A Colles' fracture is a type of
fracture of the distal forearm in which the broken end of the
radius
In classical geometry, a radius ( : radii) of a circle or sphere is any of the line segments from its center to its perimeter, and in more modern usage, it is also their length. The name comes from the latin ''radius'', meaning ray but also the ...
is bent
backwards.
Symptoms may include pain, swelling, deformity, and
bruising
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...
.
[ Complications may include damage to the ]median nerve
The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.
The median nerve originates from the lateral and medial cords of the brachial plexus, and has cont ...
.
It typically occurs as a result of a fall on an outstretched hand.[ Risk factors include osteoporosis.][ The diagnosis may be confirmed via ]X-rays
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...
.[ The tip of the ]ulna
The ulna (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...
may also be broken.
Treatment may include casting
Casting is a manufacturing process in which a liquid material is usually poured into a mold, which contains a hollow cavity of the desired shape, and then allowed to solidify. The solidified part is also known as a ''casting'', which is ejected ...
or surgery.[ Surgical reduction and casting is possible in the majority of cases in people over the age of 50.] Pain management can be achieved during the reduction with procedural sedation and analgesia
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decr ...
or a hematoma block.[ A year or two may be required for healing to occur.][
About 15% of people have a Colles' fracture at some point in their life.][ They occur more commonly in young adults and older people than in children and middle-aged adults.] Women are more frequently affected than men.[ The fracture is named after Abraham Colles who described it in 1814.][
]
Causes
The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with wrist
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carp ...
s flexed would lead to a Smith's fracture
A Smith's fracture, is a fracture of the distal radius.
Although it can also be caused by a direct blow to the dorsal forearm or by a fall with the wrist flexed, the most common mechanism of injury for Smith's fracture occurs in a palmar fall w ...
. 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
The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...
fractures.
Diagnosis
Diagnosis can be made upon interpretation of anteroposterior and lateral views alone.
The classic Colles fracture has the following characteristics:
* Transverse
Transverse may refer to:
*Transverse engine, an engine in which the crankshaft is oriented side-to-side relative to the wheels of the vehicle
*Transverse flute, a flute that is held horizontally
* Transverse force (or ''Euler force''), the tangen ...
fracture of the radius
* 2.5 cm (0.98 inches) proximal to the radio-carpal joint
* dorsal
Dorsal (from Latin ''dorsum'' ‘back’) may refer to:
* Dorsal (anatomy), an anatomical term of location referring to the back or upper side of an organism or parts of an organism
* Dorsal, positioned on top of an aircraft's fuselage
* Dorsal c ...
displacement
Displacement may refer to:
Physical sciences
Mathematics and Physics
* Displacement (geometry), is the difference between the final and initial position of a point trajectory (for instance, the center of mass of a moving object). The actual path ...
and dorsal angulation, together with radial tilt[Solomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772]
Other characteristics:
* Radial shortening
* Loss of ulnar inclination≤
* Radial angulation of the wrist
* Comminution at the fracture site
* Associated fracture of the ulnar styloid process in more than 60% of cases.
Classification
The term ''Colles fracture'' is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna
The ulna (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...
, 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
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carpal ...
and the base of metacarpus appears to be thrown backward”. The fracture is sometimes referred to as a " dinner fork" or " bayonet" deformity due to the shape of the resultant forearm.
Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications.
Treatment
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
Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...
as opposed to palmarflexion
Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...
results in less redisplacement and better functional status. Significant angulation and deformity may require an open reduction and internal fixation
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the m ...
or external fixation
External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide ...
. 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.
Repeat Xrays are recommended at one, two, and six weeks to verify proper healing.[
]
Prognosis
Recovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the person's age, gender, and medical history, and may range from two months to a year or more for complete recovery.[
]
Epidemiology
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
The epiphysis () is the rounded end of a long bone, at its joint with adjacent bone(s). Between the epiphysis and diaphysis (the long midsection of the long bone) lies the metaphysis, including the epiphyseal plate (growth plate). At the jo ...
, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis
Slipped capital femoral epiphysis (SCFE or skiffy, slipped upper femoral epiphysis, SUFE or , coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of ...
in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate
The epiphyseal plate (or epiphysial plate, physis, or growth plate) is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, wit ...
.
* More common in women because of post-menopausal osteoporosis.
History
The Colles fracture is named after Abraham Colles (1773–1843), an Irish
Irish may refer to:
Common meanings
* Someone or something of, from, or related to:
** Ireland, an island situated off the north-western coast of continental Europe
***Éire, Irish language name for the isle
** Northern Ireland, a constituent unit ...
surgeon, from Kilkenny who first described it in 1814 by simply looking at the classic deformity before the advent of X-rays
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...
. Ernest Amory Codman
Ernest Amory Codman, M.D., (December 30, 1869 – November 23, 1940) was a pioneering Boston surgeon who made contributions to anaesthesiology, radiology, duodenal ulcer surgery, orthopaedic oncology, shoulder surgery, and the study of medica ...
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
''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one.
Hi ...
, also developed the classification system.
It is sometimes said that Claude Pouteau was the first to describe the Colles' fracture (which is sometimes called the Pouteau-Colles fracture), but, according to P. Liverneaux, it is not the case.[P. Liverneaux, "Qu'a vraiment décrit Pouteau dans les fractures du poignet?" ("What wrist fracture did Pouteau actually describe?"), ''Chirurgie de la main'', 2004, 23, 6, p. 298-304]
abstract online in French
abstract online in English
See also
* Smith's fracture
A Smith's fracture, is a fracture of the distal radius.
Although it can also be caused by a direct blow to the dorsal forearm or by a fall with the wrist flexed, the most common mechanism of injury for Smith's fracture occurs in a palmar fall w ...
References
External links
*
Colles Fracture
Wheeless' Textbook
{{Fractures
Bone fractures
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