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Types
of fractures
Distal Radius
In 1814, Abraham Colles first described the classic silver fork
deformity of the wrist. A Colles fracture occurs when the dorsal
trabecular bone of the distal radius impacts into itself, resulting in
angulation and shortening. Patients present with pain, tenderness, and
swelling of the wrist. The mechanism of injury is usually a fall on an
outstretched hand.
Treatment and Prognosis
The severity of the fracture and need for reduction are assessed
radiographically. Ideally, on the anteroposterior view, shortening of the
radial styloid should be < 0.5 cm compared with the ulna. On the lateral
view, dorsal tilting of the distal radius articular surface should not go
beyond neutral. Patients with minimally displaced fractures or low
functional demands are treated with a short arm cast or splint. When a
fracture requires closed reduction, anesthesia is necessary. A local
lidocaine injection with hematoma aspiration may be sufficient, but
regional or IV general anesthesia is superior for relaxation and
analgesia. Fractures with severe shortening or intra-articular comminution
may require external fixation. In the operating room, pins are inserted
through the skin into the metacarpals and proximal radius or ulna. Next, a
metal external frame or plaster cast is applied to the pins to maintain
the fracture reduction.
The most frequent complication of distal radius fractures is finger and
shoulder stiffness. Thus, active motion of the fingers, elbow, and
shoulder should be strongly encouraged. Elevating the hand above the level
of the heart minimizes swelling. Cast immobilization is usually maintained
for 3 to 8 wk, depending on the fracture's stability. Patients can expect
pain to gradually diminish and wrist weakness to remain for 6 to 12 mo
after the injury. Physical therapy may help speed recovery. Most patients
eventually regain satisfactory pain-free function.
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analysis in hand. However, by calling
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