colle`s and smith`s fracture
DESCRIPTION
Colle`s and smith`s fracture Injuries of the forearmTRANSCRIPT
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Injuries of the forearm
Colle`s and smith`s fracture
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Normal wrist joint
• Fig : -
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Normal wrist joint
• Fig : -
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Colle’s fracture.• describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of
radius but a fracture dislocation of the inferior radioulnar joint .
• Occurs about 2.5 cm above the carpal extremity of the radius .
Commonest age group- Elderly.( 60 yrs) Women> Men. MOA – fall in outstretched hand.• Force required to cause this fracture is 192 kg in
women and 282 kg in men.
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Colle’s fracture
• Fig : -
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Clinical features.-• Swelling.• Pain.• Dinner fork defomity, it is not found in all cases
but seen only if there is a dorsal tilt or rotation of the distal fragment
Examination-Distal neurovascular status.External injuries.
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Dinner fork defomity
• Fig :
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dorsal displacement of the distal fracture fragments.
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Styloid process test :
• Normally , the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process.
• In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture.
• This is more reliable sign than dinner fork deformity
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Distance between radial and styloid processes
• Fig :
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Colle’s fracture
• Fig : -
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Frykmann`s classification :
Fracture line Distal ulnar fracture
Absent present 1 .. Extra - articular 1 2
2. Intra – articular (involving RC joint only )
3 4
3 . Intra – articular (involving distal RU joint only )
5 6
4 . Intra – articular (both RC + inferior RU joints )
7 8
RC = radiocarpalRU = radioulnar
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Frykmann`s classificationFrykmann`s classification • Fig :
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Radiograpy : X – ray of the wrist : - • AP and lateral views and lower end of the
radius Displacement in a colle`s fracture : • Dorsal displacement• Dorsal rotation• Lateral displacement• Lateral rotation• Impaction • supination
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Treatment :• Conservative methods • Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or
local anaesthesia (LA) - If the level of the styloid processes are restored back
to normal , it indicates that the reduction has been achieved satisfactorily.
- limb is immobilised by colle`s cast and a check radiograph is taken
- Removed after 6 – 8 weeks - physiotherapy
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6 immobilisation method :
• Below elbow cast (10 – 20 degree palmar flexon , 15 – 20 degree ulnar deviation ) COLLE`S CAST
• ABOVE ELBOW CAST IN SUPINATION • ABOVE ELBOW CAST IN PRONATION. ABOVE ELBOW CAST IN MID- PRONATION
. COTTON LODER`S POSITION( WRIST FULLY FLEXED)
. EXTERNAL FIXATORS
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Colle`s cast It is a below elbow cast in supination and ideally
it has to meet the following 4 criteria :- • Firm fit at the dorsum • Firm fit at the volar fracture apex• Just snuggly fitting at the forearm• Metacarpophalangeal joints should be free to
move
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Colle`s cast
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Acceptable limits of colle`s fracture:
• A dorsal tilt of less than 10 degrees• A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION :• Impaction• Median nerve intrapment
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Cont..
• Fig : -
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Surgical methods :
1 . Closed reduction and percutaneous pinning with k – wires
2 . Open reduction and plate fixation.
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Complication
Early complication :• Unstable reduction• Medial or ulnar nerve
stretched• Post reduction swelling• Compartmental syndrome• Anaesthesia problem• Injury to proximal segment
of the bone during reduction
Late complication :• Malunion • Rupture of extensor pollicis
tendon• Frozen shoulder• Carpel tunnel syndrome • Nonunion • Sudeck`s osteodystrophy
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COLLE`S FRACTURE -
Why is it called fracture of 6…?• Common at 60 years• Force required to cause colle`s fracture are
multiples of 6• 6 classical displacements• 6 method of fracture immobilisation • 6 important early and late complications• 60 per cent cases have fracture ulnar styloid
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Smith’s Fracture.• Reverse of colle’s fracture.• Wrist fracture in which the distal end of the radius
is displaced forwards. Mechanism of injury :• Fall on the back of the dorsum of the hand• Fall on the forearm in supination • Direct blow to the flexed hand
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Colle`s and smith`s fracture
• Fig : -
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Clinical features : -
• Pain • Swelling • Deformity • Loss of wrist function• Deformity is opposite to that of colle`s
fracture and is called the garden shaped deformity.
Radiography : -• AP view of the wrist
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Complication :
• Complication of colle`s Treatment : -• Closed reduction and immobilisation in a long
arm cast with forearm in supination and wrist in extension.
Unstable fractures : -• Fixation with k – wire or open reduction and
plate fixation.