Injuries of the forearm

Colle`s and smith`s fracture

Normal wrist joint

• Fig : -

Normal wrist joint

• Fig : -

Colle’s fracture.• describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of

radius but a fracture dislocation of the inferior radioulnar joint .

• Occurs about 2.5 cm above the carpal extremity of the radius .

Commonest age group- Elderly.( 60 yrs) Women> Men. MOA – fall in outstretched hand.• Force required to cause this fracture is 192 kg in

women and 282 kg in men.

Colle’s fracture

• Fig : -

Colle’s fracture

• Fig : -

AP View

• Fig : - colle`s fracture

Clinical features.-• Swelling.• Pain.• Dinner fork defomity, it is not found in all cases

but seen only if there is a dorsal tilt or rotation of the distal fragment

Examination-Distal neurovascular status.External injuries.

Dinner fork defomity

• Fig :

dorsal displacement of the distal fracture fragments.

Styloid process test :

• Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process.

• In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture.

• This is more reliable sign than dinner fork deformity

Distance between radial and styloid processes

• Fig :

Colle’s fracture

• Fig : -

Frykmann`s classification :

Fracture line Distal ulnar fracture

Absent present 1 .. Extra - articular 1 2

2. Intra – articular (involving RC joint only )

3 4

3 . Intra – articular (involving distal RU joint only )

5 6

4 . Intra – articular (both RC + inferior RU joints )

7 8

RC = radiocarpalRU = radioulnar

Frykmann`s classificationFrykmann`s classification • Fig :

Radiograpy : X – ray of the wrist : - • AP and lateral views and lower end of the

radius Displacement in a colle`s fracture : • Dorsal displacement• Dorsal rotation• Lateral displacement• Lateral rotation• Impaction • supination

Treatment :• Conservative methods • Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or

local anaesthesia (LA) - If the level of the styloid processes are restored back

to normal , it indicates that the reduction has been achieved satisfactorily.

- limb is immobilised by colle`s cast and a check radiograph is taken

- Removed after 6 – 8 weeks - physiotherapy

6 immobilisation method :

• Below elbow cast (10 – 20 degree palmar flexon , 15 – 20 degree ulnar deviation ) COLLE`S CAST

• ABOVE ELBOW CAST IN SUPINATION • ABOVE ELBOW CAST IN PRONATION. ABOVE ELBOW CAST IN MID- PRONATION

. COTTON LODER`S POSITION( WRIST FULLY FLEXED)

. EXTERNAL FIXATORS

Colle`s cast It is a below elbow cast in supination and ideally

it has to meet the following 4 criteria :- • Firm fit at the dorsum • Firm fit at the volar fracture apex• Just snuggly fitting at the forearm• Metacarpophalangeal joints should be free to

move

Colle`s cast

Acceptable limits of colle`s fracture:

• A dorsal tilt of less than 10 degrees• A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION :• Impaction• Median nerve intrapment

Cont..

• Fig : -

Surgical methods :

1 . Closed reduction and percutaneous pinning with k – wires

2 . Open reduction and plate fixation.

Complication

Early complication :• Unstable reduction• Medial or ulnar nerve

stretched• Post reduction swelling• Compartmental syndrome• Anaesthesia problem• Injury to proximal segment

of the bone during reduction

Late complication :• Malunion • Rupture of extensor pollicis

tendon• Frozen shoulder• Carpel tunnel syndrome • Nonunion • Sudeck`s osteodystrophy

COLLE`S FRACTURE -

Why is it called fracture of 6…?• Common at 60 years• Force required to cause colle`s fracture are

multiples of 6• 6 classical displacements• 6 method of fracture immobilisation • 6 important early and late complications• 60 per cent cases have fracture ulnar styloid

Smith’s Fracture.• Reverse of colle’s fracture.• Wrist fracture in which the distal end of the radius

is displaced forwards. Mechanism of injury :• Fall on the back of the dorsum of the hand• Fall on the forearm in supination • Direct blow to the flexed hand

Colle`s and smith`s fracture

• Fig : -

Clinical features : -

• Pain • Swelling • Deformity • Loss of wrist function• Deformity is opposite to that of colle`s

fracture and is called the garden shaped deformity.

Radiography : -• AP view of the wrist

Complication :

• Complication of colle`s Treatment : -• Closed reduction and immobilisation in a long

arm cast with forearm in supination and wrist in extension.

Unstable fractures : -• Fixation with k – wire or open reduction and

plate fixation.