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Colles FractureAka: Colles' Fracture

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  1. Epidemiology
    1. Most Common Wrist Injury
  2. Mechanism
    1. Fall on an outstretched hand
  3. Signs
    1. Distal Radius Fracture
      1. Displacement ("Dinner Fork" Deformity)
      2. Dorsal Angulation with volar prominence
      3. Shortening
      4. Radial Deviation of hand
    2. Ulnar styloid Injury often associated (60%)
    3. Ulnar collateral ligament injury often associated
  4. Radiology
    1. Post-Reduction Wrist XRay confirms normal radius length
    2. AP View
      1. Radial styloid is distal to ulnar styloid
      2. Articular plane of radius is directed toward ulna
        1. Normal angle: 15 to 30 degrees
    3. Lateral View
      1. Radius articular surface directed down, forward, in
      2. Normal angle: 1 to 23 degrees
      3. Appearance of tea cup and saucer
  5. Management: Anesthesia
    1. Local anesthetic sufficient if recent Fracture
      1. Hematoma Block
        1. Needle inserted dorsally into Fracture hematoma
        2. Aspirate to confirm needle within hematoma
        3. Inject 5-10 ml local anesthetic
      2. Inject tip of ulna as well
    2. General anesthetic may be needed for Fracture >4 hours
  6. Management: Manual Reduction (Technique 1)
    1. Assistant Position
      1. Grasps forearm for countertraction
    2. Surgeon Position
      1. Grasps hand of affected wrist
      2. Thumb of other hand is placed on distal fragment
    3. Break up Impaction
      1. Wrist is hyperextended
    4. Dorsal Displacement and rotation is corrected
      1. Apply traction and countertraction
      2. Continue Thumb pressure on distal fragment
      3. Distal fragment dorsal cortex apposed with proximal
    5. Radial and Dorsal Angulation Corrected
      1. Apply Ulnar and Volar pressure over distal fragment
    6. Assess if Length is Restored
      1. Palpate radial styloid
  7. Management: Finger Trap Reduction (Technique 2)
    1. Anesthesia as above
    2. Break up Impaction by hyperextending wrist
    3. Place Index finger and thumb in finger traps
    4. Apply counterweight to upper arm
    5. Manipulate Fracture as above
  8. Management: Immobilization with Sugar Tong Splint
    1. Assistant applies steady traction at hand
    2. Wrist in slight pronation
    3. Avoid volar flexion of wrist
      1. Risk of Median Nerve Compression (Carpal Tunnel)
    4. Apply cast padding from MCP heads to above elbow
    5. Apply felt pad to volar surface of proximal fragment
    6. Splint with 10 cm wide, 12 plaster plies around elbow
    7. Dorsal half ends at MCP heads
      1. Mold over the distal fragment
    8. Volar half ends 1-2 cm distal to Fracture
    9. Maintain wrist in ulnar deviation
      1. Wrap a strip of plaster around distal splint
      2. Include distal MCP
      3. Keep strip proximal to distal palmar crease
    10. ACE Wrap Sugar Tong in place
  9. Discharge Instructions
    1. Ice for 72 hours
    2. Elevation
    3. Maintain active Range of Motion of fingers and shoulder
    4. Shoulder Sling
      1. Do not use longer than 2-3 days
      2. Risk of shoulder stiffness
  10. Follow-Up
    1. Days 1-2
      1. Phone: Is Splint too tight?
    2. Days 5-7
      1. Repeat Wrist XRay
      2. Apply Short Arm Cast
      3. Anticipate mal-union after swelling decreases
        1. Elderly
          1. Mal-union may be acceptable
          2. Re-manipulation may result in greater morbidity
        2. Young
          1. Malunion unacceptable
            1. Radial head shortening results in dysfunction
          2. Correction of mal-union
            1. Re-manipulation and closed reduction
            2. Open reduction and internal fixation (ORIF)
            3. External fixator
    3. Weeks 4-6
      1. Cast may be removed
    4. Weeks 7-9
      1. Wrist support or cast until pain subsides

Colles' Fracture (C0009353)

Definition (MSH)Fracture of the lower end of the radius in which the lower fragment is displaced posteriorly.
ConceptsInjury or Poisoning (T037)
MSHD003100
EnglishCOLLES FRACTURE, Colles' fracture
Spanishfractura de Colles
Parent ConceptsRadius Fractures (C0034628), Fracture of upper limb NOS (C0178316), Fracture of distal end of radius (C0435585), Duplicate concept (C1274013)
SourcesCOSTAR, DXP, MSH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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