The Colles fracture is a radius fracture, also known as a broken spoke. Many people reflexively try to catch a fall with an outstretched hand. In the worst case, the spoke breaks on the wrist. A distal radius fracture occurs, which is also the most common type of fracture in human bones.
What is a Colles fracture?
The Colles fracture is a broken spoke on the wrist. This distal radius fracture is also known as an extension fracture and occurs at the typical fracture point (loco typico) on the wrist if the person concerned has previously tried unsuccessfully to catch a fall with an outstretched hand. The Colles fracture is the most common type of fracture in human bones. This fracture was named after the Irish surgeon Abraham Colles (1773-1843).
The Colles fracture is a forearm fracture that affects the spoke near the wrist. If this is broken, there is a distal radius fracture. Children and the elderly are often affected. Children often neglect the necessary caution when playing and suffer various fall injuries. In many cases, a fall occurs on the forearm, which is caught by the flat of the hand and, in the worst case, causes a broken spoke on the wrist.
In children, this extension fracture often occurs as a so-called greenwood fracture. In this case, the bone is broken, but the periosteum is still intact. The elderly are prone to falls due to a variety of causes. This increased risk of falling can be due to age-related reduced bone stability, osteoporosis or cardiac arrhythmias.
A broken radius can affect everyone regardless of age and occurs depending on the situation. In rare cases, the Colles fracture occurs in connection with a joint dislocation of the wrist. If these two symptoms come together, there is a Galeazzi fracture.
Symptoms, ailments & signs
The noticeable clinical symptom of Colles’ fracture is hand misalignment, in which the wrist is tilted downward. The patient is only able to move his wrist to a limited extent with great pain. This can also be accompanied by impaired sensitivity of the hand and fingers.
Depending on the strength of the impact on the outstretched hand, injuries to the skin and muscles from protruding bones are also possible. The type of radius fracture is referred to as a first to third degree open fracture, depending on the injury to the soft tissues. If the spoke is broken, but the bones are still in the correct position, the Colles fracture only causes tenderness and swelling.
Diagnosis & course
The Colles fracture can be reliably determined by an X-ray. The affected wrist is recorded in two planes from the side and from above. With this imaging procedure, the doctor safely differentiates the Colles fracture from the Smith fracture and similar fractures. The doctor also examines the visible external injuries on the affected wrist.
He determines the extent of the skin damage and clarifies whether nerves or vessels are possibly damaged. An examination of the adjacent joints shows whether there is a dislocation (dislocation). Last but not least, a detailed description of the course of the accident by the patient is helpful. In order to determine the appropriate therapy, the doctor clarifies whether the fracture is stable or unstable.
If the break is stable, the surrounding ligaments are not injured. In Germany, the AO classification (Working Group for Osteosynthesis), which distinguishes between three different types of fractures A, B and C, is helpful in making a diagnosis. Type A has an extra-articular fracture that does not extend into the wrist. In a partially intra-articular fracture (type B), the wrist is partially affected.
The stylus extension (processus styloideus radii) located on the radius bone may be broken. The articular cliffs on the side of the back of the hand are seldom fractured dorsally or on the side of the palm of the hand. The type C distal radius fracture affects the entire wrist. The resulting fracture gap is T- or Y-shaped. The healing process depends on the extent of the fracture.
With professional therapy and subsequent physiotherapy, the wrist function is fully restored. After four to six weeks, the affected wrist is functional again so that simple activities can be carried out. A complicated radius fracture can take half a year to heal completely.
In most cases, the Colles fracture is caused by a fracture on impact and therefore leads to severe pain and restrictions in the patient’s everyday life. The patient’s wrist is permanently only tilted downwards, and great pain occurs when moving. There can also be other disorders of the hand that affect the sensitivity.
After the fall, swelling usually forms. The affected area is also very sensitive to pressure and, due to the permanent pain, can also lead to sleep disorders and concentration problems. Whether or not the treatment has to be surgically depends on the extent of the Colles fracture. In many cases, the treatment can be done without surgery, with the wrist and arm immobilized.
The doctor can also move the bone pieces back to their original shape. In some cases, fixation with screws and metal plates is necessary. There are usually no further complications. After healing, the arm can be used normally again and there is no consequential damage.
When should you go to the doctor?
A broken forearm must always be treated by a doctor. If you notice a painful misalignment of your hand after a fall, it is best to go to the nearest hospital immediately. If there are sensory disorders or even symptoms of paralysis, there is a medical emergency – in this case you should call the emergency services immediately.
External injuries to the skin and muscles should also be treated quickly. In the event of an open break, rescue service help is required. The Colles fracture must then be clarified and treated in the hospital, with either surgical or conservative treatment being possible.
In the event of later complications, a visit to the doctor is recommended. For example, anyone who feels severe pain after the treatment should have this clarified immediately. After an operation, attention should be paid to possible bleeding and inflammation. Should these complications arise, a new hospital stay may be necessary. Normally, however, a Colles fracture heals relatively symptom-free. A physiotherapist can support medical therapy and thus contribute to a quick recovery.
Treatment & Therapy
The misalignment of the wrist is corrected by returning the bone ends to their original position with a reduction. The Colles fracture can be removed by either conservative or surgical reduction. If the patient only has a simple fracture of the radius, the wrist is not affected.
In this case, the non-operative reduction is sufficient. The so-called girl catcher is used here. The patient’s forearm is hung on the thumb, middle and index finger under [[Anesthesia9] and a weight is attached to the upper arm. The doctor then returns the broken spoke to its original position by applying pressure to the ends of the bones.
Once the joint position has been correctly restored, anatomically and axially, a plaster cast immobilizes the affected arm. This conservative therapy is also used for greenwood fractures when the bone is broken but the periosteum is still intact. This therapy is particularly suitable for children, as the bone mantle is still quite soft at this age and injuries are rare.
If there is an unstable radius fracture, surgical intervention is necessary because it is to be expected that the bones will shift again after the reduction. A plaster cast is not enough in this case, which is the case with almost all radius fractures with joint involvement. The pieces of bone are returned to their original position under local anesthesia. The subsequent stabilization takes place through wire fixation, screw osteosynthesis or metal plate implantation.
The break is fixed with wires, screws or metal plates. The plaster cast is removed after four weeks and the wires, screws and metal plates are removed two weeks later. With the external fixator, the fracture is immobilized from the outside by a scaffold and metal pins inserted in the metacarpal bone are stabilized from the outside. After another four weeks, the frame and the metal pins are removed again.
Outlook & forecast
The prognosis of the Colles fracture depends on the severity of the existing fracture. The more difficult and complex the fracture, the less favorable the prospect of healing.
Young people with a simple fracture have a good prognosis. The Colles fracture heals well, taking into account the medical guidelines and avoiding intense stresses on the skeletal system. A lifelong freedom from symptoms is definitely given in these patients. The healing process of the Colles fracture is individual and can take several months. Even after years, some people report various complaints such as sensitivity to the weather, although they can go about their everyday life largely symptom-free.
A complicated Colles fracture can have lifelong impairments. Mobility restrictions, reduced physical performance or functional disorders of the joints occur more frequently in these patients. Fixations and surgical interventions can be used to make corrections that lead to an improved prospect of healing.
In severe cases, artificial joints must be used so that the symptoms can be alleviated. There can also be sequelae. In addition to chronic joint problems, impairment of muscle fibers, tendons or nerve tracts are possible. If the physical complaints mean that professional or sporting activities can no longer be carried out, this can lead to a mental disorder. This makes the healing path much more difficult.
Since a Colles fracture is the direct result of falling on the palm of the hand, which can occur in any everyday situation, prevention is not possible. Older people should be determined to see if they have osteoporosis, which increases the risk of falling.
The Colles fracture requires longer follow-up care, which can last anywhere from a few days to six weeks. After an operation, the doctor must be seen every week. The sutures of the skin are removed after 12 to 14 days. The joint must be spared for between one and six weeks, depending on the severity of the fracture. The operating physician will determine the duration of the immobilization by taking into account the stability of the bones.
During the follow-up, the prognosis can be adjusted based on regular x-ray controls. Shortly after the procedure, the wound must be fixed with a forearm plaster splint. The finger joints and the thumb can be moved freely with such a splint without affecting the healing of the fracture. After removing the threads, it may be possible to switch to a removable splint for the wrist.
The cast must be changed two to three times a week for the first two weeks. In the course of the follow-up care, further X-ray examinations are carried out, which are used to determine the load-bearing capacity of the joint. Physiotherapeutic measures are available to accompany the protection. In addition, regular hand baths are carried out, through which the swelling of the Colles fracture is supported.
You can do that yourself
In everyday life, the person concerned can make sure that his movement sequences are adapted to the current possibilities. The aim should be to prevent further symptoms from occurring. Excessive stress on healthy parts of the body should be avoided. Muscle discomfort or misalignment could result, causing further pain or damage to the skeletal system.
In the case of a Colles fracture, it is advisable to generally spare the affected region. Not only the hand but also the forearm should be kept steady. Movements of the entire arm should not take place jerkily but evenly. Avoid vibrations and physical exertion.
Exercise in particular should be minimized for the healing time or restructured so that the hand is not involved. In order to still be able to cope with everyday life well, it is helpful if the support of a stable social environment is available and can be used. Work should be redistributed and carried out slowly.
In addition, it is beneficial for the healing process if the immune system is sufficiently strengthened. A balanced diet rich in vitamins has a positive influence on the symptoms subsiding as quickly as possible. In order to improve one’s own well-being, activities should take place that bring joy of life even without using the hand. This has a beneficial effect on emotional health.