Distal radius fracture by Dr Bipul Borthakur

1. DR. BIPUL BORTHAKUR
PROFESSOR, DEPT OF ORTHOPAEDICS, SMCH

3.  Colle’s fracture
 Smith fracture
 Barton’s fracture
 Chauffeur’s fracture

4.  Described by Abraham Colles in 1814
 It’s the fracture at the corticocancellous junction of
the distal radius, 2.5 cm proximal to the distal
articular surface of the radius, with typical
displacement
 Commonly seen in elderly female patients: post-
menopausal osteoporosis
 Mechanism of injury – fall on the outstretched hand
with wrist in extension

5.  Displacements in Colles’ fracture
 Shifts – Dorsal and lateral
 Tilts – Dorsal and lateral
 Impaction or proximal shift
 Supination
 Associated injuries:
 Ulnar styloid fracture
 Rupture of ulnar collateral ligament
 Rupture TFCC (triangular fibrocartilage complex)
 Rupture of the interosseous radio-ulnar ligament – DRUJ subluxation

6.  CLINICAL FEATURES:
 Pain, swelling and external deformity
– DINNER FORK DEFORMITY
 Limited ROM of wrist, tenderness
 Radial styloid rides upward to lie at
the same level or a little higher than
the ulnar styloid process

7.  INVESTIGATIONS: Plain radiograph
of forearm with elbow & wrist – AP and
lateral view
 Dorsal tilt is the characteristic displacement –
in lateral view
 Lateral tilt – in AP view
 Both can be diagnosed in x-ray – articular
surface faces dorsally or neutral in lateral view,
faces laterally or horizontal in AP view.

8.  TREATMENT:
 Undisplaced fracture – below elbow cast immobilization without any
manipulation
 With typical displacement – closed manipulation and below elbow slab or
cast immobilization for 4 to 6 weeks.
 Traction and counter-traction: disimpaction
 Correction of dorsal tilt – palmar flexion
 Correction of radial tilt – ulnar deviation

9.  TREATMENT:
 Final position of Colles’ cast
 Pronation of forearm
 Palmar flexion
 Ulnar deviation
 Take a check x-ray after Colles’ cast application to confirm the reduction
 Repeat x-rays at 7, 14 and 21 days (fracture becomes sticky) to see for
redisplacement.

10.  TREATMENT:
 Patient advised to keep the limb elevated
 Shoulder, elbow and finger joint movements have to be emphasized
 Remove the cast immediately if signs of compartment syndrome develops
 Fracture heals by 6 weeks, following which physiotherapy has to be started

11.  Reverse Colles’ fracture – ventral tilt and shift
 Fall on the outstretched hand with wrist in flexion
 Volar tilt / shift instead of dorsal tilt / shift
 More unstable than Colles’ fracture
 Garden-spade deformity

12.  Plain x-ray of wrist confirms the diagnosis
 Treatment – closed manipulation + B/E slab
or cast for 6weeks
 Traction – supination – extension of the wrist
 Surgical fixation if fracture displaces again –
volar locking plates

13.  High energy injury
 Intra-articular fracture of distal radius
 Either with volar or dorsal displacement
 Highly unstable fracture
 Demands restoration of articular congruity, alignment and length.

14.  Plain x-ray AP, lateral and oblique
views; CT scans are useful
 Usually operative treatment
 CR or OR with percutaneous K-wires
 OR with volar locking plates
 Distractor application in highly
comminuted fractures

15.  It is an intra-articular fracture of radial
styloid process.
 It results due to fall on outstretched
hand.
 It can be managed conservatively.

16.  Early:
 Nerve injury – median nerve compression
 Complex regional pain syndrome (CRPS) or Sudeck’s osteodystrophy
 Ulnar corner pain and instability
 Associated injuries of the carpus
 Redisplacement

17.  Late:
 Malunion – due to improper reduction, improper fixation and redisplacement
 Delayed union and non-union – rare unless infected or severe bone loss with instability
 Tendon rupture – EPL, FPL
 Carpal instability – due to ligament injury
 Secondary osteoarthritis – in intra-articular fractures