Colles Fracture - Causes, Symptoms, Diagnosis, and Treatment

Introduction

A fracture of the radius bone at its distal end (end of the bone close to the wrist) with dorsal angulation is called Colles fracture. It is also called a broken wrist or Colles wrist fracture, a type of distal radius fracture. It was first named after an Irish surgeon, Abraham Colles, in 1814 at the Royal College of Surgeons in Dublin. The forearm consists of two large bones: the radius bone and the ulna. The radius is the largest bone, whereas the ulna is the longest. The radius lies parallel to the ulna and pivots around it to produce the movements. The proximal surface of the radius bone articulates with the ulnar bone to form the radioulnar joint, and the radius articulates with the scaphoid and lunate bones to form the radiocarpal joint (wrist joint).

What Is Colles Fracture?

The distal end of the radius breaks, along with dorsal angulation and dorsal displacement, which may be associated with an ulnar styloid fracture, is called a Colles fracture or Colles wrist fracture. It occurs about one inch from the end of the radius bone, having a characteristic dinner fork appearance. It is the most common fracture of the wrist, seen in the elderly with low bone density or osteoporosis due to a fall and in young individuals due to trauma or a fall during sports activities. It classically presents as a transverse fracture of the distal radius associated with dorsal displacement and shortening of the wrist.

What Are the Types of Distal Radius Fractures?

Distal radius fractures are classified, according to Gosta Frykman, based on the pattern, presence of ulnar styloid fracture, and involvement of radioulnar joints:

• Type I: Transverse metaphyseal fracture, including Colles’s and Smith’s fractures.

• Type II: Type I, along with ulnar styloid fracture.

• Type III: Fractures involving the radiocarpal joint, which includes Barton’s fracture, reverse Barton fracture, and Chauffeur’s fracture.

• Type IV: Type III, along with ulnar styloid fracture.

• Type V: Transverse fracture involving the distal radioulnar joint.

• Type VI: Type V along with ulnar styloid fracture.

• Type VII: Comminuted fracture with involvement of both radiocarpal and radioulnar joints.

• Type VIII: Type VII along with ulnar styloid fracture.

Who Is More Likely to Get Colles Fracture?

Collens fractures mostly occur in women 60 and older who suffer from osteoporosis (a condition that causes weak and brittle bones). However, they can also occur in other people or other age groups due to various reasons, such as trauma from skating, car crashes, bike riding, horseback riding, skiing, and contact sports. Therefore, one should take necessary precautions, such as wearing wrist guards to protect the wrist from injury or fracture.

What Are the Causes of Colles Fracture?

Some of the causes of Colles fracture include:

• High-impact injuries like road accidents and crush injuries.

• Wrist injuries are caused during athletics or sports, skating, skiing, and biking.

• Fall from a slippery floor or ladder or heights.

• Fall on an outstretched hand (FOOSH), especially in children around puberty and in elderly people with osteoporosis.

What Are the Signs and Symptoms of Colles Fracture?

The signs and symptoms of Colles fracture include:

• Severe pain and swelling of the wrist.

• Tenderness on palpation.

• Bruising is seen around the joint.

• Inability to grasp or move the wrist or decreased range of motion.

• Numbness or tingling sensation in the wrist.

• Deformity of the wrist or wrist hanging oddly.

How Is Colles Fracture Diagnosed?

A complete medical history is taken, followed by a thorough physical examination of the wrist, and the affected and unaffected sides are compared. X-rays with both the anterior-posterior view and lateral views are recommended. X-rays are usually sufficient to confirm the diagnosis. Still, in some severe fractures, a computed tomography (CT scan) or magnetic resonance imaging (MRI) is advised, which also helps to determine soft tissue involvement. X-rays show a transverse radius fracture proximal to the radiocarpal joint. It also shows dorsal displacement of the bone and dorsal angulation. Other features seen in the radiographs are the shortening of the radius bone, loss of ulnar inclination, and, in some cases, any associated fractures.

How Is Colles Fracture Managed?

Colles fracture requires immediate care and attention to ensure proper healing or can lead to further complications. It is primarily managed by closed reduction and immobilization. However, in some cases of comminuted fractures or failure of closed reduction, open reduction and internal fixation are necessary.

• Closed Reduction: It is a procedure in which an orthopedician realigns the bones in a normal position by traction of the hand and counter traction at the elbow while applying medial force to the fracture segment. It is then immobilized with a temporary sugar tong splinting to prevent supination (rotation of hand and forearm) and pronation (natural foot movement while running and walking). Radiographs are taken after splinting, and neurovascular status is checked. Definitive treatment is done by forearm cast application for four to six weeks. Post-treatment with splinting or casing, the patient is instructed to inform in case of the appearance of red flag symptoms like severe pain, swelling, numbness, or tingling sensation, discoloration of nail beds, and decreased range of motion. Physical therapy is then advised to strengthen the ligaments and improve the range of motion.

• Surgical Management: Most fractures are managed with conservative treatment, but some unstable fractures with severe displacement require surgical management, with open reduction and internal fixation. Percutaneous pinning is followed in fractures that cannot be aligned by reduction. External fixation is done in cases of comminuted fractures for better support and a good treatment outcome.

Self-Care at Home:

1. Elevating the hand or arm above your heart rate can reduce swelling and pain caused by a Colles fracture.

2. One can also apply an ice pack over the injury.

3. A person can also wrap the ice pack in a cloth (clean) and apply it on the skin to prevent injury caused by its direct application.

4. Ice packs should be applied every few hours for at least 20 minutes to reduce swelling.

What Are the Complications of Colles Fracture?

Complications of Colles fracture can be early or delayed and present as a mild or long-term disability.

Early Complications:

• Injury of the median nerve results in severe pain, burning sensation, or numbness.

• Severe injuries can lead to increased pressure in and around the muscles, resulting in decreased oxygen and blood supply, which causes pain and numbness; this is called compartment syndrome.

• Puncture or rupture of blood vessels due to high-impact trauma.

Delayed Complications:

• Increased pressure on the median nerve results in severe pain, numbness, or loss of sensation, called carpal tunnel syndrome.

• Injuries to the cartilage and the ligaments can lead to post-traumatic arthritis (joint pain and inflammation).

• Malunion can be caused due to failure in the reduction, and if associated with a tendon injury, it leads to chronic wrist pain.

How Can Colles Fracture Be Prevented?

Preventing Colles fracture is not possible; however, one can take certain precautions to reduce the risk of these incidents, such as:

• One should wear wrist armor while riding a motorcycle.

• While skating, one can also put on wrist guards.

• One should also take precautions at home and arrange carpers, tables, and rugs so they do not accidentally lose balance over something and get injured.

• One should also ignore heights and climbing over ladders.

Conclusion

A distal radius fracture with dorsal displacement and dorsal angulation is called a Colles fracture. It is usually seen in young males due to trauma, sports injuries, or a fall in elderly women with osteoporosis. It is associated with severe pain, swelling, and wrist deformity. It can be managed successfully with conservative treatment, along with physical therapy and a healthy lifestyle.