colles fracture

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Muhammad Abdurrahman

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  • Muhammad Abdurrahman

  • Colles Fracture is: The original description was for extraarticular fractures. Present usage of eponym includes both extraarticular and intraarticular distal radius fractures demonstrating various combinations of dorsal angulation (apex volar), dorsal displacement, radial shift, and radial shortening.Clinically, it has been described as a dinner fork deformity.

  • Intraarticular fractures are generally seen in the younger age group secondary to higher-energy forces; concomitant injuries (i.e., to nerve, carpus, and distal ulna) are more frequent, as is involvement of both the radiocarpal joint and the DRUJ

  • Smith fracture (reverse Colles fracture)This describes a fracture with volar angulation (apex dorsal) of the distal radius with a garden spade deformity or volar displacement of the hand and distal radius.The mechanism of injury is a fall onto a flexed wrist with the forearm fixed in supination.This is a notoriously unstable fracture pattern; it often requires open reduction and internal fixation because of difficulty in maintaining adequate closed reduction.

  • More than 90% of distal radius fractures are of this pattern.

  • The mechanism of injury is a fall onto a hyperextended, radially deviated wrist with the forearm in pronation.younger patients - high energyolder patients - low energy / falls

  • Frykman classification of distal radius fractures

  • Non SurgicalSurgical

  • Closed Reduction and Cast ImmobilizationIndicationExtra articular
  • TechniqueUnder anesthesiaHand is grasped and traction is applied in the length of boneDistal fragment is pushed into rightful place while manipulating wrist into flexion, ulnar deviation, and pronationApply short arm cast

  • Evaluation

  • Surgical fixation CRPPExternal FixationORIF

  • Indications:Radiographic findings indicating instability (pre-reduction radiographs best predictor of stability) displaced intra-articular fracturevolar or dorsal comminutionarticular margins fracturessevere osteoporosisdorsal angulation>5 or >20 of contralateral distal radius>5mm radial shorteningcomminuted and displaced extra-articular fracturesprogressive loss of volar tilt and loss of radial length following closed reduction and casting associated ulnar styloid fractures do not require fixation

  • TechniqueCRPP (Closed Reduction Percutaneous Pinning)Kapandji intrafocal techniqueRayhack technique witharthroscopically assisted reduction

  • External Fixationrelies onligamentotaxisto maintain reductionplace radial shaft pins under direct visualization to avoid injury to superficial radial nervenonspanning ex-fixcan be useful if large articular fragmentavoid overdistraction(carpal distraction < 5mm in neutral position) and excessive volar flexion and ulnar deviationlimit duration to8 weeks and perform aggressive OTto maintain digital ROM

  • ORIF (Open Reduction Internal Fixation)volar plating volar platingpreferred overdorsal platingvolar plating associated with irritation of both flexor and extensor tendors rupture of FPL is most common with volar platesassociated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendonsnew volar locking plates offer improved support to subchondral bonedorsal plating dorsal plating historically associated withextensor tendon irritation and rupturedorsal approach indicated for displaced intra-articular distal radius fracture with dorsal comminution other technical considerations can combine with external fixation and PCPbone graftingif complex and comminutedstudy showed improved results witharthroscopically assisted reductionvolar lunate facet fragments may require fragment specific fixation to prevent early post-operative failure

  • Terima kasihMatur NuwunArigatou Gozaimasu

  • MotionsBoney anatomySoft anatomyColles fracture site

  • Allows for flexion and extension to 0Patients more comfortableBetter functional testing

  • Short term goalsControl painReduce contracturesReduce inflammationLong term goalsEqual ROMEqual strengthAllow patient to be psychologically ready to return

  • Start with the fingersPROM AAROM AROMDIP, PIP, MCP flexion/extensionRadiocarpal PROM AAROM AROMFlexion, extension, supination, pronation, radial deviation, and ulnar deviation

  • Minimal painMinimal to no swellingROM almost equal to uninvolved (20% less than uninvolved)

  • Continue with ROM activitiesWrist stretchingJoint mobilizationsStart with grade I and IIGrade III and IVConcave/Convex rules

  • Start isometric strengthening of the fingers, wrist, elbow, and shoulderTheraputtyAgainst table/wallPain free

  • Theratubing/Therabar strengtheningTheratubing- Light to heavy resistanceFlexion, extension, ulnar deviation, and radial deviationNot just for the wristTherabarSupination and pronation

  • Full pain free range of motion equal to uninvolvedStrength close to the uninvolved side (80% of uninvolved)

  • Continue to perform wrist stretchesBegin more complex strengtheningFree weightWrist flexion/extension, radial/ulnar deviation, and supination/pronationElbow flexion/extension exercisesShoulder strengthening exercises

  • Work all three jointsD1 and D2 patternsPushup- on stable groundPushup- hands and BAPS boardSport specific activitiesDepend on sport and position in that sport

  • Pain freeEqual strength to uninvolvedEqual ROM to uninvolvedAthlete is confident they can return

  • Can begin right away in phase IDepends on sportFITT PrincipleFrequency- 3x per weekIntensity- minimum 60% THRType- treadmill, elliptical, bikeTime - 20 minutes minimum

  • Joint contracturesCarpal tunnel syndromeTendon irritationLoss of reduction

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