Difference between revisions of "Colles' fracture"

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==Background==
 
==Background==
*Distal radial metaphysis fx that is dorsally displaced and angulated
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*Distal radial metaphysis fracture that is dorsally displaced and angulated
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fx)
+
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fracture)
 
*Occurs due to FOOSH
 
*Occurs due to FOOSH
*Ulnar styloid fx is often present and suggests injury to TFCC
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*Ulnar styloid fracture is often present and suggests injury to TFCC
  
 
==Clinical Features==
 
==Clinical Features==
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*Palmar paresthesias (pressure on median nerve)
 
*Palmar paresthesias (pressure on median nerve)
  
==Diagnosis==
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==Differential Diagnosis==
 +
{{Distal radius fracture DDX}}
 +
 
 +
==Evaluation==
 
[[File:Colles fracture.JPG|thumb|Colles fracture]]
 
[[File:Colles fracture.JPG|thumb|Colles fracture]]
 
[[File:Collesfracture.jpg|thumb|[[Colles' fracture]]]]
 
[[File:Collesfracture.jpg|thumb|[[Colles' fracture]]]]
 
===Imaging===
 
===Imaging===
 
*PA
 
*PA
**Distal metaphyseal fx that often appears shortened from angulation or comminution
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**Distal metaphyseal fracture that often appears shortened from angulation or comminution
 
*Lateral
 
*Lateral
 
**Provides best view of dorsal angulation and comminution
 
**Provides best view of dorsal angulation and comminution
  
==Differential Diagnosis==
+
==Management==
{{Distal radius fracture DDX}}
+
{{General Fracture Management}}
  
==Management==
+
===Specific Management===
 
*Unstable Fracture - Immediate ortho referral
 
*Unstable Fracture - Immediate ortho referral
 
**>20 degrees angulation
 
**>20 degrees angulation
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**>2/3 displacement
 
**>2/3 displacement
 
**5mm shortening of the radius
 
**5mm shortening of the radius
*Stable Fracture - Compression dressing and [[sugar tong splint]]
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*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==
 +
*Outpatient with ortho follow up
  
 
==See Also==
 
==See Also==
 
*[[Distal radius fractures]]
 
*[[Distal radius fractures]]
  
==Source==
+
==References==
*Tintinalli
+
<references/>
  
[[Category:Ortho]]
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[[Category:Orthopedics]]

Latest revision as of 04:26, 18 September 2019

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

Colle's fracture on physical exam.
  • Characteristic dorsiflexion or "dinner-fork" deformity
  • Palmar paresthesias (pressure on median nerve)

Differential Diagnosis

Distal radius fractures

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

Colles fracture

Imaging

  • PA
    • Distal metaphyseal fracture that often appears shortened from angulation or comminution
  • Lateral
    • Provides best view of dorsal angulation and comminution

Management

General Fracture Management

Specific 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

  1. 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.