What is a Colles fracture?The striking clinical symptom of the Colles fracture is the dislocation of the hand, with the wrist tilted downwards.
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The Colles fracture is a spoke break on the wrist. This distal radius fracture is also referred to as an extension fracture and occurs at the typical loco typico on the wrist when the victim has previously unsuccessfully attempted to catch a fall by an outstretched hand. The Colles fracture is the most common type of fracture of human bones. This fracture was named after the Irish surgeon Abraham Colles (1773-1843).
The Colles fracture is a forearm fracture that affects the radius near the wrist. If this is broken, there is a distal radius fracture. Often, children and the elderly are affected. Children often miss the necessary caution when playing and suffer various fall injuries. In many cases, a fall on the forearm occurs, which is intercepted by the flat hand and in the worst case causes a spoke break on the wrist.
In children, this extension fracture often occurs as a so-called green wood fracture. In this case, the bone is broken, but the periosteum is still intact. Older people are prone to falls due to various causes. This increased risk of falling may be due to age-related decreased bone stability, osteoporosis or cardiac arrhythmias.
A radius fracture can affect all people regardless of age and occurs depending on the situation. In rare cases, the Colles fracture is associated with joint dislocation of the wrist. If these two symptoms come together, there is a Galeazzi fracture.
Symptoms, complaints & signs
The striking clinical symptom of the Colles fracture is the dislocation of the hand, with the wrist tilted downwards. The patient can move his wrist restrictedly only with great pain. Accompanying this may be a sensory disturbance of the hand and fingers.
Depending on the strength of the impact on the outstretched hand, injuries of the skin and musculature due to protruding bones are possible. The type of radius fracture is referred to as a first- to third-degree open fracture, depending on the injury to the soft tissues. If there is a rupture of the spine but the bones are still in the correct position, the Colles fracture causes only pressure pain and swelling.
Diagnosis & History
The Colles fracture can be reliably detected by an X-ray. The affected wrist is taken in two planes laterally and from above. With this imaging technique, the physician will safely distinguish the Colles fracture from the Smith fracture and similar fractures. The doctor also examines the visible external injuries to the affected wrist.
It determines the extent of the skin lesions and determines if any nerves or vessels are damaged. An examination of the adjacent joints shows whether there is a dislocation (dislocation). Last but not least, a detailed description of the accident experience by the patient will help. To determine the appropriate therapy, the doctor clarifies whether a stable or an unstable fracture is present.
If the break is stable, the surrounding bands are not damaged. In Germany, the AO Classification (Association for Osteosynthesis), which distinguishes three different fracture types A, B and C, helps with the diagnosis. Type A has an extra-articular fracture that does not reach into the wrist. In the partial intra-articular fracture (type B), the wrist is partially affected.
The styloid process (styloid process) may have begun. Rarely, the joint clasps on the side of the back of the hand have broken dorsally or on the side of the hollow hand volar. The distal radius fracture type C affects the entire wrist. The fracture gap caused thereby is T- or Y-shaped. The healing process depends on the extent of the fracture.
With proper therapy and subsequent physiotherapy, the wrist function is completely restored. After four to six weeks, the affected wrist is again functional enough that simple activities can be performed. A complicated radius fracture can take half a year to complete healing.
In most cases, the Colles fracture is due to breakage in an impact and therefore causes severe pain and limitations in the patient's everyday life. The wrist of the patient is permanently only inclined downwards, during the movement very much pain. Likewise, it may come to other disorders on the hand that affect the sensitivity.
After the fall, swelling usually develops. Similarly, the affected area is very sensitive to pressure and can lead to sleep disorders and concentration disorders due to the permanent pain. Whether the treatment is operative or not depends heavily on the extent of the Colles fracture. In many cases, treatment can be performed without surgery, with the wrist and arm immobilized.
The doctor can also move the pieces of bone back to their original shape. In some cases, the fixation by screws and plates made of metal is necessary. There are usually no further complications. After healing, the arm can usually be used again and there are no consequential damages.
When should you go to the doctor?
A forearm fracture must always be treated by a doctor. Those who notice a painful misalignment of the hand after a fall are best advised to visit the nearest hospital immediately. Should sensory disturbances or paralysis appear, there is a medical emergency - in this case you should immediately switch on the rescue service.
External injuries of the skin and muscles should also be treated quickly. Rescue service is required in case of an open break. Subsequently, the Colles fracture in the hospital must be clarified and treated, whereby either an operative or a conservative treatment is possible.
For later complications, a visit to a doctor is recommended. For example, if you feel severe pain after the treatment, you should have it cleared up immediately. After surgery, attention should be paid to possible rebleeding and inflammation. If these complications occur, a new hospital stay may be required. Normally, however, a Colles fracture heals relatively free of symptoms. A physiotherapist can support the medical therapy and thus contribute to a speedy recovery.
Treatment & Therapy
The malposition of the wrist is removed by returning the bone ends to their original position with a reduction. The Colles fracture can be eliminated by both conservative and surgical reduction. If the patient has only a simple radius fracture, the wrist is not affected.
In this case, the non-surgical reduction is sufficient. The so-called girl catcher is used. The forearm of the patient is hung under [[Narkose9] on the thumb, middle and index finger and a weight attached to the upper arm. Then the doctor brings the spoke break back to its original position by applying pressure to the bone ends.
If the joint position is anatomically and correctly restored, a plaster cast will immobilize the affected arm. This conservative therapy is also used in the case of the greenwood fracture, when the bone is broken, but the periosteum is still intact. This therapy is particularly suitable for children, since the bone coat at this age is still quite soft and an injury is rare.
If there is an unstable radius fracture, surgery is necessary as it is expected that the bone will move again after the reduction. A cast is not sufficient in this case, which is the case with almost all radius fractures with joint involvement. The pieces of bone are returned to their original position under local anesthesia. The subsequent stabilization is carried out by wire fixation, screw osteosynthesis or metal plate implantation.
The breakage is fixed by wires, screws or metal plates. After four weeks, the plaster is removed and two weeks later the wires, screws or metal plates. The external fixator is immobilized from the outside by a scaffold and stabilized in the metacarpal metal pins from the outside. After another four weeks, the frame and the metal pins are removed.
Outlook & Forecast
The prognosis of the Colles fracture is due to the severity of the existing fracture. The more difficult and complex the fracture is, the less favorable is the prospect of healing.
Young people with a simple fracture have a good prognosis. Taking into account the medical requirements and avoiding intensive stress on the skeletal system, the Colles fracture heals well. Lifelong freedom from symptoms is certainly present in these patients. The healing path of the Colles fracture is individual and can span several months. Some people still report after years of various complaints such as a sensitivity to the weather, although they can dispute their everyday life as far as possible without complaining.
Lifelong impairments may be present in a complicated Colles fracture. Limitations of mobility, decreased physical performance or joint dysfunction are more common in these patients. Fixations and surgical procedures can be used to make corrections that lead to an improved healing prospect.
In severe cases, artificial joints must be used to relieve the symptoms. Also it can come to sequelae. In addition to chronic joint complaints, impairments of the muscle fibers, tendons or nerve tracts are possible. If physical or sporting activities can no longer be carried out due to the physical discomfort, a mental disorder may develop. This makes the healing process much more difficult.
Since a Colles fracture is the direct result of a fall on the flat hand, which can occur in any everyday situation, a prevention is not possible. In the elderly, it should be determined if there is osteoporosis, which increases the risk of falling.
The Colles fracture requires prolonged follow-up, which can last from a few days to six weeks. After surgery, the doctor must be consulted every one week. After 12 to 14 days, the skin fibers are removed. Depending on the severity of the fracture, the joint must be spared for between one and six weeks. The surgeon will determine the duration of immobilization by considering the stability of the bones.
During follow-up, the prognosis can be adjusted using regular X-ray controls. Shortly after the procedure, the wound must be fixed by means of a forearm plaster splint. The finger joints and the thumb can be moved freely with such a splint, without this impairing the healing of the fracture. After removing the threads, it may be necessary to change to a removable wrist strap.
The plaster cast has to be changed two to three times a week for the first two weeks. In the course of follow-up further X-ray examinations take place, on the basis of which the resilience of the joint is determined. Accompanying the protection offers physiotherapeutic measures. In addition, regular hand baths are performed, which support the decay of the Colles fracture.
You can do that yourself
In everyday life, the person concerned can make sure that his movements are adapted to the current possibilities. The aim should be to prevent the occurrence of further complaints. Excessive stress on the healthy parts of the body should be avoided. Muscular discomfort or tortuosity may occur, causing further pain or damage to the skeletal system.
In a Colles fracture, it is advisable to protect the affected region in principle. Not only the hand, but also the forearm should be kept calm. Movements of the entire arm should not be jerky but evenly. Shakes and physical exertion are to be avoided.
In particular, athletic efforts are to be minimized or restructured for the time of healing that the hand is not involved. Nevertheless, to cope well with everyday life, it is helpful if the support of a stable social environment is available and can be used. Work should be redistributed and carried out slowly.
In addition, it is beneficial for the healing process, if the immune system is sufficiently strengthened. A vitamin-rich and balanced diet has a positive influence, so that the symptoms subside as quickly as possible. To improve one's own well-being, activities should take place that bring joy of life even without the use of the hand. This has a positive effect on emotional health.