Colle`s and smith`s fracture

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Colle`s and smith`s fracture
Injuries of the forearm

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Colle`s and smith`s fracture

  1. 1. Injuries of the forearm Colle`s and smith`s fracture
  2. 2. Normal wrist joint • Fig : -
  3. 3. Normal wrist joint • Fig : -
  4. 4. Colle’s fracture. • describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint . • Occurs about 2.5 cm above the carpal extremity of the radius . Commonest age group- Elderly.( 60 yrs) Women> Men. MOA – fall in outstretched hand. • Force required to cause this fracture is 192 kg in women and 282 kg in men.
  5. 5. Colle’s fracture • Fig : -
  6. 6. Colle’s fracture • Fig : -
  7. 7. AP View • Fig : - colle`s fracture
  8. 8. Clinical features.• Swelling. • Pain. • Dinner fork defomity, it is not found in all cases but seen only if there is a dorsal tilt or rotation of the distal fragment ExaminationDistal neurovascular status. External injuries.
  9. 9. Dinner fork defomity • Fig :
  10. 10. dorsal displacement of the distal fracture fragments.
  11. 11. Styloid process test : • Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process. • In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture. • This is more reliable sign than dinner fork deformity
  12. 12. Distance between radial and styloid processes • Fig :
  13. 13. Colle’s fracture • Fig : -
  14. 14. Frykmann`s classification : Fracture line 1 .. Extra - articular 2. Intra – articular (involving RC joint only ) Distal ulnar fracture Absent 1 3 3 . Intra – articular (involving distal RU joint only ) 5 4 . Intra – articular (both RC + inferior RU joints ) RC = radiocarpal RU = radioulnar 7 present 2 4 6 8
  15. 15. Frykmann`s classification • Fig :
  16. 16. Radiograpy : X – ray of the wrist : • AP and lateral views and lower end of the radius Displacement in a colle`s fracture : • Dorsal displacement • Dorsal rotation • Lateral displacement • Lateral rotation • Impaction • supination
  17. 17. Treatment : • Conservative methods • Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or local anaesthesia (LA) - If the level of the styloid processes are restored back to normal , it indicates that the reduction has been achieved satisfactorily. - limb is immobilised by colle`s cast and a check radiograph is taken - Removed after 6 – 8 weeks - physiotherapy
  18. 18. 6 immobilisation method : • Below elbow cast (10 – 20 degree palmar flexon , 15 – 20 degree ulnar deviation ) COLLE`S CAST • ABOVE ELBOW CAST IN SUPINATION • ABOVE ELBOW CAST IN PRONATION . ABOVE ELBOW CAST IN MID- PRONATION . COTTON LODER`S POSITION( WRIST FULLY FLEXED) . EXTERNAL FIXATORS
  19. 19. Colle`s cast • • • • It is a below elbow cast in supination and ideally it has to meet the following 4 criteria :Firm fit at the dorsum Firm fit at the volar fracture apex Just snuggly fitting at the forearm Metacarpophalangeal joints should be free to move
  20. 20. Colle`s cast
  21. 21. Acceptable limits of colle`s fracture: • A dorsal tilt of less than 10 degrees • A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION : • Impaction • Median nerve intrapment
  22. 22. Cont.. • Fig : -
  23. 23. Surgical methods : 1 . Closed reduction and percutaneous pinning with k – wires 2 . Open reduction and plate fixation.
  24. 24. Complication Early complication : • Unstable reduction • Medial or ulnar nerve stretched • Post reduction swelling • Compartmental syndrome • Anaesthesia problem • Injury to proximal segment of the bone during reduction Late complication : • Malunion • Rupture of extensor pollicis tendon • Frozen shoulder • Carpel tunnel syndrome • Nonunion • Sudeck`s osteodystrophy
  25. 25. COLLE`S FRACTURE Why is it called fracture of 6…? • Common at 60 years • Force required to cause colle`s fracture are multiples of 6 • 6 classical displacements • 6 method of fracture immobilisation • 6 important early and late complications • 60 per cent cases have fracture ulnar styloid
  26. 26. Smith’s Fracture. • Reverse of colle’s fracture. • Wrist fracture in which the distal end of the radius is displaced forwards. Mechanism of injury : • Fall on the back of the dorsum of the hand • Fall on the forearm in supination • Direct blow to the flexed hand
  27. 27. Colle`s and smith`s fracture • Fig : -
  28. 28. Clinical features : • • • • • Pain Swelling Deformity Loss of wrist function Deformity is opposite to that of colle`s fracture and is called the garden shaped deformity. Radiography : • AP view of the wrist
  29. 29. Complication : • Complication of colle`s Treatment : • Closed reduction and immobilisation in a long arm cast with forearm in supination and wrist in extension. Unstable fractures : • Fixation with k – wire or open reduction and plate fixation.

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