Colles Fracture: Difference between revisions

No edit summary
No edit summary
Line 52: Line 52:
*O'Brian Score <ref name="MacDermid">MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskeletal Disord. 2003;4:24.</ref><ref name="Arora">Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237-242.</ref><ref name="Wright">Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005;30(2):289-299.</ref><ref name="Tremayne">Tremayne A, Taylor N, McBurney H, Baskus K. Correlation of impairment and activity limitation after wrist fracture. Physiother Res Int. 2002;7(2):90-99.</ref>
*O'Brian Score <ref name="MacDermid">MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskeletal Disord. 2003;4:24.</ref><ref name="Arora">Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237-242.</ref><ref name="Wright">Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005;30(2):289-299.</ref><ref name="Tremayne">Tremayne A, Taylor N, McBurney H, Baskus K. Correlation of impairment and activity limitation after wrist fracture. Physiother Res Int. 2002;7(2):90-99.</ref>


== Management / Interventions<br>  ==
== Examination&nbsp; ==


{| width="40%" cellspacing="1" cellpadding="1" border="0" align="right" class="FCK__ShowTableBorders"
== Medical management<br>&nbsp;  ==
 
{| width="40%" align="right" class="FCK__ShowTableBorders" border="0" cellspacing="1" cellpadding="1"
|-
|-
| align="right" |  
| align="right" |  
Line 60: Line 62:


|}
|}
There are a number of options for stabilization and medical treatment of this fracture. These comprise conservative management with cast immobilization or surgical options: external fixation, internal fixation, percutaneous pinning, and bone substitutes. The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient provide the best treatment option.


Conservative Treatment  
Conservative Treatment  

Revision as of 19:48, 13 June 2013

Original Editor - Stacy S Stone


Lead Editors - Emma Guettard as part of the Vrije Universiteit Brussel Evidence-based Practice Project


 Search strategy
  [edit | edit source]

We consulted Pubmed to search for randomized clinical trials. These are the words we used: Colles’ fracture physical therapy, colles’ fracture epidemiology, distal radius fracture, treatment colles fracture..[1]

  Definition/Description[edit | edit source]

A colles fracture is a fracture of the distal radius. It was first described in 1814, by Abraham Colles, an Irish surgeon. The fracture originates from a fall on the outstretched hand and is usually associated with dorsal and radial displacement of the distal fragment, and disturbance of the radial-ulnar articulation. Possibly the ulnar styliod may be fractured. Communication of the distal fragment and fractures into the joint surface are present in some of these fractures. The colles fracture is one of the most common and challenging of the outpatient fractures. (7: Level of Evidence 1B) Colles' fracture is defined as a linear transverse fracture of the distal radius approximately 20-35 mm proximal to the articular surface with dorsal angulation of the distal fragment.(3: Level of evidence 4 )

Clinical relevant anatomy
[edit | edit source]

Low energy extra-articular fracture of the distal radius. Can be associated with ulnar styloid fracture, TFCC tear, scapholunate dissociation.[8]


  Epidemiology/Etiology 
 [edit | edit source]


Females are predilected more than males for this type of injury and oftentimes there is a precedent history of osteoporosis.' In the United States and in Northern Europe, colles fractures are the most common fractures in women up to the age of 75 years.(2: level of evidence 1b ) It is known that these fractures appear mostly by young adults and the elderly.(1: Level of evidence 3a ) Stable Colles' fractures present with minimal comminution. Unstable fractures are distinctly comminuted often with corresponding avulsions of the radial or ulnar styloid, that have the potential to cause compression neuropathies, especially of the median nerve. Other complications that have been reported are degenerative joint disease and reflex sympathetic dystrophy.(3: Level of evidence 4)


  Characteristics/clinical presentation
[edit | edit source]

"Dinner Fork" Deformity[9]
 History of fall on an outstretched hand 
Dorsal wrist pain 
Swelling of the wrist 
Increased angulation of the distal radius 
Inability to grasp object[10]


Differential diagnosis [edit | edit source]

  • Radiographic Imaging - dorsally angulated fracture of distal radial metaphysis
  • CT Scan

Classifications of Distal Radial (Colles') Fracture

  • Universal Classification of Dorsally Displaced Distal Radial Fractures Type I - undisplaced
  • Universal Classification of Dorsally Displaced Distal Radial Fractures Type II - displaced
  • Melone Type I - undisplaced and minimally comminuted
  • Frykman Type I - distal radial fracture without distal ulnar fracture
  • Frykman Type II - distal radial fracture with distal ulnar fracture[1]

Outcome Measures[edit | edit source]

  • DASH
  • Patient Rated Wrist Evaluation (PRWE)
  • Green Score
  • O'Brian Score [2][3][4][5]

Examination [edit | edit source]

Medical management
 [edit | edit source]

[6]

There are a number of options for stabilization and medical treatment of this fracture. These comprise conservative management with cast immobilization or surgical options: external fixation, internal fixation, percutaneous pinning, and bone substitutes. The fracture pattern, degree of displacement, the stability of the fracture, and the age and physical demands of the patient provide the best treatment option.

Conservative Treatment

  • Immobilization in cast/splint - typically positioned in slight flexion, pronation
  • Percutaneous Pinning

Surgical Intervention

Differential Diagnosis
[edit | edit source]

Must differentially diagnose a Colles' Fracture from:

  • Carpal fracture/dislocation (particularly scaphoid and lunate)
  • Distal ulnar fracture
  • Metacarpal fracture[7]

 Key Evidence
[edit | edit source]

add appropriate resources here


 Resources
[edit | edit source]

add appropriate resources here


 Case Studies
 [edit | edit source]

add appropriate resources here 




 

Recent Related Research (from Pubmed)[edit | edit source]

Failed to load RSS feed from http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=18A2e0_HeVt_9m8Re3d7Fvfw8YV_jjDUBJEZj97LHK2Md825o|charset=UTF-8|short|max=10: Error parsing XML for RSS

References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ 1.0 1.1 1.2 Cite error: Invalid <ref> tag; no text was provided for refs named Wheeless
  2. ↑ MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskeletal Disord. 2003;4:24.
  3. ↑ Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237-242.
  4. ↑ Wright TW, Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixed-angle tine plate versus external fixation. J Hand Surg Am. 2005;30(2):289-299.
  5. ↑ Tremayne A, Taylor N, McBurney H, Baskus K. Correlation of impairment and activity limitation after wrist fracture. Physiother Res Int. 2002;7(2):90-99.
  6. ↑ besthandsurgeon. Distal Radius Fracture ORIF. Available from: http://www.youtube.com/watch?v=Ye839BYoMaY[last accessed 22/03/13]
  7. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named EMedicine
Retrieved from "https://www.physio-pedia.com/index.php?title=Colles_Fracture&oldid=71367"