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By David R. Gentile, MD, FACS

 

Colles' fracture is an eponym generally used to describe fractures of the end of the forearm bones, the radius and the ulna, nearest to the wrist. This fracture is relatively common and affects all age groups. The injury usually results from a fall on the outstretched wrist. Pain will be localized to the wrist and is usually accompanied by swelling and bruising. Depending on the amount of displacement of the fracture the arm may appear deformed. The patient will have pain when turning the wrist up or down or bending or straightening the wrist.

Initially, the arm should be immobilized, elevated, and ice applied to prevent further injury, limit swelling, and relieve pain. Acetaminophen can be used ease the pain rather than anti-inflammatory medications, which can cause additional bleeding and may slow bone healing in difficult fractures. Evaluation in the orthopaedic office can usually wait until the next day and is usually more efficient than the emergency department unless there is severe deformity or pain.

X-rays will demonstrate the extent of the injury, and comparison views of the opposite wrist will demonstrate normal anatomy for each patient. No additional images are needed unless the fracture involves the joint surface. In complicated joint injuries, a computed axial tomography scan (CT) will be useful in surgical planning.

Treatment of the fracture will be determined by the location of the fracture, how displaced the fracture is, whether the joint surface is involved, surgeon preference, and the age, activity level, and hand dominance of the patient. Simple nondisplaced fractures need to be protected in a splint or cast, which usually ends before the elbow, for a period of 4-6 weeks. When both bones of the wrist are involved, immobilization may need to extend above the elbow.

A fracture, which is misaligned, angulated, or shortened, needs to be re-aligned or reduced before application of the cast. Follow-up X-rays may need to be taken weekly for three weeks and again at six weeks to monitor fracture alignment and healing. In cases in which the fracture is unstable, involves the joint, or an acceptable reduction cannot be achieved or maintained during casting, surgery may be required.

Surgical fracture fixation may include pins placed through the skin, an external fixator, internal plate, and screws or a combination of methods to heal properly. Pins and fixators are used temporarily to hold the fracture while it heals and can be removed in the office setting. Plates and screws generally are left in place after healing, unless there is inflammation requiring their removal.

Skilled occupational hand therapy is critical in the postfracture period to restore strength and motion to return the arm to a healthy state. In most cases, patients may begin light activities within a month or two following casting or surgery. Full activity is generally allowed three to six months following the injury. Most patients are able to resume their previous activities, although complete recovery may last one year.