Colles' fracture: Difference between revisions
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(colles reduction technique) |
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**>2/3 displacement | **>2/3 displacement | ||
**5mm shortening of the radius | **5mm shortening of the radius | ||
*Stable Fracture | *Stable Fracture | ||
** Use [[Procedural sedation]] or [[Hematoma block]] | |||
**Hang 10 lb weight with finger traps or otherwise provide longitudinal traction | |||
**Recreate the injury by extending wrist to 90 degrees while elbow is flexed | |||
**Pull distal segment back, up, and then out; use both thumbs to apply volar pressure | |||
**Immobilize wrist with [[sugar tong splint]] at 15 degrees of flexion, 20 degrees of ulnar deviation, and slight pronation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
**Goals for post-reduction X rays: normal radius length, normal radial inclination of 15-30 degrees and volar tilt of 10-15 degrees | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Distal radius fractures]] | *[[Distal radius fractures]] | ||
==References== | ==References== |
Revision as of 17:52, 14 April 2017
Background
- Distal radial metaphysis fracture that is dorsally displaced and angulated
- Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fracture)
- Occurs due to FOOSH
- Ulnar styloid fracture is often present and suggests injury to TFCC
Clinical Features
- Characteristic dorsiflexion or "dinner-fork" deformity
- Palmar paresthesias (pressure on median nerve)
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
Eponyms | Description |
Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
Chauffer's | Fracture of radial styloid |
Colles' | Dorsally displaced, extra-articular fracture |
Die-punch | Depressed fracture of the lunate fossa (articular surface) |
Smith's | Volar displaced, extra-articular fracture |
Evaluation
Imaging
- PA
- Distal metaphyseal fracture that often appears shortened from angulation or comminution
- Lateral
- Provides best view of dorsal angulation and comminution
Management
- Unstable Fracture - Immediate ortho referral
- >20 degrees angulation
- Intra-articular involvement
- Marked comminution
- >2/3 displacement
- 5mm shortening of the radius
- Stable Fracture
- Use Procedural sedation or Hematoma block
- Hang 10 lb weight with finger traps or otherwise provide longitudinal traction
- Recreate the injury by extending wrist to 90 degrees while elbow is flexed
- Pull distal segment back, up, and then out; use both thumbs to apply volar pressure
- Immobilize wrist with sugar tong splint at 15 degrees of flexion, 20 degrees of ulnar deviation, and slight pronation [1]
- Goals for post-reduction X rays: normal radius length, normal radial inclination of 15-30 degrees and volar tilt of 10-15 degrees
Disposition
- Outpatient with ortho follow up
See Also
References
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.