Thursday, January 3, 2008

36 - colles fracture


Lateral view of the wrist demonstrates a Colles fracture (in which there is a dorsal angulation of the fracture fragment).

Colles fracture is defined as a fracture of the distal radius with dorsal displacement, with or without intra-articular involvement and with or without ulnar styloid fracture.


-The injury is usually produced by a fall on an outstretched hand.

- Half or more of cases are associated with an ulnar styloid fracture.

-An associated ulnar styloid fracture may be associated with tears of the TFC.

Frykman Classification of Colles Fractures is the most widely known although its prognostic value is debatable
Type
Radius
Ulna
Radiocarpal
Radioulnar
I
Extra-articular
Absent
Absent
Absent
II
Extra-articular
Present
Absent
Absent
III
Intra-articular
Absent
Present
Absent
IV
Intra-articular
Present
Present
Absent
V
Intra-articular
Absent
Absent
Present
VI
Intra-articular
Present
Absent
Present
VII
Intra-articular
Absent
Present
Present
VIII
Intra-articular
Present
Present
Present

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In 1813, Abraham Colles described the Colles fracture, which is reported to be the most common distal radial fracture. The injury is usually produced by a FOOSH mechanism with the wrist in dorsiflexion. The impact produces a transverse fracture in the distal 2-3 cm of the radial articular surface. The fracture is dorsally displaced and may be comminuted. The fracture pattern is often described as a silver or dinner-fork deformity. The fracture fragments are usually impacted and comminuted along the dorsal aspect; the fracture can extend into the epiphysis to involve the distal radiocarpal joint or the distal radioulnar joint.

Resnick noted that 50-60% of Colles fracture cases are associated with an ulnar styloid fracture.3 An associated ulnar styloid fracture should prompt an investigation for tears of the TFC. The TFC extends from the rim of the sigmoid notch of the radius to the ulnar styloid and is thought to stabilize the distal radioulnar joint .

PA and lateral views involve a minimal examination. The examiner should note the direction of displacement and angulation, the degree of comminution, the intra-articular involvement, and the radial length or variance in comparison with the normal side. The ulnar inclination is approximately 14° on the PA view, and the volar tilt is approximately 12° on the lateral view.

Two classification systems are used: the Association for Osteosynthesis (AO) system and the Frykman system.

Table 2. AO Classification of Colles Fractures

Type Description
AExtra-articular
BPartial articular

C
1
2
3
Complete articular
Simple articular and metaphyseal fracture
Simple articular with complex metaphyseal fracture
Complex articular and metaphyseal fracture

Table 3. Frykman Classification of Colles Fractures

Type Radius UlnaRadiocarpal Radioulnar
IExtra-articularAbsentAbsentAbsent
IIExtra-articularPresentAbsentAbsent
IIIIntra-articularAbsentPresentAbsent
IVIntra-articularPresentPresentAbsent
VIntra-articularAbsentAbsentPresent
VIIntra-articularPresentAbsentPresent
VIIIntra-articularAbsentPresentPresent
VIIIIntra-articularPresentPresentPresent

The AO and Frykman classifications are useful in discussing prognosis.

Complications of the Colles fracture include compressive neuropathy, posttraumatic arthrosis, Volkmann ischemic contracture, acute carpal tunnel syndrome, and shoulder-hand syndrome.

Colles fractures occur more frequently in elderly persons, as a result of osteoporosis.

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