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Comprehensive Guide to Colle's Fracture in Forearm: Diagnosis, Treatment, and Complications

This detailed guide covers Colle's fracture, including causes, clinical features, examination, classifications, treatment options like conservative and operative methods, complications, and Smith's fracture comparison.

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Comprehensive Guide to Colle's Fracture in Forearm: Diagnosis, Treatment, and Complications

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  1. Injuries of the forearm By : Dr . sanjeev

  2. Normal wrist joint • Fig : -

  3. Normal wrist joint • Fig : -

  4. Colle’s 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.

  5. Colle’s fracture • Fig : -

  6. Colle’s fracture • Fig : -

  7. AP View • Fig : - colle`s fracture

  8. 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.

  9. Dinner fork defomity • Fig :

  10. dorsal displacement of the distal fracture fragments.

  11. 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

  12. Distance between radial and styloid processes • Fig :

  13. Colle’s fracture • Fig : -

  14. Fracture line Distal ulnar fracture Frykmann`s classification : Absent present 1 1 .. Extra - articular 2 2. Intra – articular (involving RC joint only ) 3 4 6 3 . Intra – articular (involving distal RU joint only ) 5 8 7 4 . Intra – articular (both RC + inferior RU joints ) RC = radiocarpal RU = radioulnar

  15. Frykmann`s classification • Fig :

  16. Radiograpy : X – ray of the wrist : - • AP and lateral views and lower end of the radius Displacement in a colle`s fracture : • Dorsal displacement • Dorsal rotation • Lateral displacement • Lateral rotation • Impaction • supination

  17. 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

  18. 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

  19. 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 apex • Just snuggly fitting at the forearm • Metacarpophalangeal joints should be free to move

  20. Colle`s cast

  21. Acceptable limits of colle`s fracture: • A dorsal tilt of less than 10 degrees • A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION : • Impaction • Median nerve intrapment

  22. Cont.. • Fig : -

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

  24. Early complication : Unstable reduction Medial or ulnar nerve stretched Post reduction swelling Compartmental syndrome Anaesthesia problem Injury to proximal segment of the bone during reduction Late complication : Malunion Rupture of extensor pollicis tendon Frozen shoulder Carpel tunnel syndrome Nonunion Sudeck`s osteodystrophy Complication

  25. COLLE`S FRACTURE - Why is it called fracture of 6…? • Common at 60 years • Force required to cause colle`s fracture are multiples of 6 • 6 classical displacements • 6 method of fracture immobilisation • 6 important early and late complications • 60 per cent cases have fracture ulnar styloid

  26. Smith’s Fracture. • Reverse of colle’s 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 hand • Fall on the forearm in supination • Direct blow to the flexed hand

  27. Colle`s and smith`s fracture • Fig : -

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

  29. 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.

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