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 (plural, : radii) of a circle or sphere is any of the line segments from its Centre (geometry), center to its perimeter, and in more modern usage, it is also their length. The name comes from the latin ''radius'', ...

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 close ...

. 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 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 ejecte ...

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 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 Abraham Colles (23 July 1773 – 16 November 1843) was Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland (RCSI) and the President of RCSI in 1802 and 1830. A prestigious Colles Medal & Travelling Fellowsh ...

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 wi ...

. 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 fractures.

Diagnosis

$Poignet Gauche suite a fracture type Pouteau Colles$ 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 tange ...

fracture of the radius * 2.5 cm (0.98 inches)

proximal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position ...

to the radio-carpal joint * dorsal displacement and dorsal angulation, together with radial tiltSolomon 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, 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 and the base of metacarpus appears to be thrown backward”. The fracture is sometimes referred to as a "

dinner fork In cutlery or kitchenware, a fork (from la, furca 'pitchfork') is a utensil, now usually made of metal, whose long handle terminates in a head that branches into several narrow and often slightly curved tines with which one can spear foods eit ...

" or "

bayonet A bayonet (from French ) is a knife, dagger, sword, or spike-shaped weapon designed to fit on the end of the muzzle of a rifle, musket or similar firearm, allowing it to be used as a spear-like weapon.Brayley, Martin, ''Bayonets: An Illustr ...

" 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 as opposed to palmarflexion 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 ...

or external fixation. 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 A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

fractures. In children with open epiphyses, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate. * More common in women because of post-menopausal osteoporosis.

History

The Colles fracture is named after

(1773–1843), an Irish

surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

, from

Kilkenny Kilkenny (). is a city in County Kilkenny, Ireland. It is located in the South-East Region and in the province of Leinster. It is built on both banks of the River Nore. The 2016 census gave the total population of Kilkenny as 26,512. Kilken ...

who first described it in 1814 by simply looking at the classic deformity before the advent of

. Ernest Amory Codman 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. H ...

, 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 Frenchabstract online in English

References

External links

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Colles Fracture
Wheeless' Textbook {{Fractures Bone fractures Wikipedia medicine articles ready to translate