Colles' fracture
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
- 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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
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
- ↑ 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.