Injuries of the forearmColle`s and smith`s fracture

Normal wrist jointFig : -

Normal wrist jointFig : -

Colles fracture. describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint .Occurs about 2.5 cm above the carpal extremity of the radius . Commonest age group- Elderly.( 60 yrs) Women> Men. MOA fall in outstretched hand.Force required to cause this fracture is 192 kg in women and 282 kg in men.

Colles fractureFig : -

Colles fractureFig : -

AP View Fig : - colle`s fracture

Clinical features.-Swelling.Pain.Dinner fork defomity, it is not found in all cases but seen only if there is a dorsal tilt or rotation of the distal fragment

Examination-Distal neurovascular status.External injuries.

Dinner fork defomityFig :

dorsal displacement of the distal fracture fragments.

Styloid process test :Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process.In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture.This is more reliable sign than dinner fork deformity

Distance between radial and styloid processesFig :

Colles fractureFig : -

Frykmann`s classification : Fracture line Distal ulnar fractureAbsentpresent 1 .. Extra - articular122. Intra articular (involving RC joint only ) 3 4 3 . Intra articular (involving distal RU joint only ) 5 64 . Intra articular (both RC + inferior RU joints ) 78RC = radiocarpalRU = radioulnar

Frykmann`s classification Fig :

Radiograpy : X ray of the wrist : - AP and lateral views and lower end of the radius Displacement in a colle`s fracture : Dorsal displacementDorsal rotationLateral displacementLateral rotationImpaction supination

Treatment :Conservative methods Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or local anaesthesia (LA) - If the level of the styloid processes are restored back to normal , it indicates that the reduction has been achieved satisfactorily. - limb is immobilised by colle`s cast and a check radiograph is taken - Removed after 6 8 weeks - physiotherapy

6 immobilisation method : Below elbow cast (10 20 degree palmar flexon , 15 20 degree ulnar deviation ) COLLE`S CAST ABOVE ELBOW CAST IN SUPINATION ABOVE ELBOW CAST IN PRONATION. ABOVE ELBOW CAST IN MID- PRONATION. COTTON LODER`S POSITION( WRIST FULLY FLEXED) . EXTERNAL FIXATORS

Colle`s cast It is a below elbow cast in supination and ideally it has to meet the following 4 criteria :- Firm fit at the dorsum Firm fit at the volar fracture apexJust snuggly fitting at the forearmMetacarpophalangeal joints should be free to move

Colle`s cast

Acceptable limits of colle`s fracture:A dorsal tilt of less than 10 degreesA radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION :ImpactionMedian nerve intrapment

Cont..Fig : -

Surgical methods : 1 . Closed reduction and percutaneous pinning with k wires 2 . Open reduction and plate fixation.

Complication Early complication :Unstable reductionMedial or ulnar nerve stretchedPost reduction swellingCompartmental syndromeAnaesthesia problemInjury to proximal segment of the bone during reduction Late complication :Malunion Rupture of extensor pollicis tendonFrozen shoulderCarpel tunnel syndrome Nonunion Sudeck`s osteodystrophy

COLLE`S FRACTURE - Why is it called fracture of 6?Common at 60 yearsForce required to cause colle`s fracture are multiples of 66 classical displacements6 method of fracture immobilisation 6 important early and late complications60 per cent cases have fracture ulnar styloid

Smiths Fracture.Reverse of colles fracture.Wrist fracture in which the distal end of the radius is displaced forwards. Mechanism of injury :Fall on the back of the dorsum of the handFall on the forearm in supination Direct blow to the flexed hand

Colle`s and smith`s fractureFig : -

Clinical features : -Pain Swelling Deformity Loss of wrist functionDeformity is opposite to that of colle`s fracture and is called the garden shaped deformity. Radiography : -AP view of the wrist

Complication : Complication of colle`s Treatment : -Closed reduction and immobilisation in a long arm cast with forearm in supination and wrist in extension. Unstable fractures : -Fixation with k wire or open reduction and plate fixation.