Editing Colles' fracture

{{Short description|Type of distal radius fracture}}

{{Infobox medical condition (new)
| name            = Colles' fracture
| synonyms        = Colles fracture, Pouteau fracture<ref name=AOF2017/>
| image           = Collesfracture.jpg
| width           =
| alt             =
| caption         = An X-ray showing a Colles' fracture
| pronounce       =
| field           = [[Emergency medicine]], [[orthopedics]]
| symptoms        = Pain, swelling, deformity, [[bruising]]<ref name=AO2013/>
| complications   =
| onset           = Sudden<ref name=AO2013/>
| duration        =
| types           =
| causes          = Fall on an outstretched hand<ref name=AO2013/>
| risks           = [[Osteoporosis]]<ref name=AO2013/>
| diagnosis       = [[X-ray#Projectional_radiographs|X-rays]]<ref name=AO2013/>
| differential    =
| prevention      =
| treatment       = [[orthopedic cast|Cast]], surgery<ref name=Bla2010/>
| medication      =
| prognosis       = Recovery over 1 to 2 years<ref name=AO2013/>
| frequency       = ~15% lifetime risk<ref name=Bla2010/>
| deaths          =
}}

A '''Colles' fracture''' is a type of [[distal radius fracture|fracture of the distal forearm]] in which the broken end of the [[Radius (bone)|radius]] is bent [[dorsal (anatomy)|backwards]].<ref name=AO2013>{{cite web|title=Distal Radius Fractures (Broken Wrist)|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00412|website=orthoinfo.aaos.org|access-date=12 October 2017|date=March 2013|url-status=live|archive-url=https://web.archive.org/web/20170702084652/http://www.orthoinfo.aaos.org/topic.cfm?topic=A00412|archive-date=2 July 2017}}</ref> Symptoms may include pain, [[Edema|swelling]], deformity, and [[bruising]].<ref name=AO2013/> Complications may include damage to the [[median nerve]].<ref name=AOF2017>{{cite web|title=Distal forearm 23-A2.2 CRIF|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=redfix&bone=Radius&segment=Distal&classification=23-A2.2&treatment=&method=CRIF%20-%20Closed%20reduction%20internal%20fixation&implantstype=K-wires%20and%20cast&approach=&redfix_url=1428651445110&Language=en|website=www2.aofoundation.org|access-date=13 October 2017|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013172626/https://www2.aofoundation.org/wps/portal/surgery?showPage=redfix&bone=Radius&segment=Distal&classification=23-A2.2&treatment=&method=CRIF%20-%20Closed%20reduction%20internal%20fixation&implantstype=K-wires%20and%20cast&approach=&redfix_url=1428651445110&Language=en|archive-date=13 October 2017}}</ref>

It typically occurs as a result of a fall on an outstretched hand.<ref name=AO2013/> Risk factors include [[osteoporosis]].<ref name=AO2013/> The diagnosis may be confirmed via [[radiography|X-rays]].<ref name=AO2013/> The tip of the [[ulna]] may also be broken.<ref name=Pf2010>{{cite book|last1=Pfenninger|first1=John L.|last2=Fowler|first2=Grant C.|title=Pfenninger and Fowler's Procedures for Primary Care E-Book: Expert Consult|date=2010|publisher=Elsevier Health Sciences|isbn=978-1455700929|page=1292|url=https://books.google.com/books?id=loI3ZhC4UN4C&pg=PA1293|language=en|url-status=live|archive-url=https://web.archive.org/web/20171013224533/https://books.google.ca/books?id=loI3ZhC4UN4C&pg=PA1293|archive-date=2017-10-13}}</ref>

Treatment may include [[orthopedic cast|casting]] or surgery.<ref name=Bla2010/> [[Reduction (orthopedic surgery)|Surgical reduction]] and casting is possible in the majority of cases in people over the age of 50.<ref name=Ou2005>{{cite journal|last1=Oussedik|first1=S|last2=Haddad|first2=F|title=Manipulation and immobilization of Colles' fractures.|journal=British Journal of Hospital Medicine|date=September 2005|volume=66|issue=9|pages=M34-5|doi=10.12968/hmed.2005.66.Sup2.19718|pmid=16200794}}</ref> Pain management can be achieved during the reduction with [[procedural sedation and analgesia]] or a [[hematoma block]].<ref name=Ou2005/> A year or two may be required for healing to occur.<ref name=AO2013/>

About 15% of people have a Colles' fracture at some point in their life.<ref name=Bla2010/> They occur more commonly in young adults and older people than in children and middle-aged adults.<ref name=Bla2010>{{cite journal|last1=Blakeney|first1=WG|title=Stabilization and treatment of Colles' fractures in elderly patients.|journal=Clinical Interventions in Aging|date=18 November 2010|volume=5|pages=337–44|doi=10.2147/CIA.S10042|pmid=21228899|pmc=3010169 |doi-access=free }}</ref> Women are more frequently affected than men.<ref name=Bla2010/> The fracture is named after [[Abraham Colles]] who described it in 1814.<ref name=Bla2010/>

== Causes ==
The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with [[wrist]]s flexed would lead to a [[Smith's fracture]]. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the [[radio-carpal joint]] with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles fracture is a common fracture in people with [[osteoporosis]], second only to [[vertebral]] fractures.<ref>{{Cite journal |last1=Owen |first1=R A |last2=Melton |first2=L J |last3=Johnson |first3=K A |last4=Ilstrup |first4=D M |last5=Riggs |first5=B L |date=June 1982 |title=Incidence of Colles' fracture in a North American community. |url=http://dx.doi.org/10.2105/ajph.72.6.605 |journal=American Journal of Public Health |volume=72 |issue=6 |pages=605–607 |doi=10.2105/ajph.72.6.605 |pmid=7072880 |pmc=1650126 |issn=0090-0036}}</ref>

== Diagnosis ==
[[File:Poignet Gauche suite a fracture type Pouteau Colles.jpg|thumb|Colles fracture of the left hand, with posterior displacement clearly visible]]
Diagnosis can be made upon interpretation of anteroposterior and lateral views alone.<ref name=":2">{{Cite book|title=Orthopedic imaging : a practical approach|last=Adam|first=Greenspan|others=Beltran, Javier (Professor of radiology)|isbn=978-1451191301|edition=Sixth|location=Philadelphia|oclc=876669045|year = 2015}}</ref>

The classic Colles fracture has the following characteristics:<ref>{{cite web|url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|title=Colles' fracture|last=GP Notebook|access-date=2009-02-21|url-status=live|archive-url=https://web.archive.org/web/20110613225247/http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|archive-date=2011-06-13}}</ref>
* [[Transverse plane|Transverse]] fracture of the radius
* 2.5&nbsp;cm (0.98&nbsp;inches) [[Anatomical terms of location#Proximal and distal|proximal]] to the [[radio-carpal joint]]
* [[Dorsum (biology)|dorsal]] [[Displacement (orthopedic surgery)|displacement]] and dorsal angulation, together with radial tilt<ref name=":0">Solomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772</ref>

Other characteristics:<ref name=":1">{{Cite book|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=9780892035793|location=Rosemont, Ill.|oclc=706805938}}</ref><ref name=":2" />
* Radial shortening
* Loss of ulnar inclination
* Radial angulation of the wrist
* Comminution at the fracture site
* Associated fracture of the [[Ulnar styloid process|ulnar styloid]] process in more than 60% of cases.

=== Classification ===
The term ''Colles fracture'' is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the [[ulna]], that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the [[Carpal bones|carpus]] and the base of [[metacarpus]] appears to be thrown backward”.<ref>Colles A 2006 On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 445:5-7.</ref> The fracture is sometimes referred to as a "[[dinner fork]]" or "[[bayonet]]" deformity due to the shape of the resultant forearm.{{cn|date=October 2020}}

Colles' fractures can be categorized according to several systems including [[Frykman classification|Frykman]], [[Gartland & Werley classification|Gartland & Werley]], [[Lidström classification|Lidström]], [[Nissen-Lie classification|Nissen-Lie]] and the [[Older's classification]]s.{{cn|date=August 2021}}

== Treatment ==

Management depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. The cast is applied with the distal fragment in [[palmar flexion]] and ulnar deviation. A fracture with mild angulation and displacement may require closed [[reduction (orthopedic surgery)|reduction]]. There is some evidence that immobilization with the wrist in [[dorsiflexion]] as opposed to [[palmarflexion]] results in less redisplacement and better functional status.<ref>{{cite web|url=http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|title=Adult Distal Radius Frx: Non Operative Treatment - Wheeless' Textbook of Orthopaedics|url-status=live|archive-url=https://web.archive.org/web/20110423051431/http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|archive-date=2011-04-23}}</ref> Significant angulation and deformity may require an [[Open reduction internal fixation|open reduction and internal fixation]] or [[external fixation]]. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures, including Colles fracture.{{cn|date=October 2020}}
There are several established instability criteria:{{cn|date=August 2021}}
dorsal tilt >20°,
comminuted fracture,
abruption of the ulnar styloid process,
intraarticular displacement >1mm,
loss of radial height >2mm.

A higher amount of instability criteria increases the likelihood of operative treatment.

Treatment modalities differ in the elderly.<ref>{{cite journal|last=Blakeney|first=William|title=Stabilization and treatment of Colles' fractures in elderly patients|journal=Clinical Interventions in Aging|date=November 2010|pages=337–44|doi=10.2147/CIA.S10042|pmid=21228899|volume=5|pmc=3010169 |doi-access=free }}</ref>

Repeat Xrays are recommended at one, two, and six weeks to verify proper healing.<ref name=Pf2010/>

==Prognosis==
Recovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the person's age, gender, and medical history, and may range from two months to a year or more for complete recovery.<ref name=AO2013/>

== Epidemiology ==

Colles fractures occur in all age groups, although certain patterns follow an age distribution.{{cn|date=October 2020}}
* In the elderly, because of the weaker cortex, the fracture is more often extra-articular.
* Younger individuals tend to require a higher energy force to cause the fracture and tend to have more complex [[intra-articular]] fractures. In children with open [[Epiphyseal plate|epiphyses]], an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a [[slipped capital femoral epiphysis]] in the hip. This is a [[Salter-Harris fractures|Salter I or II fracture]] with the deforming forces directed through the weaker [[epiphyseal plate]].
* More common in women because of post-menopausal osteoporosis.

== History ==

The Colles fracture is named after [[Abraham Colles]] (1773–1843), an [[Ireland|Irish]] [[surgery|surgeon]], from [[Kilkenny]] who first described it in 1814 by simply looking at the classic deformity before the advent of [[X-rays]].<ref>{{WhoNamedIt|synd|2152}}</ref> [[Ernest Amory Codman]] was the first to study it using X-rays. His article, published in the ''Boston Medical and Surgical Journal'', now known as ''[[The New England Journal of Medicine]]'', also developed the classification system.<ref>
{{Cite book
| publisher = Saunders
| isbn = 978-0-7216-8461-1
| last = Mallon
| first = Bill
| title = Ernest Amory Codman : the end result of a life in medicine
| location = Philadelphia
| year = 2000
}}
</ref><ref>
{{Cite journal
| doi = 10.1056/NEJM190009271431301
| issn = 0096-6762
| volume = 143
| issue = 13
| pages = 305–308
| last = CODMAN
| first = E. A.
| title = A Study of the X-Ray Plates of One Hundred and Forty Cases of Fracture of the Lower End of the Radius
| journal = The Boston Medical and Surgical Journal
| year = 1900
| s2cid = 57812302
}}
</ref>

It is sometimes said that [[Claude Pouteau]] was the first to describe the Colles' fracture (which is sometimes called the Pouteau-Colles fracture), but, according to P. Liverneaux, it is not the case.<ref>P. Liverneaux, "Qu'a vraiment décrit Pouteau dans les fractures du poignet?" ("What wrist fracture did Pouteau actually describe?"), ''Chirurgie de la main'', 2004, 23, 6, p. 298-304, [https://www.infona.pl/resource/bwmeta1.element.elsevier-8c2aa46a-c9bd-35c6-ad82-efd8ef97c632 abstract online in French], [https://pubmed.ncbi.nlm.nih.gov/15651245/ abstract online in English].</ref>

== See also ==
* [[Smith's fracture]]

== References ==
{{reflist}}

== External links ==
* {{Chorus|00913}}
* [http://www.wheelessonline.com/ortho/colles_frx Colles Fracture] Wheeless' Textbook
{{Medical resources
| Synonyms       =
| ICD10          = {{ICD10|S|52|5|s|50}}
| AO             = 23-A2.2
| MeSH1          = 68003100
}}
{{Fractures}}

[[Category:Bone fractures]]
[[Category:Wikipedia medicine articles ready to translate]]