Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures. Diagnosis
Diagnosis can be made upon interpretation of anteroposterior and lateral views alone.The classic Colles fracture has the following characteristics:
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 tiltOther characteristics:
Radial shortening
Loss of ulnar inclination≤
Radial angulation of the wrist
Comminution at the fracture site
Associated fracture of the ulnar styloid process in more than 60% of cases. Classification
The term Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now 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”. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm.Colles fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Olders classifications. 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. 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.Repeat Xrays are recommended at one, two, and six weeks to verify proper healing. Prognosis
Recovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the persons age, gender, and medical history, and may range from two months to a year or more for complete recovery. Epidemiology
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.