Colles Fracture Of The Wrist

Pain Management And Care

How much pain is experienced with a Colles fractures varies greatly and is hard to predict.

Pain is often moderate, and the doctor may advise using ice packs, elevating the arm, and taking non-prescription painkillers.

Ibuprofen and acetaminophen may be recommended to relieve pain and inflammation. More severe pain may require prescription medication, such as opioids.

If a cast is applied, it must be kept dry at all times, and it will be necessary to put a plastic cover over it when washing.

Intermediate Colles Fracture Rehabilitation Exercises

Wrist flexion and extension with dumbbell

• As above, but hold a dumbbell in your hand. Repeat 2 sets of 10 reps. 2 times per day.

Wrist pronation and supination with hammer

• Hold a hammer in your hand with your elbow bent to 90 degrees.
• Rotate the hammer in each direction. Start with 10 times each way. Do 2 sets. Repeat 2 times a day. The closer your hand is to the head of the hammer, the easier it will be.

Advances Colles Fracture Rehabilitation ExercisesPush-ups

• Start from your hands and knees if you have to, and try to progress to full push ups . Progress to 2 sets of 10 reps. Complete 1-2x/day.

Chin-ups

• Stand on a step in front of a pull up bar. Grab onto the bars so your palms are facing you.
• Pull yourself up, squeezing your shoulder blades together, until your chin is above the bar. Slowly lower yourself back down and repeat.
• Try to progress to 2 sets of 10 reps. Complete 1-2x/day

What Causes A Colles Fracture

You might get a Colles fracture if you stretch out your hand to catch yourself in a fall. It can also happen if you experience trauma like a car accident.

A physical trauma might cause mental or emotional trauma as well. Talk with your healthcare provider about any mental or emotional issues help is available.

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Pain Management Of Smith And Colles Fractures

The pain you experience when you have a fracture is difficult to determine. If the pain is moderate, you can use ice packs and OTC painkillers and elevate the arm. To get relief from pain and inflammation, you might be given acetaminophen and ibuprofen. Severe pain might have you getting an opioid prescription.

Not Every Distal Radius Fracture Is Colles

I often see patients and physicians alike referring to any distal radius fracture as a Colles fracture. This is not an accurate statement, as there are many variations to distal radius fractures and a Colles fracture is merely one of those.

In my experience, a true Colles fracture is actually a relatively unusual injury. Much more often I see fractures that are a result of poor bone density, and in these situations, the fracture often extends into the wrist joint cartilage, a problem called an intra-articular fracture. While the location of this fracture is near to a true Colles fracture, it is clearly not the injury that Colles described. So be forewarned, when you leave the hospital emergency department, and they tell you that it’s a Colles fracture, it is possible the injury may be slightly different.

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What Questions Might A Healthcare Provider Ask To Assess Your Injury

Your healthcare providers will talk to you to get more information about the nature of your injury. They might ask questions like:

• Where is your pain?
• What does your pain feel like?
• How did you injure your wrist?
• What are your symptoms?
• What medications are you on?
• Have you taken any medications yet for the pain?

What Is The Treatment For A Distal Radius Fracture

• Fracture displacement
• Joint involvement
• Associated ulna fracture and injury to the median nerve
• Whether it is the dominant hand
• Your occupation and activity level

In any case, the immediate fracture treatment is the application of a splint for comfort and pain control. If the fracture is displaced, it is reduced before it is placed in a splint. Fracture reduction is performed under local anesthesia, which means only the painful area is numbed.

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Rehabilitation And Return To Activity

Most people do return to all their former activities after a distal radius fracture. The nature of the injury, the kind of treatment received, and the body’s response to the treatment all have an impact. In some cases, you can experience permanent limitations in function after such injuries.

Almost all patients will have some stiffness in the wrist. This will generally lessen in the month or two after the cast is taken off or after surgery and continue to improve for at least 2 years. If your doctor thinks it is needed, you will start physical therapy within a few days to weeks after surgery, or right after the last cast is taken off.

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury.

Colles Fracture Fact Sheet

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Special Concerns In Children And Elderly

Due to the abundant circulation in that region, the fractured parts of the radius tend to refuse well. If this fracture occurs in children, however, the fracture line may extend through the distal epiphyseal plate, potentially leading to misalignment of the plate with the radius. If this occurs, growth of the radius may be affected.

In patients above 50 years of age, osteoporosis screening is recommended for a better outcome. Osteoporosis is one of the biggest risk factors in wrist fractures and patients suffering from osteoporosis tend to have greater deformity after Colles fracture.

Colles’ Fracture Treatment And Management

• The fracture needs to be reduced under whatever form of anaesthesia is appropriate. The manoeuvre involves disimpaction of the fracture and a movement forwards and medially .
• A back slab is applied and a repeat X-ray taken to assess the adequacy of reduction. If the position is unsatisfactory the procedure needs to be repeated. If the fracture appears unstable then orthopaedic help is required. Percutaneous pinning is sometimes necessary.
• The optimum position for immobilising the wrist, whether the cast should be extended proximal to the elbow and how long the wrist should be immobilised are all still debated.
• Surgical reduction is recommended for intra-articular fractures if there is any articular incongruity.
• Healing usually takes about six weeks.

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Scaphoid Fracture Treatment And Management

• To avoid undertreatment of occult fractures, patients with clinically suspected scaphoid fractures are treated with cast immobilisation followed by repeat examination and further imaging.
• Since over 90% of people with a suspected scaphoid fracture don’t have a true fracture, there is significant over-treatment. This carries with it costs – both personal and to the healthcare system.
• There is an increasing trend to treat undisplaced or minimally displaced scaphoid wrist fractures with immediate surgical fixation. However, current evidence does not support routine surgical treatment:
• Surgery appears to facilitate early return of function but at the expense of a higher risk of complications .
• Rate of union between immediate surgical fixation and immobilisation with early fixation of those fractures that fail to unite, is similar.

Outlook Of Smith And Colles Fractures

When the cast is on, you need to keep it dry. Most people who get Smith or Colles fractures have a full recovery. However, there are some guidelines to promote full recovery.

• Fractures usually heal after about six weeks but might take longer if the injury was severe. Full recovery can take as long as a year.
• You might need physical therapy and rehabilitation to get the arm back to functioning. It also helps to boost the energy of the limb. Its advisable to do light activities for at least two months after treatment.
• You might experience some stiffness before the hand recovers fully. Depending on the severity of the fracture, this can last up to two years.

Getting a fracture doesnt mean its the end of the road. You can still resume your favorite activities once you fully recover from your fracture. Most people get Colles fractures as opposed to Smith fractures. Smith fractures are usually not as severe as Colles fractures but should still be checked out by a specialist. In case you get a wrist injury, you need to understand when to take pain relief medication and when to seek medical attention to prevent any complications from arising.

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Treatment For Distal Radius Fractures: Closed Reduction Casting Surgery Fixation And Biologics

The scope of treatment for distal radius fractures has changed considerably in recent years. Methods of treatment include casting as well as percutaneous or open surgery, and new and exciting surgical options have developed over the past decade.

Treatment always begins with a closed reduction of a displaced fracture, generally done under local anesthesia and a light sedative, in the emergency department of a hospital.

Closed reduction

Using various forms of anesthesia to minimize discomfort, the physician manipulates the fracture fragments into proper alignment without making an incision or directly exposing the fracture.

A plaster splint or cast is applied and molded to the patients forearm and hand. Often, the plaster may extend above the elbow to help provide additional stability and neutralize the extensive forces that can be generated by natural movements of the arm and forearm.

Following closed reduction, subsequent treatment will be recommended based on an array of patient-related and radiographic factors. The condition and needs of the patient are of paramount importance when considering treatment options, and include the patients general medical status, activity level, age, and bone quality.?

If a patients medical condition permits, the goals of treatment are relatively straightforward: restoration of bony alignment, attainment of a smooth joint surface, and provision of stability until healing.

Casting

Figure 7. Casting for a stable distal radius fracture

Surgical Procedures To Treat A Colles Fracture

Open reduction, or surgical management as it is often called, allows for much greater precision in setting a bone. If not correctly in place, a malunion of the fractured bone will occur. This effectively prevents a full recovery from being achieved.

Through surgery, either pins or a plate are used to hold the bone parts in place. Most fractures are aided in this way using locked Volar plating. This is a plate that offers increased amounts of stability.

This is fixed in place using Kirschner wires which are sterilized stainless steel pins widely used in medicine. This whole procedure is viewed by a surgeon using fluoroscopy, a type of live X-ray video feed that provides a detailed image of the site.

Like any surgical procedure, there are some small risks involved. However, this operation can greatly increase the speed and overall success of recovery. Furthermore, it is the only way to correct more severe and complicated breaks to a satisfactory level.

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How Is A Colles Fracture Treated

Treatment of Colles fractures depend on the type of Colles fracture present, the age and activity level of the patient, the surgeons preference in treatment method, and the patient s desires regarding immobilization and return to activity. As Colles fractures are so common, many methods of treatment have been developed to stabilize the fractures and allow the bone to heal. The goal is to return the wrist to its prior level of functioning.

An Individualized Treatment Plan For Distal Radius Fractures

Fractures of the distal radius are very common, and are treated using either casting or surgical techniques such as internal and external fixation. There are nearly as many ways to treat a distal radius fracture as there are distal radius fractures.

In other words, there is no one treatment that is effective for all types of fractures. Each fracture requires individual treatment customized to deal with the specific characteristics of the fracture.

“An important consideration when treating a fracture of the distal radius,” stresses Dr. Wolfe, “is to assess its personality and customize ones treatment to best match its personality.”

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Fractures Of The Distal Radius And Ulna

Fractures of the distal radius, ulna, or both account for approximately three quarters of bony injuries of the wrist. The radius articulates directly with the carpal bones the ulna has attachments to the triangular fibrocartilage, which is interposed between the distal ulna and the triquetrum in the proximal row of carpal bones. The radius and ulna themselves articulate at the DRUJ, about which occurs the movements of supination and pronation at the wrist. They are enveloped in a common joint capsule and share multiple ligamentous attachments. Along the midshaft of both bones is the interosseus membrane. Several muscle groups attach on the distal aspect of both bones and contribute to the displacement of fracture fragments.

Extension fractures of the distal radius

Multiple classification schemes have been developed for extension injuries of the distal radius. These tend to be complex and cumbersome. In general, however, the greater the degree of displacement and comminution, the more severe the injury. Extension of a fracture into the radiocarpal or the DRUJ is also a marker for a more severe injury. More complex fractures tend to be more unstable.

If a concomitant supinating force is applied, often the distal ulna also fractures. Approximately 60% of distal radius fractures are associated with fracture of the ulnar styloid. Approximately 60% of ulnar styloid fractures also have an associated fracture of the ulnar neck.

Flexion fractures of the distal radius

Diagnosis Of Distal Radius Fractures

• Anteroposterior and lateral x-rays

Clinical manifestations may include dorsal angulation or displacement of the distal radius in addition to pain, swelling, and tenderness.

Distal radius fractures are usually visible on anteroposterior and lateral x-rays. Occasionally, CT is necessary to identify intra-articular fractures.

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Recovering From A Colles Fracture Or Distal Radius Fracture

After the casting period, many muscles surrounding the wrist may have atrophied. To protect the bones of the wrist, the muscles surrounding the wrist must remain strong. To strengthen these muscles post casting, the treatingphysician may require the patient to participate in physical therapy.

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Ulnar Styloid Process Fracture

• The ulnar styloid may be fractured in an injury to the wrist.
• Suggested by local tenderness over the styloid process.
• Fracture of the ulnar styloid may be associated with a distal radius fracture.
• A fractured ulnar styloid process may not be easily apparent on X-ray if there is no displacement.
• A minimally displaced fracture can be treated by a long arm cast in mid-supination for 3 or 4 weeks.
• Fractures at the base are more likely to lead to instability of the distal radioulnar joint. Closed reduction and pinning with a K wire or screw may be needed or open reduction may be necessary to achieve stability.
• An accompanying ulnar styloid non-union in patients with distal radius malunion has no apparent adverse effect on outcome or function after corrective radial osteotomy. An accompanying non-union of the ulnar styloid can heal following corrective radial osteotomy.

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How Can I Prevent A Colles Fracture

Preventing a Colles fracture might not be possible, but you can take certain safety precautions to lower your risk of injury, including:

• Wear a wrist guard when you skate.
• Wear wrist armor when youre on a motorcycle.
• Stay off ladders and avoid other heights.
• Rearrange your home so that theres nothing to trip over like rugs or small tables.

Falls arent always preventable. Do what you can to protect yourself.

Supervised Active Rehabilitation Program Used In The Study

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