Colles’ fracture Power Point

1. Forearm Case #4

2. History and Physical 52yo female presents to ED after slipping and falling forward on outstretched hand. Pt had obvious deformity to dorsal right wrist, but no obvious laceration. Pt states she fell on her extended hand as she was trying to break her fall. She denies any other injuries, no LOC. T 98.8 P 88 BP 156/78 O2 99% Gen- in obvious pain but NAD MSK obvious deformity to dorsal wrist, TTP dorsal wrist. 1+ radial pulse RUE, ROM limited 2/2 pain in right wrist. No laceration Neuro- 5/5 motor in all extremities except right wrist, which is limited by pain. Sensory nl throughout except for slight paresthesia over thenar eminence.

3. Radiographs

4. Diagnosis: Colles ’ Fx Distal Radius Fracture, with dorsal displacement/angulation of distal fragment. Referred to as “Dinner Fork Deformity”

5. Pain control Emergent Ortho consultation for all open fx or if radius unable to be reduced Prompt reduction necessary for: Intra-articular step-off >1 mm Radial inclination <15 degrees Volar tilt less than neutral (0 degrees) Shortening or loss of radial length greater than 2 mm as compared with the opposite side Urgent ortho consultation for the following, b/c los of reduction is frequent c omplicated fractures with significant displacement (more than 20 degrees of dorsal angulation ), marked dorsal comminution , intra-articular extension Sugar-tong splint if indicated (d/c with prompt ortho f/u) ED Managment

6. Most common wrist fracture Usually caused by FOOSH with extended wrist, often in seen in elderly Complications of improper reduction include arthritis of wrist joint Neurovascular exam important, for median nerve injury possible Pearls

7. More Images

8. http://rcpilibrary.blogspot.com/2010/12/winter-weather-and-colles-fracture.html http://www.radiologyassistant.nl/en/476a23436683b http://www.worldortho.com/dev/index.php?option=com_content&task=view&id=1116&Itemid=430 http://www.wheelessonline.com/ortho/colles_frx Rosen’s emergency medicine : concepts and clinical practice / editor-in-chief, John A. Marx ; senior editors , Robert S. Hockberger , Ron M. Walls ; editors, James G. Adams ... [et al.].—7th ed. References