What is a Colles fracture?

Colles Fracture: Definition and Clinical Significance

A Colles fracture is a specific type of distal radius fracture characterized by dorsal displacement, dorsal angulation, and impaction of the distal fragment, typically resulting from a fall onto an outstretched hand. 1

Anatomical Characteristics

• Colles fracture presents with the classic "dinner-fork deformity" due to the dorsal displacement and angulation of the distal radius fragment 2
• The fracture occurs approximately 2-3 cm proximal to the radiocarpal joint in the metaphyseal region of the distal radius 1, 3
• The volar cortex fails due to tensile stresses while the dorsal cortex exhibits compression and comminution 3

Mechanism of Injury

• Most commonly results from a fall onto a dorsiflexed and pronated hand 2
• The force is transmitted through the wrist to the distal radius, causing the characteristic fracture pattern 1, 3
• Different from other distal radius fracture patterns such as Smith's fracture (volar angulation) or Barton's fracture (intra-articular) 1

Epidemiology

• Distal radius fractures are among the most common fractures, accounting for approximately 18% of fractures in the elderly population 4
• Shows a bimodal distribution with higher incidence in younger (<18 years) and older (>65 years) populations 4
• More common in patients with osteoporosis, particularly postmenopausal women 4

Clinical Presentation

• Visible deformity of the wrist with the characteristic "dinner-fork" appearance 2
• Pain, swelling, and tenderness over the distal radius 5
• Limited range of motion of the wrist 5
• May be associated with ulnar styloid fractures or other carpal injuries 1

Diagnosis

• Radiographic evaluation is the primary diagnostic tool 5
• Standard views include posteroanterior and lateral projections of the wrist 5
• Radiographic findings include:
  • Dorsal angulation of the distal fragment
  • Radial shortening
  • Loss of radial inclination
  • Possible comminution of the dorsal cortex 1, 3

Treatment Options

• Treatment goals focus on restoring anatomical alignment and function 5
• For non-displaced or minimally displaced fractures, conservative treatment with cast immobilization is appropriate 2
• For displaced fractures, closed reduction followed by cast immobilization is often performed 1
• Surgical intervention is indicated for:
  • Unstable fractures
  • Intra-articular involvement
  • Significant displacement or angulation
  • Comminuted fractures 2
• Surgical options include:
  • External fixation (particularly non-bridge type for extra-articular fractures)
  • Internal fixation with volar locking plates (recommended for comminuted fractures) 2

Rehabilitation

• Early mobilization of uninvolved joints (shoulder, elbow, fingers) is essential during the healing period 2
• Progressive wrist rehabilitation after immobilization to restore range of motion and strength 5
• Attention to potential complications such as stiffness, complex regional pain syndrome, and malunion 5

Historical Context

• First described by Abraham Colles in 1814, before the advent of radiography 1, 6
• The term "Pouteau-Colles fracture" is sometimes used, though Pouteau described various forearm fractures rather than this specific pattern 6

Clinical Significance

• Colles fractures in middle-aged and older adults may serve as a sentinel indicator of osteoporosis 3
• Patients with a Colles fracture have approximately a 2-fold increased risk of subsequent fractures 4
• Proper management is crucial to prevent long-term functional impairment and maintain quality of life 5