Colles' fracture

A Colles' fracture, also Colles fracture, is a fracture of the distal radius bone. For more detailed discussion see distal radius fracture.

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Eponym

It is named after Abraham Colles (1773-1843), an Irish surgeon who first described this in 1814 before the advent of X-rays.^[2]

Terminology

The term Colles fracture is classically used to describe a fracture through the distal metaphysis no further than 4 centimeters proximal to the distal articular surface of the radius. However, now the term tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments.

In older and younger patients

Colles fractures occur in all age groups, although certain patterns follow an age distribution.

• In the elderly, because of the relatively weaker cortex, the fracture is more often extraarticular.

• Younger individuals tend to require a relatively higher energy force to cause the fracture and tend to have more complex intraarticular fractures. In children with open physes, an equivalent fracture is the epiphyseal slip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate.

Causes

The fracture is most commonly caused by people falling backward onto a hard surface and breaking their fall with extended, outstretched hands - falling with wrists flexed would lead to a Smith's fracture. It can also be caused by overuse. It usually occurs about an inch or two proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic dinner fork like deformity.

Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures.

Treatment

Treatment of depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone.The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation or external fixation.

References

1. ^ Al-Ansari K, Howard A, Seeto B, Yoo S, Zaki S, Boutis K (2007). "Minimally angulated pediatric wrist fractures: is immobilization without manipulation enough?". CJEM : Canadian journal of emergency medical care = JCMU : journal canadien de soins médicaux d'urgence 9 (1): 9-15. PMID 17391594.
2. ^ synd/2152 at Who Named It