Musculoskeletal · Orthopedic Trauma
The facts most likely to be tested
A Colles fracture is a distal radius fracture caused by a fall on an outstretched hand (FOOSH).
The classic radiographic appearance is a dorsal displacement and dorsal angulation of the distal radial fragment.
Physical examination reveals the pathognomonic dinner fork deformity due to the posterior displacement of the distal fragment.
The most common associated injury is an ulnar styloid fracture.
Initial management for a non-displaced or minimally displaced fracture is closed reduction followed by sugar-tong splinting.
The most serious long-term complication is median nerve compression leading to acute carpal tunnel syndrome.
Elderly patients with low-energy trauma resulting in a Colles fracture require a DEXA scan to screen for osteoporosis.
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A 68-year-old female presents to the emergency department after tripping on a rug and landing on her right hand. She complains of severe wrist pain and swelling. Physical examination reveals a prominent dorsal angulation of the distal forearm, described as a dinner fork deformity. Neurovascular examination is intact, with no sensory deficits in the distribution of the median nerve. Radiographs confirm a distal radius fracture with dorsal displacement.
What is the most appropriate initial management for this patient?
Closed reduction and sugar-tong splinting
The patient presents with a classic Colles fracture; the initial management for a displaced distal radius fracture is closed reduction to restore alignment, followed by immobilization in a sugar-tong splint.
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Etiology / Epidemiology
Common in postmenopausal women and osteoporotic patients following a FOOSH injury.
Clinical Manifestations
Presents with the classic dinner fork deformity due to dorsal angulation of the distal radius.
Diagnosis
Radiography is the gold standard; look for dorsal displacement and radial shortening.
Treatment
Closed reduction followed by sugar-tong splinting is the first-line management.
Prognosis
Monitor for median nerve compression; acute carpal tunnel syndrome is a major risk.
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Epidemiology & Etiology
Most frequent in elderly women with decreased bone mineral density. Occurs via a fall on an outstretched hand (FOOSH) with the wrist in dorsal extension. High-energy trauma may cause this in younger patients.
Pertinent Anatomy
Involves the distal radius metaphysis. The fracture fragment is displaced dorsally and proximally, often associated with an ulnar styloid fracture.
Pathophysiology
The force of impact causes the distal radius to shear off and shift dorsally. This creates the characteristic dinner fork deformity. The radial inclination is typically lost due to the shortening of the radius.
Clinical Manifestations
Patients present with acute wrist pain, swelling, and the pathognomonic dinner fork deformity. Always assess for median nerve paresthesias or motor deficits. Check for compartment syndrome if pain is out of proportion to injury.
Diagnosis
Radiography (AP and lateral views) is the gold standard. Key findings include dorsal angulation, dorsal displacement, and radial shortening of the distal radius fragment.
Treatment
Initial management is closed reduction under hematoma block or sedation. Immobilize with a sugar-tong splint. Open reduction internal fixation (ORIF) is indicated for intra-articular involvement or significant comminution.
Prognosis
Most patients regain function, but malunion is common. Monitor for median nerve neuropathy and post-traumatic arthritis. Complex regional pain syndrome is a potential long-term sequela.
Differential Diagnosis
Smith fracture: volar angulation of the distal radius
Barton fracture: intra-articular fracture with subluxation
Chauffeur fracture: radial styloid fracture
Scaphoid fracture: snuffbox tenderness without deformity
Distal radioulnar joint dislocation: instability of the distal ulna