Colles fracture is a radius fracture, also known as a spoke fracture. Many people reflexively try to break a fall by extending their hand. In the worst case, the radius breaks at the wrist. A distal radius fracture occurs, which is also the most common type of fracture of human bones.
What is a Colles fracture?
Colles fracture is a radial fracture of the wrist. This distal radius fracture is also known as an extension fracture and occurs at the typical fracture site (loco typico) at the wrist when the affected person has previously tried unsuccessfully to break a fall by extending their hand. Colles fracture is the most common type of fracture of human bones. This fracture was named after the Irish surgeon Abraham Colles (1773-1843).
Causes
Colles’ fracture is a forearm fracture that involves the radius near the wrist. If this is broken, a distal radius fracture is present. It often affects children and the elderly. Children often lack the necessary caution when playing and suffer various fall injuries. In many cases, a fall occurs on the forearm, which is cushioned by the flat hand and, in the worst case, causes a radial fracture of the wrist. In children, this extension fracture often occurs as a so-called greenstick fracture. In this case, the bone is broken, but the periosteum is still intact. Elderly people are prone to falls due to a variety of causes. This increased risk of falling can be due to decreased bone stability due to age, osteoporosis, or cardiac arrhythmias. A radius fracture can affect anyone regardless of age and occurs situationally. In rare cases, Colles fracture occurs in conjunction with dislocation of the wrist joint. If these two symptoms coincide, a Galeazzi fracture is present.
Symptoms, complaints, and signs
The prominent clinical symptom of Colles fracture is the deformity of the hand, in which the wrist is tilted downward. The patient can only move his wrist in a limited manner with great pain. Accompanying sensory disturbance of the hand and fingers may occur. Depending on the strength of the impact on the outstretched hand, injuries to the skin and musculature caused by protruding bones are also 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 fracture of the radius, but the bones are still in the correct position, the Colles fracture causes only pressure pain and swelling.
Diagnosis and course
Colles fracture can be diagnosed with certainty by taking an x-ray. The affected wrist is imaged in two planes, laterally and from above. With this imaging technique, the physician reliably distinguishes the Colles fracture from the Smith fracture and similar fractures. Furthermore, the physician examines the visible external injuries on the affected wrist. He determines the extent of the skin injuries and clarifies whether nerves or vessels may have been damaged. An examination of the adjacent joints shows whether a dislocation (luxation) has occurred. Last but not least, a detailed description of the course of the accident by the patient is helpful. To determine the appropriate therapy, the physician clarifies whether a stable or an unstable fracture is present. If the fracture is stable, the surrounding ligaments are not injured. In Germany, the AO classification (Arbeitsgemeinschaft für Osteosynthese), which distinguishes between three different fracture types A, B and C, is helpful in making the diagnosis. In type A, there is an extraarticular fracture that does not extend into the wrist. In partial intra-articular fracture (type B), the wrist is partially involved. The styloid process located on the radius bone may be fractured. Rarely, the articular cliffs on the dorsal side of the hand or on the volar side of the palm are fractured. Type C distal radius fracture involves the entire wrist. The fracture gap caused in this case is T- or Y-shaped. The healing process depends on the extent of the fracture. With proper therapy and subsequent physiotherapy, wrist function is fully restored.After four to six weeks, the affected wrist is functional again to the extent that simple activities can be performed. In the case of a complicated radius fracture, it may take six months to heal completely.
Complications
In most cases, the Colles fracture occurs due to a fracture on impact and therefore leads to severe pain and limitations in the patient’s daily life. In this case, the patient’s wrist is permanently inclined only downward, and very great pain occurs during movement. Likewise, there may be other disorders of the hand that affect the sensitivity. After the fall, a swelling usually forms. Likewise, the affected area reacts very sensitively to pressure and can also lead to sleep disturbances and to concentration disorders due to the permanent pain. Whether or not treatment needs to be surgical depends largely on the extent of the Colles fracture. In many cases, treatment can be done without surgery, immobilizing the wrist and arm. The doctor can likewise move the bone pieces back to their original shape. In some cases, this requires fixation with metal screws and plates. There are usually no further complications. After healing, the arm can be used normally again and there is no subsequent damage.
When should you go to the doctor?
A forearm fracture must be treated by a doctor in any case. Anyone who notices a painful deformity of the hand after a fall is best to visit the nearest hospital immediately. If sensory disturbances or even signs of paralysis occur, this is a medical emergency – in this case, the emergency services should be called in immediately. External injuries to the skin and muscles should also be treated quickly. In the case of an open fracture, rescue service assistance is required. The Colles fracture must then be clarified and treated in hospital, where either surgical or conservative treatment is possible. In case of later complications, a visit to the doctor is recommended. For example, anyone who experiences severe pain after treatment should have this clarified immediately. After an operation, attention should be paid to possible post-operative bleeding and inflammation. If these complications occur, a further stay in hospital may be necessary. Normally, however, a Colles fracture heals relatively symptom-free. A physiotherapist can support the medical therapy and thus contribute to a rapid recovery.
Treatment and therapy
The deformity of the wrist is corrected by returning the ends of the bones to their original position with reduction. Colles fracture can be eliminated by both conservative and surgical reduction. If the patient has only a simple fracture of the radius, the wrist is not affected. In this case, nonoperative reduction is sufficient. In this case, the so-called girl catcher is used. The patient’s forearm is suspended from the thumb, middle finger and index finger under [[anesthesia9]] and a weight is attached to the upper arm. The physician then returns the radius fracture to its original position by applying pressure to the ends of the bones. Once the joint position is anatomically and axially correctly restored, a cast immobilizes the affected arm. This conservative therapy is also used for greenstick fractures when the bone is broken but the periosteum is still intact. This therapy is particularly suitable for children, as the bone mantle is still quite soft at this age and an injury is rather rare. If an unstable radius fracture is present, surgical intervention is necessary, since it is to be expected that the bones will shift again after reduction. A cast is not sufficient in this case, which is the case with almost all radius fractures involving joints. The bone pieces are returned to their original position under local anesthesia. Subsequent stabilization is achieved by wire fixation, screw osteosynthesis or metal plate implantation. In this process, the fracture is fixed by wires, screws or metal plates. After four weeks, the plaster cast is removed and two weeks later the wires, screws or metal plates, respectively. The external fixator immobilizes the fracture from the outside by means of a scaffold and metal pins inserted into the metacarpal bone stabilize it from the outside.After another four weeks, the rack and metal pins are removed.
Outlook and prognosis
The prognosis of Colles’ fracture is conditioned by the severity of the existing fracture. The more difficult and complex the fracture, the less favorable the outlook for recovery. Young people with a simple fracture have a good prognosis. Taking into account the medical guidelines and avoiding intense stress on the skeletal system, the Colles fracture heals well. Lifelong freedom from symptoms is quite possible in these patients. The healing process of the Colles fracture is individual and can take several months. Some people still report various complaints such as weather sensitivity years later, although they can go about their daily lives largely free of symptoms. In the case of a complicated Colles fracture, lifelong impairments may be present. Restrictions in mobility, a reduced physical capacity or functional disorders of the joints occur more frequently in these patients. Corrections can be made by means of fixations and surgical interventions, leading to an improved chance of recovery. In severe cases, artificial joints must be inserted to provide relief from the symptoms. Likewise, sequelae may occur. In addition to chronic joint complaints, impairment of muscle fibers, tendons or nerve tracts is possible. If professional or sporting activities can no longer be carried out due to the physical complaints, a psychological disorder may develop. This makes the healing path much more difficult.
Prevention
Because a Colles fracture is the direct result of a fall on the flat of the hand, which can occur in any everyday situation, prevention is not possible. In older people, it should be determined whether osteoporosis is present, which increases the risk of falls.
Follow-up care
Colles fracture requires prolonged follow-up, which can last from a few days to six weeks. After surgery, the patient must see the doctor at one-week intervals. After 12 to 14 days, the skin sutures are removed. The joint must be rested for between one and six weeks, depending on the severity of the fracture. The operating physician will determine the length of immobilization by considering the stability of the bones. During follow-up, the prognosis can be adjusted based on regular X-ray checks. Shortly after the procedure, the wound must be immobilized using a forearm plaster splint. The finger joints as well as the thumb can be moved freely with such a splint without affecting the healing of the fracture. After removal of the stitches, it may be possible to switch to a removable splint for the wrist. The cast must be changed two to three times per week for the first two weeks. In the course of follow-up care, further X-ray examinations are performed to determine the load-bearing capacity of the joint. Physiotherapeutic measures are offered to accompany the sparing. In addition, regular hand baths are performed, through which the decongestion of the Colles fracture is supported.
What you can do yourself
In everyday life, the affected person can make sure that his or her movement patterns are adapted to the current possibilities. The aim here should be to prevent the occurrence of further complaints. Too much strain on healthy parts of the body should be avoided. Muscle complaints or misalignments could develop, causing further pain or damage to the skeletal system. In the case of a Colles fracture, it is advisable to generally take it easy on the affected region. Not only the hand but also the forearm should be kept still. Movements of the entire arm should be smooth rather than jerky. Vibration and physical exertion should be avoided. Athletic exertion in particular should be minimized for the period of healing or restructured so that the hand is not involved. In order to nevertheless be able to cope well with everyday life, it is helpful if the support of a stable social environment is available and can be called upon. Work should be redistributed and performed 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 to life even without the use of the hand. This has a beneficial effect on emotional health.
