A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the

radius In classical geometry, a radius (: radii or radiuses) of a circle or sphere is any of the line segments from its Centre (geometry), center to its perimeter, and in more modern usage, it is also their length. The radius of a regular polygon is th ...

is bent backwards. Symptoms may include pain, swelling, deformity, and

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clo ...

. Complications may include damage to the

median nerve The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve originates from the lateral and medial cords of the brachial plexus, and has cont ...

. It typically occurs as a result of a fall on an outstretched hand. Risk factors include

osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk. It is the most common reason f ...

. The diagnosis may be confirmed via

X-rays An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

. The tip of the

ulna The ulna or ulnar bone (: ulnae or ulnas) is a long bone in the forearm stretching from the elbow to the wrist. It is on the same side of the forearm as the little finger, running parallel to the Radius (bone), radius, the forearm's other long ...

may also be broken. Treatment may include

casting Casting is a manufacturing process in which a liquid material is usually poured into a mold, which contains a hollow cavity of the desired shape, and then allowed to solidify. The solidified part is also known as a casting, which is ejected or ...

or surgery. Surgical reduction and casting is possible in the majority of cases in people over the age of 50. Pain management can be achieved during the reduction with procedural sedation and analgesia or a hematoma block. A year or two may be required for healing to occur. About 15% of people have a Colles' fracture at some point in their life. They occur more commonly in young adults and older people than in children and middle-aged adults. Women are more frequently affected than men. The fracture is named after

Abraham Colles Abraham Colles (23 July 1773 – 16 November 1843) was an Irish surgeon and physician who served as Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland, Royal College of Surgeons in Ireland (RCSI) and the P ...

who described it in 1814.

Causes

The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with

wrist 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; "The wrist contains eight bones, roughly aligned in two rows, known as the carpal ...

s flexed would lead to a Smith's fracture. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres 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

, second only to

vertebral Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

fractures.

Diagnosis

$Poignet Gauche suite a fracture type Pouteau Colles$ Diagnosis can be made upon interpretation of anteroposterior and lateral views alone. The classic Colles fracture has the following characteristics: *

Transverse Transverse may refer to: *Transverse engine, an engine in which the crankshaft is oriented side-to-side relative to the wheels of the vehicle *Transverse flute, a flute that is held horizontally * Transverse force (or ''Euler force''), the tangen ...

fracture of the radius * 2.5 cm (0.98 inches)

proximal Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

to the radio-carpal joint *

dorsal Dorsal (from Latin ''dorsum'' ‘back’) may refer to: * Dorsal (anatomy), an anatomical term of location referring to the back or upper side of an organism or parts of an organism * Dorsal, positioned on top of an aircraft's fuselage The fus ...

displacement Displacement may refer to: Physical sciences Mathematics and physics *Displacement (geometry), is the difference between the final and initial position of a point trajectory (for instance, the center of mass of a moving object). The actual path ...

and dorsal angulation, together with radial tiltSolomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772 Other characteristics: * Radial shortening * Loss of ulnar inclination * Radial angulation of the wrist * Comminution at the fracture site * Associated fracture of the ulnar styloid process in more than 60% of cases.

Classification

The term ''Colles fracture'' is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the

, 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 In human anatomy, the metacarpal bones or metacarpus, also known as the "palm bones", are the appendicular skeleton, appendicular bones that form the intermediate part of the hand between the phalanges (fingers) and the carpal bones (wrist, wris ...

appears to be thrown backward”. The fracture is sometimes referred to as a "

dinner fork In cutlery or kitchenware, a fork (from 'pitchfork') is a utensil, now usually made of metal, whose long handle terminates in a head that branches into several narrow and often slightly curved tines with which one can spear foods either to h ...

" or "

bayonet A bayonet (from Old French , now spelt ) is a -4; we might wonder whether there's a point at which it's appropriate to talk of the beginnings of French, that is, when it wa ... , now spelt ) is a knife, dagger">knife">-4; we might wonder whethe ...

" deformity due to the shape of the resultant forearm. Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications.

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 flexion 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 Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

as opposed to palmarflexion results in less redisplacement and better functional status. Significant angulation and deformity may require an

open reduction and internal fixation Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the ...

external fixation External fixation is a surgical treatment wherein Kirschner wire, Kirschner pins and wires are inserted and affixed into bone and then exit the body to be attached to an external apparatus composed of rings and threaded rods — the Ilizarov app ...

. 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. Repeat Xrays are recommended at one, two, and six weeks to verify proper healing.

Prognosis

Recovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the person's age, gender, and medical history, and may range from two months to a year or more for complete recovery.

Epidemiology

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 A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

fractures. In children with open

epiphyses An epiphysis (; : epiphyses) is one of the rounded ends or tips of a long bone that ossify from one or more secondary centers of ossification. Between the epiphysis and diaphysis (the long midsection of the long bone) lies the metaphysis, inc ...

, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a

slipped capital femoral epiphysis Slipped capital femoral epiphysis (SCFE or skiffy, slipped upper femoral epiphysis, SUFE or , coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of ...

in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker

epiphyseal plate The epiphyseal plate, epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with ma ...

. * More common in women because of post-menopausal osteoporosis.

History

The Colles fracture is named after

(1773–1843), an Irish

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

, from

Kilkenny Kilkenny ( , meaning 'church of Cainnech of Aghaboe, Cainnech'). is a city in County Kilkenny, Republic of Ireland, Ireland. It is located in the South-East Region, Ireland, South-East Region and in the Provinces of Ireland, province of Leinst ...

who first described it in 1814 by simply looking at the classic deformity before the advent of

. 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 ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. Founded in 1812, the journal is among the most prestigious peer-reviewed medical journals. Its 2023 impact factor w ...

'', also developed the classification system. It is sometimes said that Claude Pouteau was the first to describe the Colles' fracture (which is sometimes called the Pouteau-Colles fracture), but, according to P. Liverneaux, it is not the case.P. Liverneaux, "Qu'a vraiment décrit Pouteau dans les fractures du poignet?" ("What wrist fracture did Pouteau actually describe?"), ''Chirurgie de la main'', 2004, 23, 6, p. 298-304
abstract online in Frenchabstract online in English

References

External links

*
Colles Fracture
Wheeless' Textbook {{Fractures Bone fractures Wikipedia medicine articles ready to translate