Colles' fracture
Encyclopedia
A Colles' fracture, also Colles fracture, is a fracture of the distal radius
in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet
" deformity due to the shape of the resultant forearm. For a more detailed discussion see distal radius fracture
.
, 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 classic Colles fracture has the following characteristics:
s flexed would lead to a Smith's fracture
. It can also be caused by overuse. Orignally it was described in elderly people, post-menopausal women. It usually occurs about an inch or two proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity.
Colles' fracture is a common fracture in people with osteoporosis
, second only to vertebral fractures
.
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.
(1773–1843), an Irish
surgeon
who first described it in 1814 just by looking at the classical deformity before the advent of X-rays. Ernest Amory Codman
was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.
Radius (bone)
The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...
in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet
Bayonet
A bayonet is a knife, dagger, sword, or spike-shaped weapon designed to fit in, on, over or underneath the muzzle of a rifle, musket or similar weapon, effectively turning the gun into a spear...
" deformity due to the shape of the resultant forearm. For a more detailed discussion see distal radius fracture
Distal radius fracture
A distal radius fracture is a common bone fracture of the radius in the forearm. Because of its proximity to the wrist joint, this injury is often called a wrist fracture...
.
Terminology
The term Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, now the term tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulnaUlna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...
, 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 classic Colles fracture has the following characteristics:
- TransverseTransverse planeThe transverse plane is an imaginary plane that divides the body into superior and inferior parts. It is perpendicular to the coronal and sagittal planes....
fracture of the radius - 1 inch (2.54 cm) proximal to the radio-carpal joint
- dorsalDorsum (biology)In anatomy, the dorsum is the upper side of animals that typically run, fly, or swim in a horizontal position, and the back side of animals that walk upright. In vertebrates the dorsum contains the backbone. The term dorsal refers to anatomical structures that are either situated toward or grow...
displacementDisplacement (orthopedic surgery)Displacement in orthopedic surgery refers to change in alignment of the fracture fragments. In the context of joints, displacement implies that the joint surfaces are not in anatomical alignment....
and angulation
Causes
The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched arms - falling with wristWrist
In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...
s flexed would lead to a Smith's fracture
Smith's fracture
A Smith's fracture, also sometimes known as a reverse Colles' fracture is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension...
. It can also be caused by overuse. Orignally it was described in elderly people, post-menopausal women. It usually occurs about an inch or two proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity.
Colles' fracture is a common fracture in people with osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
, second only to vertebral fractures
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
.
Diagnosis
- Dorsal tilt
- Radial shortening
- Loss of ulnar inclination
- Radial angulation of the wrist
- Dorsal displacement of the distal fragment
- Comminution at the fracture site
- Associated fracture of the ulnar styloid process in more than 60% of cases.
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 flexionPalmar flexion
Palmar flexion is one of the movements of the wrist and hand which takes place at the wrist joint, where the angle between the palm and the forearm is decreased. The opposite of this is dorsiflexion or extension, where the angle between the back of hand and the forearm is reduced....
and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction
Reduction (orthopedic surgery)
Reduction is a medical procedure to restore a fracture or dislocation to the correct alignment. When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal without any deformity the bony fragments must be re-aligned to their...
. There is some evidence that immobilization with the wrist in dorsiflexion
Dorsiflexion
Dorsiflexion is the movement which decreases the angle between the dorsum of the foot and the leg, so that the toes are brought closer to the shin. The movement moving in opposite directions is called plantarflexion...
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
External Fixation
External fixation is a surgical treatment used to set bone fractures in which a cast would not allow proper alignment of the fracture.-Method:...
. 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.
Eponym
It is named after Abraham CollesAbraham Colles
Abraham Colles was professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland. Descended from a Worcestershire family, some of whom had sat in Parliament, he was born to William Colles and Mary Anne Bates of Woodbroak, Co. Wexford...
(1773–1843), an Irish
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...
surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
who first described it in 1814 just by looking at the classical deformity before the advent of X-rays. Ernest Amory Codman
Ernest Amory Codman
Ernest Amory Codman, M.D., was a pioneering Boston surgeon who made contributions to anaesthesiology, radiology, duodenal ulcer surgery, orthopaedic oncology, shoulder surgery, and the study of medical outcomes....
was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.
In older and younger people
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 epiphysesEpiphyseal plateThe epiphyseal plate is a hyaline cartilage plate in the metaphysis at each end of a long bone...
, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysisSlipped capital femoral epiphysisSlipped capital femoral epiphysis is a medical term referring to a fracture through the physis , which results in slippage of the overlying epiphysis....
in the hip. This is a Salter I or II fractureSalter-Harris Fractures-External links:*...
with the deforming forces directed through the weaker epiphyseal plateEpiphyseal plateThe epiphyseal plate is a hyaline cartilage plate in the metaphysis at each end of a long bone...
. - More common in women because of post-menopausal osteoporosis.
External links
- Colles Fracture Detailed information for Orthopedic Doctors