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.

-Most common distal radial 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
A	Extra-articular
B	Partial 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	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

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.