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Distal radius (Colles) fractures

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Fractures of the distal radius are common. Fractures of the distal radius are often suffered sustained after a fall on the out-stretched hand and are often associated with osteoporosis.  Distral radius fractures are frequently accompanied by fractures of the ulnar styloid (with possible injury to the cartilage attached to it) or with injuries to the wrist ligaments. The involvement of the nearby cartilage and ligaments gives rise to the apt description of distal radius fractures as “soft tissue injuries surrounding a broken bone”. The Associated injuries to the nearby cartilage and ligaments are also frequently seen. The eponym “Colles’ fracture”  has been used to describe all distal radius fractures, though that name refers specifically to fractures that are angulated dorsally.

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A patient with a fracture of the  distal metaphysis of the radius usually radius typically describes falling on an outstretched hand or sustaining a direct blow to the wrist. He or she may will complain of wrist pain or and swelling.

The deformity that results from the Colles’ fracture is described as a “dinner fork" deformity because of depression at the fracture site, dorsal angulation, and dorsal displacement of the distal radius.

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  • An open wound
  • Acute carpal tunnel syndrome (characterized by  weakness or loss of thumb or index finger flexion, tingling [“paresethesia”] or loss alterations of sensation in the median distribution)
  • Vascular injury (which is rare)
  • Injury to the elbow 
  • Injury to the ulnar side of the wrist
  • Injury to the carpal bones

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PA, lateral, and oblique radiographs of the distal radius that include the carpal bones should be obtained. All three radiographs should be examined for a loss of normal anatomy, disruption of the articular surface, involvement of the distal radio-ulnar and radiocarpal jointjoints, and evidence of comminution.

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Many fractures of the distal radius can be treated without surgery. Nonsurgical treatment is indicated usually indicated for non-displaced or minimally displaced and extra-articular displace fractures.  

Acutely, non-displaced or minimally displaced fractures can be treated with a sugar tong splint. Upon examination 5 to 7 days after initial treatment, the splint can be exchanged for a short arm cast.  Immobilization for 6-8 weeks usually suffices; though radiographic healing and clinical exam dictate the length of treatment.  A new cast may be required mid-way through treatment if atrophy of the forearm renders the initial cast too loose.

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If a displaced fracture of the distal radius is left untreated, the resulting deformity will leave the person with dorsal angulation, loss of supinationlimited supination, and a weak grip. Malunion of the fracture site is associated with wrist pain and rupture of the extensor pollicis longus tendon.

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Evaluation for osteoporosis is part of the treatment in an older patient with a distal radius fracture and low energy mechanism of injury. The following lab tests should be ordered to rule out secondary obtained to evaluate for secondary causes of osteoporosis: complete blood count, complete metabolic panel (including calcium and phosphatephosphorus, parathyroid hormone levels, and testosterone for males), thyroid stimulating hormone level, 25-hydroxyvitamin D level, and alkaline phosphatase. Serum calcium, phosphate, and alkaline phosphatase are normal in a patient with osteoporosis, but alkaline phosphatase may be elevated for months after a fracture.

Additionally, a dual energy x-ray absorptiometry (DEXA) scan of the vertebral bodies and femur can be ordered to evaluate the patient’s bone mineral density and screen for osteoporosis. Initiation of treatment may prevent a later hip fracturesubsequent fragility fracture.

 

Miscellany

Eponyms about for fracture of the distal radius.

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