Colles' Fracture (Distal Radius)
Colles' fracture is the most common fracture in humans (>40 years), typically affecting osteoporotic women. It is a fracture of the distal radius (corticocancellous junction) with dorsal displacement.
[Image of Colles Fracture Deformity]1. The Deformity
The classic presentation is the "Dinner Fork Deformity". The fracture fragment displaces in a specific pattern:
- Dorsal displacement (Backward shift).
- Dorsal tilt (Backward angulation).
- Lateral displacement & tilt.
- Impaction (Shortening).
2. Mechanism of Injury
- FOOSH: Fall On Outstretched Hand with the wrist in Extension.
3. Management
- Conservative: Closed Manipulation and Colles' Cast (Below elbow, hand in Palmar flexion + Ulnar deviation).
- Cotton Loder position (extreme flexion/ulnar deviation) is avoided now due to Carpal Tunnel risk.
- Surgical: K-wire fixation or Volar Locking Plate (for unstable fractures).
4. Complications
Important:
1. Malunion: Very common (Deformity persists but function is often okay).
2. Sudeck's Atrophy (CRPS): Severe pain, swelling, and stiffness.
3. Rupture of EPL tendon: Extensor Pollicis Longus snaps due to attrition.
1. Malunion: Very common (Deformity persists but function is often okay).
2. Sudeck's Atrophy (CRPS): Severe pain, swelling, and stiffness.
3. Rupture of EPL tendon: Extensor Pollicis Longus snaps due to attrition.
25 Practice MCQs
Q1. Colles' fracture involves displacement of the distal fragment:
Answer: A). Dorsal tilt creates the dinner fork deformity.
Q2. The deformity associated with Colles' fracture is called:
Answer: B). Resembles an upside-down fork.
Q3. Mechanism of injury for Colles' fracture is:
Answer: A). Extension causes dorsal displacement.
Q4. Which tendon is prone to late rupture after Colles' fracture?
Answer: B). It rubs against the bony ridge (Lister's tubercle) and snaps.
Q5. Sudeck's Osteodystrophy is now known as:
Answer: A). A severe complication with pain out of proportion to injury.
Q6. The ideal position for casting a Colles' fracture is:
Answer: A). This reverses the mechanism of injury.
Q7. A "Cotton Loder" position (extreme flexion) increases the risk of:
Answer: B). It increases pressure in the carpal tunnel significantly.
Q8. Most common long-term complication of Colles' fracture is:
Answer: A). It rarely fails to join, but often joins in a deformed position.
Q9. The fracture occurs at the:
Answer: A). The weakest point in osteoporotic bone (~2cm from joint).
Q10. Which nerve is most commonly compressed in acute Colles' fracture?
Answer: A). Due to swelling or position of fragments.
Q11. "Shoulder-Hand Syndrome" is a variant of:
Answer: A). Stiffness in shoulder + Pain/Swelling in hand.
Q12. Normal radial tilt (volar tilt) is about 11 degrees. In Colles', it becomes:
Answer: A). The joint surface faces backwards.
Q13. Associated ulnar styloid fracture occurs in:
Answer: A). Often causes TFCC issues.
Q14. Active finger movements in the cast are encouraged to:
Answer: A). Prevents the "stiff hand" complication.
Q15. In elderly patients, the primary goal of treatment is:
Answer: A). Function > Anatomy in low-demand elderly.
Q16. External fixators are used for Colles' fracture when:
Answer: A). Ligamentotaxis pulls fragments into place.
Q17. What is "Radial Shortening"?
Answer: A). Leading to Ulnar Impaction Syndrome (ulna hits the carpus).
Q18. Percutaneous K-wiring usually pins the distal fragment to the:
Answer: A). E.g., Kapandji technique.
Q19. Rupture of EPL is treated by:
Answer: A). The frayed tendon ends are too poor for direct repair.
Q20. Which movement is most restricted after malunion?
Answer: A). Because of the dorsal tilt deformity.
Q21. A "Die-Punch" fracture involves:
Answer: A). An intra-articular vertical load injury.
Q22. The cast is usually removed after:
Answer: B). When clinical union is present.
Q23. Contrast baths are used in physiotherapy for:
Answer: A). Alternating hot and cold water improves circulation.
Q24. Vitamin C (500mg) is sometimes prescribed to prevent:
Answer: A). Some evidence suggests it reduces risk.
Q25. Chauffeur's fracture involves:
Answer: A). Intra-articular avulsion of the radial styloid.
No comments:
Post a Comment