Colles' fracture: Difference between revisions
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==Background== | ==Background== | ||
*Distal radial metaphysis | *Distal radial metaphysis fracture that is dorsally displaced and angulated | ||
**Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" | **Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fracture) | ||
*Occurs due to FOOSH | *Occurs due to FOOSH | ||
*Ulnar styloid | *Ulnar styloid fracture is often present and suggests injury to TFCC | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 13: | Line 13: | ||
{{Distal radius fracture DDX}} | {{Distal radius fracture DDX}} | ||
== | ==Evaluation== | ||
[[File:Colles fracture.JPG|thumb|Colles fracture]] | [[File:Colles fracture.JPG|thumb|Colles fracture]] | ||
[[File:Collesfracture.jpg|thumb|[[Colles' fracture]]]] | [[File:Collesfracture.jpg|thumb|[[Colles' fracture]]]] | ||
===Imaging=== | ===Imaging=== | ||
*PA | *PA | ||
**Distal metaphyseal | **Distal metaphyseal fracture that often appears shortened from angulation or comminution | ||
*Lateral | *Lateral | ||
**Provides best view of dorsal angulation and comminution | **Provides best view of dorsal angulation and comminution | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Unstable Fracture - Immediate ortho referral | *Unstable Fracture - Immediate ortho referral | ||
**>20 degrees angulation | **>20 degrees angulation | ||
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**>2/3 displacement | **>2/3 displacement | ||
**5mm shortening of the radius | **5mm shortening of the radius | ||
*Stable Fracture | *Stable Fracture | ||
**Use [[Procedural sedation]] or [[Hematoma block]] | |||
**Hang 10 lb weight with finger traps or otherwise provide longitudinal traction | |||
**Recreate the injury by extending wrist to 90 degrees while elbow is flexed | |||
**Pull distal segment back, up, and then out; use both thumbs to apply volar pressure | |||
**Immobilize wrist with [[sugar tong splint]] at 15 degrees of flexion, 20 degrees of ulnar deviation, and slight pronation <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
**Goals for post-reduction X rays: normal radius length, normal radial inclination of 15-30 degrees and volar tilt of 10-15 degrees | |||
==Disposition== | |||
*Outpatient with ortho follow up | |||
==See Also== | ==See Also== | ||
| Line 37: | Line 49: | ||
<references/> | <references/> | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 04:26, 18 September 2019
Background
- Distal radial metaphysis fracture that is dorsally displaced and angulated
- Fracture line may extend into radioulnar or radiocarpal joint ("die-punch" fracture)
- Occurs due to FOOSH
- Ulnar styloid fracture is often present and suggests injury to TFCC
Clinical Features
Colle's fracture on physical exam.
- Characteristic dorsiflexion or "dinner-fork" deformity
- Palmar paresthesias (pressure on median nerve)
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
| Eponyms | Description |
| Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
| Chauffer's | Fracture of radial styloid |
| Colles' | Dorsally displaced, extra-articular fracture |
| Die-punch | Depressed fracture of the lunate fossa (articular surface) |
| Smith's | Volar displaced, extra-articular fracture |
Evaluation
Imaging
- PA
- Distal metaphyseal fracture that often appears shortened from angulation or comminution
- Lateral
- Provides best view of dorsal angulation and comminution
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Unstable Fracture - Immediate ortho referral
- >20 degrees angulation
- Intra-articular involvement
- Marked comminution
- >2/3 displacement
- 5mm shortening of the radius
- Stable Fracture
- Use Procedural sedation or Hematoma block
- Hang 10 lb weight with finger traps or otherwise provide longitudinal traction
- Recreate the injury by extending wrist to 90 degrees while elbow is flexed
- Pull distal segment back, up, and then out; use both thumbs to apply volar pressure
- Immobilize wrist with sugar tong splint at 15 degrees of flexion, 20 degrees of ulnar deviation, and slight pronation [1]
- Goals for post-reduction X rays: normal radius length, normal radial inclination of 15-30 degrees and volar tilt of 10-15 degrees
Disposition
- Outpatient with ortho follow up
See Also
References
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.