Colles’ Fracture: Definition, Mechanism, Clinical Features & Management

Colles’ fracture is a transverse fracture of the distal end of the radius, occurring approximately 2.5 cm (1 inch) proximal to the wrist joint. It is commonly caused by a fall on an outstretched hand and results in dorsal displacement and angulation of the distal fragment, leading to the characteristic "dinner fork deformity."

Etiology (Causes)

1. Trauma – Fall on an outstretched hand (FOOSH injury).
2. Osteoporosis – Common in elderly individuals, especially postmenopausal women.
3. Direct Injury – A direct blow to the wrist.

Pathophysiology

• When a person falls with an outstretched hand, the force is transmitted to the distal radius, causing a fracture.
• The distal fragment displaces dorsally (backward) and laterally, creating an apex-volar angulation.
• The ulnar styloid process may also fracture in some cases.

Clinical Features

1. Symptoms

• Pain – Severe pain over the wrist.
• Swelling – Due to soft tissue injury and hematoma formation.
• Restricted wrist movements – The patient is unable to use the affected hand properly.

2. Signs

• Dinner Fork Deformity – The wrist appears deformed, resembling an upturned fork.
• Dorsal angulation – The distal fragment of the radius moves backward.
• Radial deviation – The hand shifts towards the thumb side.
• Localized tenderness – Over the distal radius.
• Crepitus – A grating sensation due to bone fragments moving against each other.

Diagnosis

1. Clinical Examination

• Check for swelling, deformity, tenderness, and restricted movement.
• Assess for nerve injury (median nerve compression may lead to carpal tunnel syndrome).

2. Radiological Investigations

• X-ray (AP and Lateral views of the wrist):
• Transverse fracture of the distal radius.
• Dorsal displacement and angulation of the distal fragment.
• Possible fracture of the ulnar styloid process.

Management

1. First Aid & Initial Treatment

• Immobilization – Apply a splint to stabilize the wrist.
• Elevation – To reduce swelling.
• Pain Management – Give analgesics (NSAIDs).

2. Reduction (Realigning the Fracture)

• Closed Reduction (for undisplaced fractures):
• The doctor applies traction to pull the bone fragments into proper alignment.
• The wrist is then immobilized in a plaster cast in palmar flexion and ulnar deviation.
• Open Reduction and Internal Fixation (ORIF) (for displaced or unstable fractures):
• Surgery is done using plates, screws, or Kirschner wires (K-wires) to fix the fracture.

3. Immobilization

• A below-elbow plaster cast is applied for 4-6 weeks.
• Regular X-rays are done to monitor healing.

4. Rehabilitation

• Physiotherapy after cast removal to restore wrist strength and movement.

Complications

Early Complications

1. Median Nerve Injury – Can cause carpal tunnel syndrome.
2. Compartment Syndrome – Increased pressure in the forearm leading to pain and swelling.

Late Complications

1. Malunion – Leads to a permanent dinner fork deformity.
2. Stiffness of Wrist Joint – Due to prolonged immobilization.
3. Post-Traumatic Arthritis – Chronic pain and joint stiffness.
4. Complex Regional Pain Syndrome (CRPS) – Severe pain and swelling due to nerve involvement.

Prognosis

• Good prognosis if the fracture is properly reduced and immobilized.
• Poor prognosis in elderly patients with osteoporosis, leading to malunion or stiffness.

Summary for Quick Revision

• Cause – Fall on an outstretched hand.
• Site – Distal radius (2.5 cm from the wrist).
• Deformity – Dinner fork deformity (dorsal displacement).
• Diagnosis – X-ray (AP & Lateral views).
• Treatment – Closed reduction + Plaster cast (4-6 weeks) or Surgery (ORIF) for unstable fractures.
• Complications – Median nerve injury, malunion, stiffness, arthritis.