Colles Fracture - Late Complications

- extensor pollicis longus rupture:
- RSD
- often RSD following colles fractures will result from over distraction of an external fixator;
- in the presentation by D Stoffelen and PL Broos (15 th Annual Meeting of the Orthopaedic Trauma Association 1999), the authors found
use of calcitonin to be helpful in treating this disorder;
- vitamin C: Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?
- loss of reduction and secondary deformity;
- median nerve compression;
- Predictors of Acute Carpal Tunnel Syndrome Associated With Fracture of the Distal Radius
- malunion:
- distal radioulnar joint injury;
- extension of Colles frx into the RU joint has a worse prognosis;
- in stable extra-articular fractures, there will often be frx extension into the DRUJ, which is the most likely source of symptoms;
- patients may note:
- weak grip;
- localized pain;
- loss of supination;

Colles Fracture - Radiographic Findings

- x-ray appearance is that of a dorsally angulated fracture of distal radial metaphysis (2-3 cm proximal to wrist joint),
w/ or w/o associated frx of ulnar styloid;
- initial frx line is almost always on volar side & is single line;

Colles Fracture - Associated Injuries

- ulnar styloid frx
- TFCC tear
- according to the report by Richards et al 1997 et, TFCC tears occurred in 53% of extra-articular distal radius fractures vs 35% of intra-articular fractures;
- scapholunate dissociation:
- Intercarpal Ligament Injuries Associated with Fractures of the Distal Part of the Radius

Colles Fracture- Frykman Classification

Fracture Distal Ulnar Fracture:
Absent Present
Extra articular I II
Intra articular involving radiocarpal joint III IV
Intra articular involving distal RU joint V VI
Intra articular involving both radiocarpal & VI VIII
distal radioulnar joints

- Discussion:
- Frykman classification considers involvement of radiocarpal & RU joint,
in addition to presnce or absence of frx of ulnar styloid process;
- classification does not include extent or direction of initial displacement,
dorsal comminution, or shortening of the distal fragment;
- hence, it is less useful in evaluating outcome of treatment

Incidence of Colles' fracture in a North American community.( A generalised example )

In a 30-year period, 1,137 adult residents of Rochester, Minnesota experienced 1235 Colles' fractures. Fracture incidence among women increased over sixfold between ages 35-39 and 60-64 and then leveled off. Male rates were lower in every age group and did not rise as dramatically. Fractures associated with moderate trauma were responsible for the increased incidence with age and the excess among women. Overall, Rochester rates were 30 per cent or more greater than those reported from communities in other countries

Colles Fracture (Dinner fork deformity)

This frx was described by Abraham Colles in 1814, originally described as low energy extra articular frx of distal radius occuring in elderly individuals;
- frx is typically dorsally displaced and angulated;
- mechanism:
- fracture is also caused by a forced dorsiflexion of the wrist;
- occurs in pts > 50 years of age who fall on out stretched hand;
- dorsal surface undergoes compression while volar surface undergoes tension;

Japan's swine flu cases top 2,000: health ministry

TOKYO (AFP) — Japan's tally of swine flu cases topped 2,000 on Wednesday but no deaths or serious conditions have been reported among them, the health ministry said.

The number of A(H1N1) virus infections in Japan reached 2,033 by midday but most of them have already been cured, the ministry added.

The total has increased daily by around 100 cases in the past few days, the ministry said, adding that the infections have been reported in all but one of the country's 47 prefectures.

Japan's first cases, in a Japanese teacher and two students who had returned from a study trip to North America, were reported on May 9. The number had reached 1,000 by June 25.