History

Fact Explanation
limited range of motion and loss of function colles fracture result in displacement and angulation of the distal fragment of the fracture resulting in shortening of the forearm and limitation to the natural movements at the wrist. (1)
numbness in digits in median ditributuion the fracture segment can easily impact on the median nerve or it can get secondary contusions result in the numbness of the secondary area of the arm supplied by it distally. (2)
common in females in females with aging due to hormonal changes there is a reduction in bone mass which result in osteoporotic fractures and also increase the frequency of the falls (3)
age 35-39 and 60-64 in young people mostly due to orientation of falls and the protective response to falls(fall from outstretched hand)and in old people it is mostly due to post menapausal changes resulting osteoporosis (3,4)
osteoporosis primary osteoporosis is mostly due to osteogenesis imperfecta where there is an increase in bone fragility due to collagen defect and secondaries due to endocrine abnormalities ,chronic diseases. (5)
history of fall traumatic colles fractures are commonly seen with a history of fallen outstretched hand (1)
References
  1. KIM DK, KIM MJ, KIM YS, OH CS, LEE SS, LIM SB, KI HC, SHIN DH. Long bone fractures identified in the Joseon Dynasty human skeletons of Korea Anat Cell Biol [online] 2013 Sep, 46(3):203-209 [viewed 15 October 2014] Available from: doi:10.5115/acb.2013.46.3.203
  2. STEPHENSON WH. Some Complications of Colles' Fracture and Their Treatment Postgrad Med J [online] 1951 Dec, 27(314):627-632 [viewed 15 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2530561
  3. O'NEILL TW, VARLOW J, SILMAN AJ, REEVE J, REID DM, TODD C, WOOLF AD. Age and sex influences on fall characteristics. Ann Rheum Dis [online] 1994 Nov, 53(11):773-775 [viewed 21 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005461
  4. OWEN RA, MELTON LJ 3RD, JOHNSON KA, ILSTRUP DM, RIGGS BL. Incidence of Colles' fracture in a North American community. Am J Public Health [online] 1982 Jun, 72(6):605-607 [viewed 21 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1650126
  5. BOYCE AM, GAFNI RI. Approach to the Child with Fractures J Clin Endocrinol Metab [online] 2011 Jul, 96(7):1943-1952 [viewed 22 October 2014] Available from: doi:10.1210/jc.2010-2546

Examination

Fact Explanation
radial shortening radial shortening is due to dorsal and proximal displacement of the distal fracture fragment(1)
silver folk deformity distal fragment of the radius is tilting backward where posterior and laterally displaced (2)
radial and ulnar styloid processes felt at same level on examination it is due to tearing the tip of the styloid process where normally the radial styloid is more diatal than ulnar(2)
broadening of the wrist due to tearing loose of radio ulnar ligaments there is instability in the wrist joint(2)
local swelling and redness in general examonation local swelling and pain is due to the sprain or the rupture of the internal lateral ligaments of the wrist.(3)
References
  1. KIM DK, KIM MJ, KIM YS, OH CS, LEE SS, LIM SB, KI HC, SHIN DH. Long bone fractures identified in the Joseon Dynasty human skeletons of Korea Anat Cell Biol [online] 2013 Sep, 46(3):203-209 [viewed 15 October 2014] Available from: doi:10.5115/acb.2013.46.3.203 (1)
  2. ELY LW. Orthopedics: Colles' Fracture Cal West Med [online] 1927 Nov, 27(5):674-675 [viewed 15 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1655637 (2,3,4)
  3. STEPHENSON WH. Some Complications of Colles' Fracture and Their Treatment Postgrad Med J [online] 1951 Dec, 27(314):627-632 [viewed 21 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2530561

Differential Diagnoses

Fact Explanation
smiths fracture both are wrist injuries but instead of dorsal displacement there is an anterior displacement and its confirmed by doing x ray AP and lateral (1)
fractured forearm-galeazzi its a fracture in the radius with a dislocation of radio-ulnar joint.it can be distinguish from colles fracture in an x ray invoved in wrist and elbow (2)
fractured hand most common is scaphoid fracture .it also occurs with fall on outstretched hand and mostly tenderness in anatomical snuffbox is characteristic (3)
dislocation of the wrist scapholunate dislocation is common because of carpal instability.in X ray PA view cortical ring sign. (3)
De Quervain’s tendinitis involved in extensor pollicis brevis also present with local swelling and pain where A positive Finkelstein’s test is pathognomonic .(3)
References
  1. ALEXANDER DI. Wrist Injuries Can Fam Physician [online] 1982 Jun:1169-1171 [viewed 15 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2306521
  2. THOMAS BP, SREEKANTH R. Distal radioulnar joint injuries Indian J Orthop [online] 2012, 46(5):493-504 [viewed 22 October 2014] Available from: doi:10.4103/0019-5413.101031
  3. VAN VUGT RM, BIJLSMA J, VAN VUGT AC. Chronic wrist pain: diagnosis and management. Development and use of a new algorithm Ann Rheum Dis [online] 1999 Nov, 58(11):665-674 [viewed 22 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1752796

Investigations - for Diagnosis

Fact Explanation
x ray lateral x ray shows the fracture lineproximal to radioulnar joint , proximally displaced distal fragment of the radius , and prominent callus overlying the fracture site and also other adjust fracture such in ulnar styloid and capal bones (1)
MRI its a reliable method of detecting the fracture when the standard x ray films are not dignostic and its also help to diagnose associated or in a doubt to differentiate scaphoid fractures where initial xrays are normal.(3)
Bone scan this is highly sensitive in first 24 hours to detect associated adjust fractures as well (2)
References
  1. KIM DK, KIM MJ, KIM YS, OH CS, LEE SS, LIM SB, KI HC, SHIN DH. Long bone fractures identified in the Joseon Dynasty human skeletons of Korea Anat Cell Biol [online] 2013 Sep, 46(3):203-209 [viewed 15 October 2014] Available from: doi:10.5115/acb.2013.46.3.203
  2. SCHUBERT HE. Scaphoid fracture. Review of diagnostic tests and treatment. Can Fam Physician [online] 2000 Sep:1825-1832 [viewed 23 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2145017
  3. PINCUS S, WEBER M, MEAKIN A, BREADMORE R, MITCHELL D, SPENCER L, ANDERSON N, CATTERSON P, FARISH S, CRUICKSHANK J. Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures West J Emerg Med [online] 2009 Nov, 10(4):227-232 [viewed 23 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791722

Investigations - Fitness for Management

Fact Explanation
full blood count Hb level is checked before giving general anaesthesia as a baseline investigation (1)
ECG to assess baseline cardiao respiratory reserve before anaesthesia (1)
fasting blood sugar to assess the diabetic control as base line investigation for surgery (1)
serum electrolytes assess the renal function (1)
References
  1. ARMSTRONG P, PAYNE M, BROCKWAY M. Anaesthesia and Colles' fractures. BMJ [online] 1990 Jan 27, 300(6719):261 [viewed 22 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1662084

Management - General Measures

Fact Explanation
2% lignocaine 5ml manipulation under anaesthesia is done by hematoma block where local infiltration of lidnocaine to dorsally in to hematoma. it also helps to reduce the pain(1)
conservative management with Closed reduction and cast immobilization minimally displaced and stable fractures or for people who considered too frail to undergo surgery colles pop cast is applied and it removes after 6 weeks (4)
monitor the distal circulation monitor the circulation by capillary refilling time ,pallor is important after the cast is applied which result in vascular compromise(4).
put ice pack to injured area pain and the inflammation is reduce using the ice pack.(3)
splinting splinting help as a immediate management as protection by take the weight off the joint(3)
bandaging Compression of the swollen area using bandage will help to reduce the swelling and control the spread into uninjured areas(3)
limb elevation it reduces the blood flow to the area and minimize the swelling (3)
Rehabilitation occupational therapy with active joint exercises to wrist elbow and shoulder edema prevention and joint strengthening.early mobilization is important to prevent joint stiffness. (2)
References
  1. WADSWORTH TG. Colles' fracture. BMJ [online] 1990 Jul 28, 301(6745):192-194 [viewed 15 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1663578
  2. CHRISTENSEN OM, KUNOV A, HANSEN FF, CHRISTIANSEN TC, KRASHENINNIKOFF M. Occupational therapy and Colles' fractures Int Orthop [online] 2001 Mar, 25(1):43-45 [viewed 21 October 2014] Available from: doi:10.1007/s002640000183
  3. BLACK WS, BECKER JA. Common forearm fractures in adults. Am Fam Physician [online] 2009 Nov 15, 80(10):1096-102 [viewed 22 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19904894
  4. BLAKENEY WG. Stabilization and treatment of Colles' fractures in elderly patients Clin Interv Aging [online] 2010:337-344 [viewed 15 October 2014] Available from: doi:10.2147/CIA.S10042

Management - Specific Treatments

Fact Explanation
intra-medullary K-wire fixation stabilize the distal radius and prevention of secondary displacement of distal radial fractures , k wires are inserted to intramedullary canal manually.(1)
internal fixation fixed angle locking screws bare applied to achieve anatomical reduction, and in establishing stable fixation to allow perfect reduction ,early range of motion and early rehabilitation compared to external fixation.but it creates more surgical trauma , increase the operation time and the risk of superficial wound infections.it is done using local intravenous infiltration of anesthesia mostly in elderly patient who failed to under go GA and more time consuming.(2,3,4)
External fixation for treating complex fractures of the distal radius where pins are insert in to distal fragment of radius or 2nd metacarpal bone.But it creates more post operative surgical complications and pin track infections (2,3)
References
  1. MOSTAFA MF. Treatment of distal radial fractures with antegrade intra-medullary Kirschner wires Strategies Trauma Limb Reconstr [online] 2013 Aug, 8(2):89-95 [viewed 15 October 2014] Available from: doi:10.1007/s11751-013-0161-z
  2. BLAKENEY WG. Stabilization and treatment of Colles' fractures in elderly patients Clin Interv Aging [online] 2010:337-344 [viewed 15 October 2014] Available from: doi:10.2147/CIA.S10042
  3. CUI Z, PAN J, YU B, ZHANG K, XIONG X. Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis Int Orthop [online] 2011 Sep, 35(9):1333-1341 [viewed 27 October 2014] Available from: doi:10.1007/s00264-011-1300-0
  4. LOCKEY A. Anaesthetic for Colles' fracture. J Accid Emerg Med [online] 1998 May, 15(3):207 [viewed 27 October 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1343074