Makindo Medical Notes

💥 A Colles’ fracture is a fracture of the distal radius with dorsal displacement, classically following a fall on an outstretched hand (FOOSH). 👉 Common in elderly patients, particularly those with osteoporosis.

🩺 Clinical Features

• Deformity: Classic “dinner-fork” appearance with dorsal wrist swelling.
• Pain & Tenderness: Over distal radius, worsens with wrist movement.
• Neurological Assessment: Check:
  • Median nerve: Thenar function, sensation over palmar thumb/index.
  • Radial nerve: Wrist extension, sensation over dorsal web space.
  • Ulnar nerve: Finger abduction/adduction, sensation over little finger border.
• Vascular Assessment: Check radial & ulnar pulses, capillary refill, and hand perfusion.

🩻 X-Ray Findings

• Fracture: Distal radius with dorsal displacement/angulation.
• Impaction: On AP, radial styloid should be ~1 cm distal to ulnar styloid.
• Angulation: On lateral, normal joint line tips forward by ~5°. If tilted backwards >10°, manipulation is indicated.

🛠️ Management

• Analgesia: Ensure adequate pain relief.
• Immobilisation:
  • Apply a wrist splint or below-elbow backslab.
  • Broad arm sling for comfort.
• Referral: Stable fractures can be referred to the Virtual Fracture Clinic (VFC).

✋ Indications for Manipulation

1. Displacement of the ulnar styloid.
2. Impaction: radial styloid < 1 cm distal to ulnar styloid.
3. Angulation: dorsal tilt >10° (i.e., >15° from normal volar tilt).
4. Distal neurological deficit on exam.

Colles’ fractures are manipulated to preserve wrist function. If patient is unfit for GA, manipulation can be done under procedural sedation in ED. All requiring manipulation must be referred to on-call orthopaedics.

⚠️ Complications

• Malunion → persistent deformity & functional loss.
• Median nerve compression (carpal tunnel syndrome).
• Ulnar styloid fracture non-union.
• Stiffness and complex regional pain syndrome (CRPS).