Let’s take a close look at a Colles’ Fracture

Have you ever experienced a broken wrist following a fall on an outstretched arm giving rise to a swollen wrist which is so painful? This type of a fracture is called a Colles’ fracture, named after Abraham Colles, who wrote papers on it in 1814, interestingly even before X-rays were discovered.

“Colles’ wrist fracture occurs when the distal end of the radius bone in your forearm breaks. Radius is the larger of the two bones of the forearm in which the distal part primarily supports in forming the wrist joint.  Therefore it’s also commonly known as a distal radius fracture or wrist fracture. However, it is important to remember not all fractures of the wrist are Colles fractures” explains Dr Yohan Mendis Abeysekera, Consultant Orthopedic surgeon, (MBBS(Sjp) MD-Orth(Col) MRCS(Eng) FEBOT). 

In order to name a fracture as Colles’ there should be a specific fracture pattern in the X-rays, eg ; a distal radius break happens when the bone breaks about 1 inch from the wrist on the thumb side where the broken piece of bone points upwards.

Colles’ fracture is almost always the results of a fall on outstretched hand following an accidental trip or fall following loss of balance. In such occasions your natural instincts may place your hands on the floor to prevent damaging your head. Such trivial force may break the distal part of the radius closer to your wrist and commonly seen in older people with weaker brittle bones and in children whose bones are soft.

Dinner fork deformity
Colles’ fracture causes immediate pain, tenderness, bruising with swelling and in a typical presentation, the wrist will have an abnormal bend, classically known as a “dinner fork” or “Bayonet” deformity. 

Risk factors
In Osteoporosis even a mild trauma like a fall from a standing position can break the wrist. This is the reason these fractures are commoner in post-menopausal females who are more prone for osteoporosis. 

“Additionally, conditions which can make you more likely to fall eg: have low muscle mass or poor muscle strength, or lack agility and have poor balance invariably will increase the risk of a Colles’ fracture. A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough” highlights Dr. Abeysekera.

Diagnosis
Colles’s fracture is usually diagnosed clinically and confirmed with X-rays. In certain complex fractures even a CT may need prior to the decision of operative management.

Management
According to doctor, the most important treatment initially is immobilizing the wrist in a splint. Simply a hard board/magazine can be wrapped around your wrist to support it. An ice pack at the injured site and holding the fare arm in a sling around the neck could certainly prevent further swelling and Analgesics like Paracetamol/ Brufen can help pain relief until medical advice is sought.

“Simple undisplaced fractures are managed with a lightweight cast or more comfortable splint. If the fracture is displaced it is necessary to manipulate the fracture under anesthesia or sedation in order to correct the deformity. Usually, the cast is taken off after 4-6 weeks with reassuring fracture healing evident in X-rays”

“In a severely displaced or comminuted fracture a simple manipulation and a cast may not be adequate enough for a reduction or even if reduced it may not be possible to successfully maintain the reduced position without any surgical intervention”

Physiotherapy will be of great use
Whatever the treatment, success of the outcome depends on subsequent physiotherapy to achieve the wrist function. It is important to start regular exercises to help rebuild strength in your wrist and regain your normal range of motion when you are safe to do so. 

Complications
“It will take a year or more to achieve the complete healing of the fracture. One should be able to do light activities about a month or two after your cast is removed. Usually, more intense activities can be started in about 3 to 6 months. This again depends on the severity and the type of treatment received. Wrist will probably feel stiff for about a month or two after the cast is off and a dull ache or stiffness can be present for about two years. Rarely Some may develop nerve compressions around the wrist (Carpel tunnel Syndrome) or spontaneous Tendon ruptures as complications”

Prevention
Adequate nutrition with enough calcium intake and regular exercises will help to strengthen your bones and muscles, which makes you less likely to fall and fracture a bone. Also if you get a wrist fracture with a simple trauma, this could be the first red light of your poor bone quality! Check on that and start treatment to prevent a more severe fracture in the future.