Anda di halaman 1dari 29

Injuries of the

forearm
Colle`s and smith`s
fracture

Normal wrist joint


Fig : -

Normal wrist joint


Fig : -

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 fracture
Fig : -

Colles fracture
Fig : -

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
ExaminationDistal neurovascular status.
External injuries.

Dinner fork defomity


Fig :

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 processes
Fig :

Colles fracture
Fig : -

Frykmann`s classification :
Fracture line
1 .. Extra - articular
2. Intra articular (involving RC
joint only )

Distal ulnar
fracture

Absent
1
3

3 . Intra articular (involving distal


RU joint only )

4 . Intra articular (both RC +


inferior RU joints )
RC = radiocarpal
RU = radioulnar

present
2
4
6
8

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 displacement
Dorsal rotation
Lateral displacement
Lateral rotation
Impaction
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 MID- PRONATION
.ABOVE
CAST IN WRIST FULLY
COTTON ELBOW
LODER`S POSITION(
PRONATION
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 apex
Just snuggly fitting at the forearm
Metacarpophalangeal joints should be
free to move

Colle`s cast

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

Cont..
Fig : -

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

Complication
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

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

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
hand
Fall on the forearm in supination
Direct blow to the flexed hand

Colle`s and smith`s fracture


Fig : -

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

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.