Colle`s and smith`s fracture Injuries of the forearm

1. Injuries of the forearm
Colle`s and smith`s fracture

2. Normal wrist joint
• Fig : -

3. Normal wrist joint
• Fig : -

4. Colle’s fracture.
• describe by : - Abraham colle`s - 1814.
Definition : - it is not just fracture lower end of
radius but a fracture dislocation of the inferior
radioulnar joint .
• Occurs about 2.5 cm above the carpal extremity of
the radius .
Commonest age group- Elderly.( 60 yrs)
Women> Men.
MOA – fall in outstretched hand.
• Force required to cause this fracture is 192 kg in
women and 282 kg in men.

5. Colle’s fracture
• Fig : -

6. Colle’s fracture
• Fig : -

7. AP View
• Fig : - colle`s fracture

8. Clinical features.• Swelling.
• Pain.
• Dinner fork defomity, it is not found in all cases
but seen only if there is a dorsal tilt or rotation of
the distal fragment
ExaminationDistal neurovascular status.
External injuries.

9. Dinner fork defomity
• Fig :

10. dorsal displacement of the distal
fracture fragments.

11. Styloid process test :
• Normally , the radial styloid proces is lower by
1.3 cm when compaired to the ulnar styloid
process.
• In colle`s both radial and ulnar styloid
processes are at the same level and are found
in all displacements of colle`s fracture.
• This is more reliable sign than dinner fork
deformity

12. Distance between radial and styloid
processes
• Fig :

13. Colle’s fracture
• Fig : -

14. Frykmann`s classification :
Fracture line
1 .. Extra - articular
2. Intra – articular (involving RC
joint only )
Distal ulnar fracture
Absent
1
3
3 . Intra – articular (involving distal
RU joint only )
5
4 . Intra – articular (both RC +
inferior RU joints )
RC = radiocarpal
RU = radioulnar
7
present
2
4
6
8

15. Frykmann`s classification
• Fig :

16. Radiograpy :
X – ray of the wrist : • AP and lateral views and lower end of the
radius
Displacement in a colle`s fracture :
• Dorsal displacement
• Dorsal rotation
• Lateral displacement
• Lateral rotation
• Impaction
• supination

17. Treatment :
• Conservative methods
• Operative methods
CONSERVATIVE METHODS :
- closed reduction under general anaesthesia (GA),or
local anaesthesia (LA)
- If the level of the styloid processes are restored back
to normal , it indicates that the reduction has been
achieved satisfactorily.
- limb is immobilised by colle`s cast and a check
radiograph is taken
- Removed after 6 – 8 weeks
- physiotherapy

18. 6 immobilisation method :
• Below elbow cast (10 – 20 degree palmar
flexon , 15 – 20 degree ulnar deviation )
COLLE`S CAST
• ABOVE ELBOW CAST IN SUPINATION
• ABOVE ELBOW CAST IN PRONATION
. ABOVE ELBOW CAST IN MID- PRONATION
. COTTON LODER`S POSITION( WRIST FULLY
FLEXED)
. EXTERNAL FIXATORS

19. Colle`s cast
•
•
•
•
It is a below elbow cast in supination and ideally
it has to meet the following 4 criteria :Firm fit at the dorsum
Firm fit at the volar fracture apex
Just snuggly fitting at the forearm
Metacarpophalangeal joints should be free to
move

20. Colle`s cast

21. Acceptable limits of colle`s fracture:
• A dorsal tilt of less than 10 degrees
• A radial shorteing of less than 5 mm.
OPERATIVE METHODS :
INDICATION :
• Impaction
• Median nerve intrapment

22. Cont..
• Fig : -

23. Surgical methods :
1 . Closed reduction and percutaneous pinning
with k – wires
2 . Open reduction and plate fixation.

24. Complication
Early complication :
• Unstable reduction
• Medial or ulnar nerve
stretched
• Post reduction swelling
• Compartmental syndrome
• Anaesthesia problem
• Injury to proximal segment
of the bone during
reduction
Late complication :
• Malunion
• Rupture of extensor pollicis
tendon
• Frozen shoulder
• Carpel tunnel syndrome
• Nonunion
• Sudeck`s osteodystrophy

25. COLLE`S FRACTURE Why is it called fracture of 6…?
• Common at 60 years
• Force required to cause colle`s fracture are
multiples of 6
• 6 classical displacements
• 6 method of fracture immobilisation
• 6 important early and late complications
• 60 per cent cases have fracture ulnar styloid

26. Smith’s Fracture.
• Reverse of colle’s fracture.
• Wrist fracture in which the distal end of the radius
is displaced forwards.
Mechanism of injury :
• Fall on the back of the dorsum of the hand
• Fall on the forearm in supination
• Direct blow to the flexed hand

27. Colle`s and smith`s fracture
• Fig : -

28. Clinical features : •
•
•
•
•
Pain
Swelling
Deformity
Loss of wrist function
Deformity is opposite to that of colle`s
fracture and is called the garden shaped
deformity.
Radiography : • AP view of the wrist

29. Complication :
• Complication of colle`s
Treatment : • Closed reduction and immobilisation in a long
arm cast with forearm in supination and wrist
in extension.
Unstable fractures : • Fixation with k – wire or open reduction and
plate fixation.