Colle’s fracture

Definition – A Colle’s fracture is a fracture of the radius within 2.5 cms of the wrist with or without avulsion of the ulnar styloid process and with a characteristic deformity. The lower fragment is usually tilted backwards, shifted backwards with a tilt radially. Colle’s fracture is the commonest of all fractures.

Mechanism
Elderly women are more often involved due to osteoporosis. It usually occurs from a fall on the outstretched and dorsiflexed hand and the momentum of the body imposes a supination force which breaks the lower end of the radius transversally.

Displacements

1. Rotational Displacements – Occur on two axis:
   1. On longitudinal axis, the distal fragment rotates outwards.
   2. The distal fragment also rotates on a transverse axis.
2. Linear Displacement – The whole lower fragment is displaced–
   1. Backwards.
   2. Upwards.
   3. Laterally.

In total, the altered contour of, the wrist due to displaced distal fragment looks like a ‘Dinner-fork deformity.

Clinical Features

1. Seen mainly in middle-aged and elderly women.
2. Osteoporosis is a frequent contributing factor.
3. Patient usually presents with a deformed and swollen wrist with gross displacement of the lower fragment.
4. Patient often presents with typical ‘Dinner-fork deformity.’

On Examination

1. Tenderness first proximal to the wrist; may feel the deformity on careful palpation.
2. Normally the tip of the radial styloid process is situated 1 cm distal to the tip of the ulnar styloid process, but after Colle’s fracture, the tips may be at the same level or even the ulnar one may be lower.
3. Wrist movements are limited and painful.

X-ray identifies the fracture in a majority of cases.

Treatment

1. Reduction – In 3 stages :
   1. Disimpaction.
   2. Palmar flexion.
   3. Ulnar deviation.
2. Immobilisation.

Reference: A Handbook of Surgery by Dr Mansi Sharma