Distal End Radius Fractures - Colles, Smiths & Bartons

ORTHOPEDICS
Definition, Mechanism, Clinal features, Diagnosis and treatment of Colles, Smiths and Bartons Fracture in Distal end Radius.

1. Colles ’ Fracture Smith’s Fracture Barton’s Fracture

2. Described by Abraham Colles in 1814. It is the most common of all fractures in elderly. Usually in older women. Fall on a out stretched hand .

3. Colles ’ Fracture It is a Transverse fracture of the distal end of the radius at its Cortico-Cancellous Junction with typical Dorsal Displacement of the distal fragment.

4. Distal end of the radius articulates with the carpal bones and the ulna Normally the articular surface of radius faces ventrally and medially . Tip of radial styloid is 1cm distal to the tip of the ulnar styloid. Relevant Anatomy

5. Mechanism of Action History of fall on an outstretched hand Force is applied in the length of the forearm with the wrist in extension Fracture occurs transversely at the cortico-cancellous junction.

6. The distal fragment collapses into- Dorsal Displacement Dorsal Tilt Lateral/Radial Displacement Lateral/ Radial Tilt Supination Impaction of Fragments Also associated with extension and shortening.

7. Associated injuries Fracture of styloid process of ulna Rupture of the Ulnar collateral ligament Rupture of the triangular Fibro-cartilage complex (TFCC) of ulna. Rupture of the interosseos , radio- ulnar ligament causing radio- ulnar subluxation .

8. Clinical Features Pain, tenderness, swelling and irregularity of the lower end of radius. “Dinner Fork Deformity” Radial styloid comes at the level of the ulnar styloid.

9. Dinner Fork Deformity

10. Radiological findings Transverse fracture of the distal end radius at cortico-cancellous junction. The distal fragment shows – Dorsal tilt & displacement – Lateral View Lateral tilt & Displacement – AP View Maybe associated with communition or broken ulnar styloid process.

11. Dinner Fork Deformity

12. Closed reduction and manipulation Under general or regional anesthesia. “Shaking Hand Position” Firm longitudinal traction to disimpact . Distal fragment into palmar flexion and Ulnar deviation.

13. Colles ’ Cast Colles ’ Cast is used to immobilize undisplaced or reduced fracture. It is below elbow cast with Palmar Flexion Ulnar Deviation a. b.

14. Complications

15. Smiths Fracture Reverse of Colles ’ Fracture Ventral tilt and displacement of the Distal fragment

16. Clinical features - “Garden Spade Deformity” X-Ray – Ventral tilt and displacement Treatment- Conservative - closed reduction and proper cast immobilization for 6 weeks. Surgical - K-wire or plate is used.

17. Barton’s Fracture Intra- Articular fracture of distal radius. Depending upon the type of displacement- Volar Barton’s (Anterior type) Dorsal Barton’s (Posterior type)

18. Extends from articular surface of the radius to either its anterior and posterior cortices. The small distal fragment is displaced along with the carpals. Treatment Closed Reduction and Plaster Cast Internal Fixation by Plate or K-wire

19. Apley’s System of Orthopaedics and Fractures – 9 th edition Essential Orthopaedics – Maheshwari & Mhaskar – 5 th edition