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Colles Fracture

Contents

Mechanism of Injury

The Colles fracture, the most common fracture of the wrist, was first described by Abraham Colles in 1814. In this injury, there is a complete fracture of the distal radius (typically the last two centimeters) usually accompanied by damage to the ulnar collateral ligament or the ulnar styloid process. Middle aged women and elderly are more commonly reported with this type of fracture.

Styloid process of the radius - ventral view

Colles fracture typically occurs when a person falls and uses a pronated hand and outstretched arm to try to break the fall. In this position the wrist is usually at 40-90° in dorsiflexion. The pressure from the fall over-extends the hand and breaks the radius just above the wrist. When this occurs, the distal part of the bone tends to become dorsally displaced. It is also frequently comminuted, meaning it is broken into multiple pieces.

In most people, the radial styloid process is longer, and therefore projects farther, than the ulnar styloid process. In a Colles fracture, the radius may be shortened, reversing this relationship. The ulnar styloid process may be avulsed, or broken off, as well which results from the force through an intact triangular fibrocartilage complex. A distal radial fracture with palmar displacement can also occur.

Styloid process of the ulna - ventral view

Frykman’s Classification

Gosta Frykman identified many different forms of Colles fracture and classified it into eight different types based on the extra- or intra-articular nature of fractures involving the distal ends of the radius and ulna.

Clinical Presentation & Assessment

The clinical presentation of Colles fracture is frequently described as a dinner fork deformity - distal fracture of the radius causes posterior displacement of the distal fragment, causing the forearm to be angled posteriorly just proximal to the wrist. With the hand displaying its normal forward arch, the patient’s forearm and hand resemble the curvature of a dinner fork.

Dinner fork deformity

Neurovascular assessment is performed on the affected hand by taking radial and ulnar pulses. Gentle check on the ability of fingers to perform abduction and adduction, and movements on each interphalangeal joints is also done.

Interphalangeal joints 2-5 - ventral view

Diagnosis & Management

A plain radiograph is usually required to confirm the diagnosis. Reduction is done usually for a displaced fracture under general anesthesia or interscalene brachial block. A splint or cast is required to hold the forearm in a stable and in immobilised position. In case of displaced intra-articular fractures with palmar dislocation, open reduction and internal fixation are sometimes required. Physiotherapy is advised after fracture healing for better strengthening of muscles and range of movements.

Complications

Patients frequently heal well with no complications at all. If redisplacement of the Colles fracture is seen a few cases week after reduction, it's important to take and check radiographs a week-10 days after injury. Possible complications include:

  • malunion
  • persistent translation of the carpus
  • shortening of radius
  • stiffness of the wrist and the forearm

Few very rare complications are carpal tunnel syndrome, Sudeck's atrophy and ulnar and radial compression neuropathy

Special Concerns in Children & Elderly

Due to the abundant circulation in that region, the fractured parts of the radius tend to refuse well. If this fracture occurs in children, however, the fracture line may extend through the distal epiphyseal plate, potentially leading to misalignment of the plate with the radius. If this occurs, growth of the radius may be affected.

In patients above 50 years of age, osteoporosis screening is recommended for a better outcome. Osteoporosis is one of the biggest risk factors in wrist fractures and patients suffering from osteoporosis tend to have greater deformity after Colles fracture.

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Show references

References:

  • Le, T., Bhushan, V., Sochat, M., et al: First Aid for the USMLE Step 1 2017, McGraw-Hill Education (2017), p. 435
  • Moore, K. L., Dalley, A. F., & Agur A. M. R: Clinically Oriented Anatomy, Seventh Ed., Lippincott Williams & Wilkins (2014), p. 686.
  • Kumar, V., Abbas, A. K., & Aster, J. C: Robbins Basic Pathology, Ninth Ed., Elsevier Saunders (2013), p. 768-70.
  • Altizer L,L. Colles Fracture. Orthopaedic Nursing; Mar/Apr 2008; 27, 2; ProQuest pg. 140
  • Wadsworth T.,G: Colles' fracture Failure in management may cause permanent disability. BMJ Volume 301. 1990

Article, Review and Layout:

  • Nadia Solomon
  • Uruj Zehra
  • Adrian Rad

Illustrators:

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