Model Answer
0 min readIntroduction
Colles' fracture, a distal radius fracture, is one of the most common fractures encountered in clinical practice, particularly among older women with osteoporosis. It typically results from a fall onto an outstretched hand (FOOSH) with the wrist in extension and ulnar deviation. The fracture pattern is characterized by dorsal displacement and comminution of the distal radius. Prompt and appropriate management is crucial to restore wrist function and prevent long-term complications. This answer will detail the clinical presentation, diagnosis, and management of a Colles' fracture in a 60-year-old female presenting after a fall.
Understanding Colles' Fracture
Colles' fracture is an incomplete fracture of the distal radius with dorsal displacement of the distal fragment. It’s extra-articular, meaning it doesn’t involve the joint surface directly, but can disrupt the joint congruity. The mechanism of injury, as described in the question, is a fall on an outstretched hand (FOOSH) with the wrist extended and ulnar deviated. This forces the impact onto the radius, leading to the characteristic fracture pattern.
Clinical Presentation
A 60-year-old lady presenting after a fall on an outstretched hand exhibiting the following signs and symptoms are highly suggestive of a Colles’ fracture:
- Pain: Immediate and intense pain at the wrist, exacerbated by movement.
- Swelling: Rapidly developing swelling around the wrist and dorsal forearm.
- Deformity: A characteristic “dinner fork” deformity – dorsal angulation and swelling giving the wrist the appearance of a bent fork.
- Tenderness: Point tenderness over the distal radius.
- Neurological Assessment: Assess for median and ulnar nerve compromise, although this is less common in isolated Colles’ fractures.
Diagnosis
Diagnosis is confirmed with radiographic imaging:
- X-ray: Anteroposterior (AP) and lateral views of the wrist are essential. The lateral view will demonstrate the dorsal angulation and displacement of the distal fragment.
- CT Scan: May be considered in complex fractures or when assessing intra-articular extension.
Management
Management depends on fracture stability, displacement, patient age, and comorbidities. Options include:
Conservative Management
- Closed Reduction: If the fracture is displaced, closed reduction under anesthesia or hematoma block is attempted to realign the fragments.
- Immobilization: Following reduction, the wrist is immobilized in a sugar-tong splint or cast for 6-8 weeks. Regular follow-up X-rays are needed to monitor alignment.
- Pain Management: Analgesics are used to control pain.
- Physiotherapy: After cast removal, physiotherapy is crucial to regain wrist range of motion and strength.
Surgical Management
Surgical intervention is indicated in:
- Unstable fractures
- Significantly displaced fractures that cannot be adequately reduced
- Open fractures
- Associated ligament injuries
- Failed closed reduction
Surgical Options:
- Volarly Plated Distal Radius Fracture Fixation: This is the gold standard. A volar plate is applied to the distal radius through a small incision, providing stable fixation.
- External Fixation: Used for highly comminuted fractures or when soft tissue conditions are unfavorable for internal fixation.
- K-wire Fixation: Can be used for minimally displaced fractures or as an adjunct to volar plating.
Potential Complications
Complications of Colles’ fracture include:
- Malunion: Incorrect healing of the fracture, leading to deformity and functional impairment.
- Non-union: Failure of the fracture to heal.
- Stiffness: Loss of wrist range of motion.
- Carpal Tunnel Syndrome: Compression of the median nerve due to swelling and fracture fragments.
- Radiocarpal Arthritis: Development of arthritis in the wrist joint over time.
- Complex Regional Pain Syndrome (CRPS): A chronic pain condition.
Conclusion
Colles’ fracture is a common injury requiring prompt diagnosis and appropriate management. While conservative treatment can be effective for stable, minimally displaced fractures, surgical intervention is often necessary for unstable or significantly displaced fractures to restore optimal wrist function and prevent long-term complications. Careful post-operative rehabilitation is essential to maximize recovery and minimize the risk of stiffness and chronic pain. Ongoing research focuses on improving fixation techniques and rehabilitation protocols to enhance outcomes for patients with Colles’ fractures.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.