COLLES FRACTURE

GENERAL

   

This is the most common wrist fracture and often occurs in postmenopausal women. It usually results from a fall onto the outstretched hand and leads to the Radius (larger forearm bone) crushing into itself and tilting backwards.

A Colles fracture results in the radius shortening or conversely the ulna becomes too long and impacts against the wrist bones.

Normally the radius is tilted forward approx. 10 degrees on a side view.

On a front view of the wrist the radius and ulnar are approximately the same length.

POST REDUCTION




ULNAR LENGTH




END-ON VIEW FOREARM

    

ISSUES

There are many issues to take into consideration in the management of this fracture.

• Age, Activity Level, General Health.
• Non - Dominant Hand.
• Undisplaced.
• Displaced.
• Joint Surface Involved - Step ( __---- ) or Gap ( ---- ---- ).
• Comminution (many fragments).
• Osteoporosis (soft bones).
• Growth Plate Involved (children).
• Other Injuries - for example - nerve, cartilage, ligaments.
• Stable.
• Unstable.
• Acceptable.
• Unacceptable.
• Risks of Surgery.

Any given Colles fracture may be well treated in several different ways.

TREATMENT

The aim is to hold the fractured bones in a satisfactory position until healing occurs (usually in a plaster cast for 6 weeks) and avoid complications along the way. If the fracture is displaced then a "Closed Reduction" may be required (pulling on the bones under an anaesthetic to realign the fracture). If the fracture is very unstable additional measures may be required to stabilise the fracture ("Open Reduction"). For example...

• Plates.
• Screws.
• Wires.
• External Fixateurs.
• Bone graft from the hip.
• Norian cement (derived from Coral).

   



Sometimes the best long-term functional result is achieved by accepting a degree of deformity and starting early movement once the fracture has healed. One has to balance the advantages versus the risks of an operation and this is a decision that requires considerable experience.

PLASTER

The arm should be comfortable in the cast. If it feels uncomfortable despite Panadol and elevation, or if the cast feels too tight then let your doctor know immediately. While in the cast it is important to exercise the fingers, elbow and shoulder to prevent stiffness.

The arm may be X-Rayed regularly if the fracture is unstable to make sure that the fracture position does not change. The outer bandage around the half plaster slab needs to be tightened regularly so that the plaster feels snug but not too tight.

AFTER PLASTER REMOVED

Your doctor will give you a Tubigrip bandage for comfort. This can be removed for showering or when no longer required for support.

Perform finger and wrist exercises and grip strengthening exercises squeezing putty or a squash ball.

It is not uncommon to experience some discomfort for a few months in the wrist especially on the side away from the thumb. This usually settles with time.

Do not do any heavy lifting or play sport for 6 weeks after the plaster is removed. Do not return to driving until you can turn the steering wheel in an emergency.

COMPLICATIONS

• Swelling – plaster too tight.
• Malunion – angled, shortening.
• Complex Regional Pain Syndrome (CRPS).
• Nerve Entrapment e.g. Carpal Tunnel.
• Tendon Rupture.
• Arthritis.
• Other.