MANUAL MINORS
A Colles’ fracture is a fracture of the distal radius, usually caused by a fall onto an outstretched hand with the wrist in extension. It is most common in older adults with osteoporosis but can occur at any age. It is characterised by the dorsal displacement of the distal fragment of the radius, giving the wrist a “dinner fork” appearance.
Diagnosis
The diagnosis is based on:
Severe, acute wrist pain, along with swelling and visible deformity (the “dinner fork” deformity).
Limitation of wrist and hand movements.
X-rays are essential to confirm the fracture and show the backward and upward displacement of the distal radius fragment.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Smith’s Fracture | Similar to Colles’ fracture but with the distal fragment displaced towards the palm (flexion rather than extension). |
Wrist Sprain | Pain and swelling without evidence of fracture on X-ray. |
Scaphoid Fracture | Localised pain in the anatomical snuffbox, without visible deformity or significant displacement. |
Barton’s Fracture | Fracture-dislocation of the distal radius involving the radiocarpal joint, with a displaced articular component. |
Emergency Management
Immediate immobilisation of the wrist and forearm with a splint or cast to prevent further displacement of bone fragments.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatories to control pain.
X-rays to confirm the type and extent of the fracture.
If displacement is present, closed reduction in the emergency department under local anaesthesia or sedation may be necessary to realign the bone fragments.
Definitive Treatment
Stable or non-displaced fractures: Managed with immobilisation in a cast for 4-6 weeks.
Displaced or unstable fractures: May require closed reduction and casting, or surgical fixation with plates and screws if the fracture cannot be adequately reduced or there is a high risk of secondary displacement.
Rehabilitation is crucial after immobilisation to regain wrist mobility, strength, and function. Complications may include joint stiffness, chronic pain, or in severe cases, complex regional pain syndrome.
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