpal heads.

12. SURGICAL METHODS
Closed reduction and per-cutaneous
fixation using K- wire.
Open reduction and plate fixation.

13. COMPLICATIONS
 Stiffness of joints
 Malunion
 Subluxation of inferior radio- ulnar joint
 Carpel-tunnel syndrome
 Sudeck’s osteodystrophy
 Rupture of extensor pollicis longus tendon.

14. SMITH’S FRACTURE
 Smith fracture(reverse
colle’s) is the fracture
of distal radius where
the distal fragment
displaces anteriorly.
 Bimodal- distribution:
young males( most
common) and elderly
females.

21. SCAPHOID FRACTURE
 A scaphoid fracture is
more common in young
adults. It is rare in
children and in elderly
people.
 Commonly, fracture
occurs through the waist
of scaphoid. Rarely it
occurs through the
tuberosity.
 It may be either a crack
fracture or a displaced
fracture.

23. BLOOD SUPPLY

25. CLINICAL FEATURES
Pain
Swelling
On/E-
 Tenderness at scaphoid fossa
(anatomical snuff box)
 Decrease thumb movement

26. X-RAY
 PA view
 Semipronated
view
 Semisupinated
view
 Ziter view-

27. TREATMENT
 Conservative treatment- Affected hand is
immobilized in a scaphoid cast for 3-4
months.
 Scaphoid cast is applied from below elbow
to metacarpel heads, includes thumb. Wrist
is maintained at little dorsiflexion and radial
deviation( glass holding position).

29. COMPLICATIONS
Avascular necrosis
Delayed union and non-union
Wrist osteoarthritis

30. MONTEGGIA FRACTURE
 This is a fracture of upper-third of
ulna with dislocation of head of
radius.
 Types:
 Extension type- where the
ulna fracture angulates anteriorly
and the radial head dislocates
anteriorly.
 Flexion type- where the ulna
fracture angulates posteriorly and
the radial head dislocates
posteriorly.

31. TREATMENT
This is very unstable fracture.
Reduction is attempted under general
aneasthesia. If closed reduction is not
possible, an open reduction and internal
fixation using a plate is performed.

32. GALEAZZI FRACTURE
 This is a fracture of
lower-third of radius
with dislocation or
subluxation of distal
radio-ulnar joint.
 Displacement-Radius
fracture is angulated
medially and anteriorly
and dorsal dislocation
of distal end of ulna.

33. TREATMENT
It is difficult to achieve and maintain
perfect reduction by conservative
methods( except in children).
Open-reduction and internal fixation of
radius with plate is done in adults.

34. THANK YOU