Colles' fracture

The fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with wrists flexed would lead to a Smith's fracture. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures.{{Cite journal |last1=Owen |first1=R A |last2=Melton |first2=L J |last3=Johnson |first3=K A |last4=Ilstrup |first4=D M |last5=Riggs |first5=B L |date=June 1982 |title=Incidence of Colles' fracture in a North American community. |url=http://dx.doi.org/10.2105/ajph.72.6.605 |journal=American Journal of Public Health |volume=72 |issue=6 |pages=605–607 |doi=10.2105/ajph.72.6.605 |pmid=7072880 |pmc=1650126 |issn=0090-0036}}

File:Poignet Gauche suite a fracture type Pouteau Colles.jpg

Diagnosis can be made upon interpretation of anteroposterior and lateral views alone.{{Cite book|title=Orthopedic imaging : a practical approach|last=Adam|first=Greenspan|others=Beltran, Javier (Professor of radiology)|isbn=978-1451191301|edition=Sixth|location=Philadelphia|oclc=876669045|year = 2015}}

The classic Colles fracture has the following characteristics:{{cite web|url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|title=Colles' fracture|last=GP Notebook|access-date=2009-02-21|url-status=live|archive-url=https://web.archive.org/web/20110613225247/http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|archive-date=2011-06-13}}

• Transverse fracture of the radius
• 2.5 cm (0.98 inches) proximal to the radio-carpal joint
• Dorsal displacement and dorsal angulation, together with radial tiltSolomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772

Other characteristics:{{Cite book|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=9780892035793|location=Rosemont, Ill.|oclc=706805938}}

• Radial shortening
• Loss of ulnar inclination
• Radial angulation of the wrist
• Comminution at the fracture site
• Associated fracture of the ulnar styloid process in more than 60% of cases.

The term Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”.Colles A 2006 On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 445:5-7. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm.{{cite web | last=Summers | first=Kevin | last2=Mabrouk | first2=Ahmed | last3=Fowles | first3=Sarah M. | title=Colles Fracture | publisher=StatPearls Publishing | date=31 July 2023 | pmid=31971712 | url=https://www.ncbi.nlm.nih.gov/books/NBK553071/ | access-date=21 June 2025 | url-status=live | archive-date=21 June 2025 | archive-url=https://web.archive.org/web/20250621130404/https://www.ncbi.nlm.nih.gov/books/NBK553071/}}{{cite book | last=S | first=Sagar | last2=Sharma | first2=Rohit | last3=Najjar | first3=Reabal | title=Radiopaedia.org | chapter=Bayonet deformity (wrist) | publisher=Radiopaedia.org | date=30 November 2015 | doi=10.53347/rid-41367 | doi-access=free | url=https://radiopaedia.org/articles/bayonet-deformity-wrist | url-status=live | archive-date=21 June 2025 | archive-url=https://web.archive.org/web/20250621130704/https://radiopaedia.org/articles/bayonet-deformity-wrist}}

Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications.{{cn|date=August 2021}}

Management depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. There is some evidence that immobilization with the wrist in dorsiflexion as opposed to palmarflexion results in less redisplacement and better functional status.{{cite web|url=http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|title=Adult Distal Radius Frx: Non Operative Treatment - Wheeless' Textbook of Orthopaedics|url-status=live|archive-url=https://web.archive.org/web/20110423051431/http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|archive-date=2011-04-23}} Significant angulation and deformity may require an open reduction and internal fixation or external fixation. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures, including Colles fracture.{{cn|date=October 2020}}

There are several established instability criteria:{{cn|date=August 2021}}

dorsal tilt >20°,

comminuted fracture,

abruption of the ulnar styloid process,

intraarticular displacement >1mm,

loss of radial height >2mm.

A higher amount of instability criteria increases the likelihood of operative treatment.

Treatment modalities differ in the elderly.{{cite journal|last=Blakeney|first=William|title=Stabilization and treatment of Colles' fractures in elderly patients|journal=Clinical Interventions in Aging|date=November 2010|pages=337–44|doi=10.2147/CIA.S10042|pmid=21228899|volume=5|pmc=3010169 |doi-access=free }}

Repeat Xrays are recommended at one, two, and six weeks to verify proper healing.

Recovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the person's age, gender, and medical history, and may range from two months to a year or more for complete recovery.

Colles fractures occur in all age groups, although certain patterns follow an age distribution.{{cn|date=October 2020}}

• In the elderly, because of the weaker cortex, the fracture is more often extra-articular.
• Younger individuals tend to require a higher energy force to cause the fracture and tend to have more complex intra-articular fractures. In children with open epiphyses, an equivalent fracture is the "epiphyseal slip", as can be seen in other joints, such as a slipped capital femoral epiphysis in the hip. This is a Salter I or II fracture with the deforming forces directed through the weaker epiphyseal plate.
• More common in women because of post-menopausal osteoporosis.

The Colles fracture is named after Abraham Colles (1773–1843), an Irish surgeon, from Kilkenny who first described it in 1814 by simply looking at the classic deformity before the advent of X-rays.{{WhoNamedIt|synd|2152}} Ernest Amory Codman was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.

{{Cite book

| publisher = Saunders

| isbn = 978-0-7216-8461-1

| last = Mallon

| first = Bill

| title = Ernest Amory Codman : the end result of a life in medicine

| location = Philadelphia

| year = 2000

}}

{{Cite journal

| doi = 10.1056/NEJM190009271431301

| issn = 0096-6762

| volume = 143

| issue = 13

| pages = 305–308

| last = CODMAN

| first = E. A.

| title = A Study of the X-Ray Plates of One Hundred and Forty Cases of Fracture of the Lower End of the Radius

| journal = The Boston Medical and Surgical Journal

| year = 1900

| s2cid = 57812302

}}

It is sometimes said that Claude Pouteau was the first to describe the Colles' fracture (which is sometimes called the Pouteau-Colles fracture), but, according to P. Liverneaux, it is not the case.P. Liverneaux, "Qu'a vraiment décrit Pouteau dans les fractures du poignet?" ("What wrist fracture did Pouteau actually describe?"), Chirurgie de la main, 2004, 23, 6, p. 298-304, [https://www.infona.pl/resource/bwmeta1.element.elsevier-8c2aa46a-c9bd-35c6-ad82-efd8ef97c632 abstract online in French], [https://pubmed.ncbi.nlm.nih.gov/15651245/ abstract online in English].

• Smith's fracture

{{reflist}}

• {{Chorus|00913}}
• [http://www.wheelessonline.com/ortho/colles_frx Colles Fracture] Wheeless' Textbook

{{Medical resources

| Synonyms =

| ICD10 = {{ICD10|S|52|5|s|50}}

| AO = 23-A2.2

| MeSH1 = 68003100

}}

{{Fractures}}

Category:Bone fractures

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