bubble_chart Overview

This type of fracture was described in detail by Abraham Colles in 1814, and since then, it has been referred to as Colles fracture. It refers to a fracture of the cancellous bone at the distal end of the radius, with displacement toward the dorsal side. Colles fracture is one of the most common fractures, accounting for approximately 6.7% of all fractures. It occurs more frequently in middle-aged and elderly individuals, with a higher incidence in women.

bubble_chart Pathogenesis

It is often caused by indirect external force. When falling, the elbow is extended, the forearm is pronated, the wrist is dorsiflexed, and the palm strikes the ground. The stress acts on the distal radius, resulting in a fracture. Most are transverse. Comminuted fractures are also not uncommon.

bubble_chart Clinical Manifestations

Wrist pain and swelling, especially with limited palmar flexion. In cases of severe fracture displacement, a "dinner fork" deformity may appear, characterized by dorsal bulging of the wrist and palmar protrusion. The contour of the ulnar styloid process disappears. The wrist widens, and the hand shifts toward the radial side. The distal end of the ulna protrudes, while the radial styloid process moves upward to reach or exceed the level of the ulnar styloid process. Tenderness is present at the distal radius, and the fracture end displaced toward the radial-dorsal side can be palpated. In comminuted fractures, bone crepitus may be felt.

bubble_chart Auxiliary Examination

The X-ray reveals typical displacement with the following features:

1. The distal radius fracture fragment is displaced dorsally.

2. The distal radius fracture fragment is displaced radially.

3. The radius is shortened, with impaction or comminution of the dorsal cortex at the fracture site.

4. The fracture is angulated volarly.

5. The distal radial fragment is supinated.

Additionally, it shows partial or complete dislocation of the ulnar head. Radial displacement of the distal radius fracture indicates a tear at the triangular fibrocartilage complex margin. This is often accompanied by an avulsion fracture of the ulnar styloid process. The volar tilt and ulnar inclination are reduced or become negative angles.

bubble_chart Treatment Measures

1. For non-displaced fractures, a functional position gypsum splint or small splint can be used for 4 weeks.

2. For displaced fractures, closed reduction is required. The surgeon should pull the patient's palm and thumb along the longitudinal axis of the forearm, ulnarly deviate the wrist, and pronate the forearm. Then, flex the wrist volarly while simultaneously applying pressure to the distal radial fracture segment in the volar and ulnar directions. Maintain the wrist in pronation and grade I volar flexion-ulnar deviation, and apply a forearm gypsum splint or small splint for 4 weeks. After 10–14 days, switch to a neutral position for another 4 weeks.

3. Reduction criteria

⑴ The radial styloid process should be 1–2 cm lower than the ulnar styloid process.

⑵ The dorsal side of the distal radius must be flat without bony protrusions, and the volar concave curvature should be restored.

⑶ The hand should not be radially deviated, the ulnar head contour should be normal, and finger movement should be unimpaired.

⑷ X-ray should show the distal radial articular surface tilting toward the volar side.

4. Treatment for malunion For mild deformities that do not significantly affect wrist function, surgical treatment is not considered. For moderate deformities with only rotational impairment, an ulnar head resection can be performed. For severe deformities without forearm rotational impairment, Campbell's procedure—partial ulnar head resection and distal radial osteotomy—may be performed.

bubble_chart Complications

1. Stiffness of the shoulder and elbow joints Caused by failure to actively move the joints during fracture treatment.

2. Sudeck's atrophy Also known as reflex sympathetic dystrophy. Manifested by swelling and stiffness of the wrist and fingers, red and thinning skin, and generalized bone atrophy. Sometimes the onset is sudden. Often caused by lack of active exercise after a fracture.

3. Rupture of the extensor pollicis longus tendon Usually occurs 4 weeks or more after the injury. It results from the original injury compromising the tendon's blood supply, leading to ischemic necrosis, or due to the fracture involving Lister's tubercle, causing the tendon to rupture from constant friction over the uneven bony groove. {|102|}