Colles' fracture

Colles' fracture
Classification and external resources
An X-ray image of a fractured radius showing the characteristic Colles' fracture with displacement and angulation of the distal end of the radius
ICD-10	S52.5
AO	23-A2.2
MeSH	68003100

Terminology

The term of Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. 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. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”.^[2]

The classic Colles fracture has the following characteristics:^[3]

Transverse fracture of the radius
2.5 cm (0.98 inches) proximal to the radio-carpal joint
dorsal displacement and dorsal angulation, together with radial tilt^[1]

Causes

The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched arms - falling with wrists flexed would lead to a Smith's fracture. It can also be caused by overuse. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles' fracture is a common fracture in people with osteoporosis, second only to vertebral fractures.

Diagnosis

Colles' fracture

Colles' fracture on X-ray.

Colles' fracture of the left hand, with posterior displacement clearly visible.

A severe Colles fracture may assume a bayonet-like displacement.

Dorsal tilt
Radial shortening
Loss of ulnar inclination≤
Radial angulation of the wrist
Dorsal displacement of the distal fragment
Comminution at the fracture site
Associated fracture of the ulnar styloid process in more than 60% of cases.

Treatment

Management 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. There is some evidence that immobilization with the wrist in [dorsiflexion] as opposed to palmarflexion results in less redisplacement and better functional status.^[4] Significant angulation and deformity may require an open reduction and internal fixation or external fixation. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures, including Colles' fracture. There are several established instability criteria: dorsal tilt >20°, comminuted fracture, abruption of the ulnar styloid process, intraarticular displacement >1mm, loss of radial height >2mm.

A higher amount of instability criteria increases the likelihood of operative treatment.

Treatment modalities differ in the elderly.^[5]

Eponym

It is named after Abraham Colles (1773–1843), an Irish surgeon, from Kilkenny. who first described it in 1814 by simply looking at the classical deformity before the advent of X-rays.^[6] Ernest Amory Codman was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.^[7]^[8]

In older and younger people

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

In the elderly, because of the weaker cortex, the fracture is more often extra-articular.
Younger individuals tend to require a higher energy force to cause the fracture and tend to have more complex intra-articular fractures. In children with open epiphyses, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate.
More common in women because of post-menopausal osteoporosis.

References

1 2 Solomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772
↑ Colles A 2006 On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 445:5-7.
↑ GP Notebook. "Colles' fracture". Retrieved 2009-02-21.
↑ "Adult Distal Radius Frx: Non Operative Treatment - Wheeless' Textbook of Orthopaedics".
↑ Blakeney, William (November 2010). "Stabilization and treatment of Colles’ fractures in elderly patients". Clinical Interventions in Aging: 337. doi:10.2147/CIA.S10042.
↑ synd/2152 at Who Named It?
↑ Mallon, Bill (2000). Ernest Amory Codman : the end result of a life in medicine. Philadelphia: Saunders. ISBN 978-0-7216-8461-1.
↑ CODMAN, E. A. (1900). "A Study of the X-Ray Plates of One Hundred and Forty Cases of Fracture of the Lower End of the Radius". The Boston Medical and Surgical Journal 143 (13): 305–308. doi:10.1056/NEJM190009271431301. ISSN 0096-6762.

External links

00913 at CHORUS

Colles Fracture Detailed information for Orthopedic Doctors

Fractures and cartilage injuries (Sx2, 800–829)

General

Humerus fracture:	Supracondylar Holstein–Lewis fracture

Forearm fracture:	Ulnar fracture Monteggia fracture Hume fracture Radius fracture/Distal radius Galeazzi Colles' Smith's Barton's Essex-Lopresti fracture

Hand fracture

Pelvic fracture

Leg

Tibia fracture:	Bumper fracture Segond fracture Gosselin fracture Toddler's fracture Pilon fracture Plafond fracture Tillaux fracture

Fibular fracture:	Maisonneuve fracture Le Fort fracture of ankle Bosworth fracture

Combined tibia and fibula fracture:	Trimalleolar fracture Bimalleolar fracture Pott's fracture

Crus fracture:	Patella fracture

Femoral fracture:	Hip fracture

Foot fracture

Orthopaedic eponyms

Medical eponyms

Fractures	Bankart's fracture Barton's fracture Bennett's fracture Bosworth fracture Chance fracture Chopart's fracture-dislocation Colles' fracture Dupuytren's fracture Duverney fracture Essex-Lopresti fracture Galeazzi fracture Gosselin fracture Holstein–Lewis fracture Holdsworth fracture Hutchinson's fracture Hoffa fracture Hume fracture Jefferson fracture Jones fracture Lisfranc fracture Maisonneuve fracture Malgaigne's fracture Monteggia fracture Moore's fracture Pipkin fracture-dislocation Plafond fracture Pott's fracture Rolando fracture Segond fracture Shepherd's fracture Smith's fracture Stieda fracture Tillaux-Chaput avulsion fracture Wagstaffe-Le Fort avulsion fracture Volkmann avulsion fracture

Classifications	Bado classification Danis–Weber classification Denis classification Evans-Jensen classification Ficat classification Frykman classification Garden classification Gartland classification Gruen zone Gustilo open fracture classification Haruguchi classification Hawkin's classification Herbert classification Herscovici classification Ideberg classification Jupiter and Mehne classification Lauge-Hansen classification Le Fort fracture of skull Loder classification Mayfield classification Milch classification Neer classification Pipkin classification Pauwel's classification Riseborough and Radin classification Ruedi-Allgower classification Salter–Harris fracture Schatzker classification of tibia plateau fractures Tile classification Schatzker classification of olecranon fractures Sanders classification Seddon classification Seinsheimer classification Schenck classification Teisen classification Tscherne classification Thompson and Epstein classification Vancouver classification Wassel classification Winquist and Hansen classification Young-Burgess classification

Procedures	Akin osteotomy Bankart repair Broström procedure Brunelli procedure Cotrel–Dubousset instrumentation Cunningham Shoulder Reduction Darrach's procedure Darrah procedure Evans technique Girdlestone's Procedure Keller procedure Kocher manoeuvre Krukenberg procedure Latarjet procedure Mumford procedure Ponseti method Swanson's Arthroplasty Tommy John surgery Weil's Osteotomy Weaver–Dunn procedure Zadek's procedure

Anatomy	Gerdy's tubercle Guyon's Canal Harrison's groove Haversian canal Humphrey's ligament Lisfranc joint Lisfranc ligament Lister's tubercle Martin-Gruber Anastomosis Schmorl's nodes Volkmann's canals

CPRs	Harris Hip Score Kocher criteria Mirel's Score Rowe Score

Clinical signs	Andersson lesion Baastrup's sign Bouchard's nodes Boutonniere deformity Coopernail's sign Codman triangle Destot's sign Frankel's sign Heberden's node Kanavel's sign Larrey's sign Trendelenburg gait

Clinical examination	Allis test Apley grind test Apley scratch test Barlow's maneuver Clarke's test Cozen's test Cotton test Durkan's test Finkelstein's test Froment's sign Jobe's test Kapandji score Gaenslen's test Galeazzi test Gerber's test Hawkins–Kennedy test Hubscher's maneuver Lachman test Lasègue's sign McMurray test Mulder's sign Neer impingement sign O'Brien's test Ober's test Ortolani test Patrick's test Phalen maneuver Simmonds' test Schober's test Speed's test Thomas test Thompson test Tinel sign Trendelenburg's sign Yergason's test Waddell's signs Watson's test Wilson test

Congenital conditions	Albers-Schonberg disease Albright's hereditary osteodystrophy Antley–Bixler syndrome Apert syndrome Beals syndrome Bechterew's Bruck syndrome Camurati–Engelmann disease Catel–Manzke syndrome Cole carpenter syndrome Conradi–Hünermann syndrome Currarino syndrome Ehlers–Danlos syndrome Eiken syndrome Ellis–van Creveld syndrome Erlenmeyer flask deformity Fairbanks disease Hajdu–Cheney syndrome Jansen's metaphyseal chondrodysplasia Kashin–Beck disease Klippel–Feil syndrome Klippel–Trénaunay–Weber syndrome Kniest dysplasia Lobstein syndrome Madelung's deformity Maffucci syndrome Marfan syndrome Marie-Strümpell disease Marshall syndrome Marshall–Smith syndrome McCune–Albright syndrome Melnick–Needles syndrome Morton's toe Ollier disease Rett syndrome Rubinstein–Taybi syndrome Scheuermann's disease Schwartz–Jampel syndrome Silver–Russell syndrome Teunissen–Cremers syndrome Trevor disease Wiedemann syndrome

Acquired conditions	Baker's cyst Bankart lesion Barré–Liéou syndrome Blount's disease Brodie abscess Chandler's disease De Quervain syndrome Dupuytren's contracture Ewing's sarcoma Freiberg disease Garre's sclerosing osteomyelitis Gorham's disease Haglund's deformity Hill–Sachs lesion Iselin's disease Kashin–Beck disease Kienbock's disease Köhler disease Legg–Calvé–Perthes syndrome Morton's neuroma O'Donoghue's triad Osgood–Schlatter disease Paget's disease of bone Panner disease Perthes Lesion Preiser disease Sever's disease Stener lesion Sudeck's atrophy Tietze syndrome Volkmann's contracture

Orthopedic implants	Austin Moore prosthesis Baksi's prosthesis Charnley prosthesis Denis Browne bar Ender's nail Grosse-Kempf nail Harrington rod Herbert screw Kirschner wire Kuntscher nail Moore's pin Neer's prosthesis Rush nail Schanz screw Seidel nail Smith Peterson nail Steinmann pin Swanson prosthesis Talwalkar nail Thompson prosthesis

Orthopaedic instruments	Bryant's traction Charnley Retractor Darrach elevator Faraboeuf forceps Gigli saw Hohmann retractor Ilizarov apparatus Inge retractor Jungbluth forceps Matta forceps Taylor Spatial Frame Thomas splint Verbrugge forceps Volkmann retractor Weber forceps

Surgical approaches	Hardinge lateral approach to the hip Moore or Southern posterior approach to the hip Smith-Petersen anterior approach to the hip Watson-Jones anterolateral approach to the hip

Radiographic signs	Baumann's angle Blumensaat's line Bohler's angle Cobb angle Fairbank's changes Gilula's Lines Harris lines Hilgenreiner's line Kellgren-Lawrence grading scale Klein's line Loosers zone Pauwel's angle Perkin's line Shenton's Line Southwick angle Thurstan Holland sign Trethowan's sign Terry-Thomas sign

Radiographic projections	Judet view Broden's view

Principles	Wolff's law Hueter-Volkmann law Charley's principles of three-point fixation

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Colles' fracture

Terminology

Causes

Diagnosis

Treatment

Eponym

In older and younger people

See also

References

External links