Colle`s and smith`s fracture

Colle`s and smith`s fracture
Injuries of the forearm

1. Injuries of the forearm
Colle`s and smith`s fracture

2. Normal wrist joint
•Fig : -

3. Normal wrist joint
•Fig : -

4. 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.

5. Colle’s fracture
•Fig : -

6. Colle’s fracture
•Fig : -

7. AP View
•Fig : - colle`s fracture

8. 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.

9. Dinner fork defomity
•Fig :

10. dorsal displacement of the distal
fracture fragments.

11. 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

12. Distance between radial and styloid
processes
•Fig :

13. Colle’s fracture
•Fig : -

14. 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 = radiocarpal
RU = radioulnar

15. Frykmann`s classificationFrykmann`s classification
•Fig :

16. 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

17. 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

18. 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

19. 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

20. Colle`s cast

21. 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

22. Cont..
•Fig : -

23. Surgical methods :
1 . Closed reduction and percutaneous pinning
with k – wires
2 . Open reduction and plate fixation.

24. 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

25. 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

26. 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

27. Colle`s and smith`s fracture
•Fig : -

28. 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

29. 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.