Colles' fracture

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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
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

  • 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.