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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Donald Fohrman
Donald W. Fohrman & Associates, Ltd.