Colles Fracture

INTRODOCTION:

Colles’ fracture is a broken bone in the arm near the wrist. The bone that is broken is called the radius. The radius is the shorter of the two bones of your lower arm and is on the thumb side of your arm.Its a fracture at distal end of radius with fracture line running transversely at cortico-cancellous junction(about 2cm from distal articular surface) showing typical posterior and lateral displacement of the distal fragment resulting in the characteristic dinner fork like deformity in adults.

CAUSES:

Such injuries often occur when a person slips or stumbles and puts out an open hand to break the fall. Such a fall can break a bone, especially in an older person whose bones are weakened and brittle (a condition called osteo porosis).

PATHO-ANATOMY:

DISPLACEMENT:

The following displacements are seen in colle’s fracture

  • Impaction of fragments
  • Dorsal displacement
  • Dorsal tilt
  • Lateral displacement
  • Lateral tilt
  • Supination

As the displacement occurs some amount of comminution of the dorsal and lateral cortices,and of the soft cancellous bone of the distal fragment occurs.Rarely the whole of the distal fragments is broken into pieces.

Injuries most commonly associated with colle’s fracture are : 

  • Fracture of styloid process of ulna.
  • Rupture of the ulnar collateral ligament
  • Rupture of triangular cartilage of ulna
  • Rupture of interosseous radio ulnar ligament producing radio ulnar subluxation.

CLINICAL FEATURES: 

  • Sudden pain
  • Swelling
  • Bruising
  • Disfigurement of wrist
  • Dinner fork deformity

DIAGNOSIS: 

Examination:

  • Tenderness
  • Irregularity of the distal end of radius

Radiological features: 

  • The dorsal tilt is most characteristic displacement.its detected by looking at the direction of the distal articular surface of radiuson lateral X-RAY.Normally it faces ventrally.if after fracture it faces dorsally or becomes neutral a dorsal tilt is present.
  • Lateral tilt is detected on anterior posterior X-RAY.Normally the distal articular surface faces medially,if it faces laterally or becomes horizontal a lateral tilt is present.

TREATMENT:

You will be given medication to lessen the pain. If necessary, your doctor will move the ends of the broken bones back into proper alignment. If the break is very severe, you may be given general anesthesia so that the bone can be repositioned during surgery. A cast or splint may be applied to help maintain the position of the bones. To maintain the alignment an external fixator may be applied as shown below. X-Ray on the left shows fracture and the pins. The arrow in the right side X-Ray shows the rod of the external fixator.

In some cases small wires arepassed under anaesthesia to maintain aligmment. Wires as well as external fiaxtor needs no cutting of the skin and can be taken out without anaesthesia in the Out patient Department.A Colles’ fracture usually takes up to 8 weeks to heal. X-Rays may be taken from time to time during recovery to see how it is healing.

Older people in poor health may need extra help to maintain an independent lifestyle while they recover from a Colles’ fracture.When the cast or splint is removed, the affected wrist and the fingers, hand, and shoulder on that side may be stiff for several more weeks. Your health care provider may prescribe exercise and physical therapy.You will not be able to bend your wrist while the cast or splint is in place. You may need someone to help you with daily activities such as cooking, housework, driving, and self-care (showering and dressing) until the cast or splint is removed.

COMPLICATIONS: 

  • Stiffness of finger joint
  • Malunion
  • Subluxation of the inferior radio-ulnar joint
  • Carpal tunnel syndrome
  • Sudecks osteodystropy
  • Rupture of the extensor pollicis longus tendon

PHYSIOLINE’S SPECIALISED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Pain relief
  • Reduce swelling
  • Reduce stiffness
  • Strengthening of muscles around wrist
  • Prevention of complications

Visit Physioline for the Consultation and treatment