Colles Fracture

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Colles fracture
Colles fracture
    • Colles fracture
      • This is a fracture at the distal end of the radius, (MCQ)
      • Occurs at cortico-cancellous junction  (MCQ)
      • Occurs about 2 cm from the distal articular surface(MCQ)
      • It is the commonest fracture in people above forty years of age, (MCQ)
      • It is particularly common in women because of post-menopausal osteoporosis(MCQ)
      • It nearly always results from a fall on an out-stretched hand.(MCQ)
    • Relevant anatomy
      • Normally, the distal articular surface of the radius faces ventrally and medially
      • The tip of the radial styloid is about 1 cm distal to the tip of the ulnar styloid.
    • Pathoanatomy
      • Displacement:
        • The fracture line runs transversely at the cortico-cancellous junction.
        • The following are the displacements seen in Colles’ fracture
        • Impaction of fragments
          • Dorsal displacement
          • Dorsal tilt
          • Lateral displacement
          • Lateral tilt
          • Supination
      • As the displacement occurs, some amount of comminution of the dorsal and lateral cortices, and that of the soft cancellous bone of the distal fragment occurs
      • commonly associated injuries a(MCQ)
        • Fracture of the styloid process of the ulna.
        • Rupture of the ulnar collateral ligament.
        • Rupture of the triangular cartilage of the ulna.
        • Rupture   of  theinterosseous  radio-ulnarligament, causing radio-ulnar subluxation.
    • Diagnosis
      • tenderness and irregularity of the lower end of the radius is found.
      • typical‘dinner fork deformity’(MCQ)
      • radialstyloid process comes to lie at thesame level or a little higher than the ulnar styloid process.(MCQ)
    • Radiological features:
      • The dorsal tilt is the most characteristic displacement(MCQ)
      • It can be detected on a lateral X-ray.
      • alateral tilt can be detected on an antero-posterior X-ray.
    • Treatment
      • Conservative Treatment
        • undisplacedfracture(MCQ)
          • immobi-lisation in a below-elbow plaster cast for six weeks is sufficient.
        • displaced fractures(MCQ)
          • the standard method of treatment is manipulative reduction followed by immobilisation in Colles’ cast
          • An X-ray is taken to check the success of the closed reduction.
          • The patient is encouraged to move his fingers as soon as the plaster dries.
          • shoulder and elbow joints are moved through their full range several times in a day. It is important to make check X-raysevery week for the first 3 weeks in order to detect re-displacement.(MCQ)
          • The plaster is removed after six weeks(MCQ)
        • Comminuted fractures
          • In most elderly people, malunion is compatible with useful functions
          • In young adults, (MCQ)
            • fractures aresometimes transfixed percutaneouslyusing two K-wires which are incorporated in the plaster cast
        • Ligamentoraxis
          • external fixator is used to keep the fracture ‘distracted’, so that the stretched ligaments and periosteum keep the comminuted fragments in place
          • Recent method :fix these fractures with LCP (Locking compression plate).
    • Complications
      • Most patients progress rapidly to full functional recovery
      • Stiffness of joints:
        • Finger stiffness is thecommonest complication(MCQ)
        • theshoulder, wrist andelbow are the other joints which commonly getstiff.
        • This occurs because of lack of exercise
        • can be prevented by actively moving these joints.
        • The joints which are out of plaster should bemoved several times a day.
    • Malunion:
      • A Colles’ fracture always unites
      • malunion occurs in a large proportion of cases.(MCQ)
      • The cause of malunion is redisplacement of thefracture within the plaster
      • a‘dinner fork’deformity results. (MCQ)
      • There may be a limitation ofwrist movement and forearm rotation.(MCQ)
      • Treatment:
        • Not always does a malunitedColles’ fracture need treatment.(MCQ)
        • Often, the only disadvantage is the ugly deformity, which does not hamper the day-to-day activities of the patient. (MCQ)
        • In some active adults, the deformity and impairment of functions may be severe enough to justify correction by an osteotomy.
    • Subluxation of the inferior radio-ulnar joint:
      • Shortening of the radius because of the impaction of the distal fragment leads to subluxation of the distal radio-ulnar joint. (MCQ)
      • The head of the ulna becomes unduly prominent.
      • Wrist movements, especially ulnar deviation and forearm rotations are painful and restricted.
      • Treatment:
        • A minor degree of displacement, especially in an elderly person may be accepted.
        • excision of the lower end of the ulna (Darrach’s resection) (MCQ)
    • Carpal tunnel syndrome:
      • ccurs a long time after the fractureunites.
      • The median nerve is compressed in thecarpal tunnel, which is encroached by the fracture callus(MCQ)
      • Treatment is decompression of the carpal tunnel.
    • Sudeck’sosteodystrophy:
      • Colles’ fracture is thecommonest cause of Sudeck’s dystrophy in theupper limb.
      • It is noticed after the plaster isremoved.
      • The patient complains of pain, stiffnessand swelling of the hand.
      • The overlying skinappears stretched and glossy. (MCQ)
      • Treatment is byintensive physiotherapy.
        • Full recovery takes a longtime, but eventually occurs.
    • Rupture of the extensor pollicislongustendon: (MCQ)
      • occurs a long time after the fracture has united.
      • Itis either due to
        • loss of blood supplyto the tendonat the time of fracture (MCQ)
        • friction the tendon is subjected to everytimeitmoves over a malunited fracture.
      • Treatment is bytendon transfer (extensor indicis to extensorpollicislongus).
    • Smith’s fracture (Reverse of Colles1 Fracture)
      • It differs from Colles’ fracture in that the distal fragment displaces ventrally and tilts ventrally. (MCQ)
      • Treatment is by closed reductionand plaster cast immobilisationfor 6 weeks. (MCQ) S