COLLE’S FRACTURE

Definition:
• Fracture at the distal end of the radius at it’s cortico-cancellous junction
about 2 cm from the distal articular surface.
Risk Factors:
• Above 40 years of age
• Postmenopausal osteoporosis
• Falling on an out stretched hand
Anatomy:
 Radio-ulnar joint
 Radio-carpal joint
 The tip of the radial styloid is 1 cm distal to
the tip of the ulnar styloid
Pathoanatomy:
 The fracture line travels transversely at the cortico cancellous junctions.
 In some cases one or more displacements may occur.
Displacement:
 Impaction of fragments
 Dorsal displacement
 Dorsal tilt
 Lateral displacement
 Lateral tilt
 Supination
Injuries associated with Colle’s fracture:

 Fracture of ulnar styloid process

 Rupture of ulnar collateral ligament
 Rupture of triangular cartilage of ulna
 Interosseous radio-ulnar ligament rupture causing radio-ulnar subluxation
Diagnosis:
 Patient presents with pain ,swelling and deformity of the
Wrist along with irregularity of the lower end of radius.
 DINNER FORK DEFORMITY
 The radial styloid process would lie at the same level or a
Little higher than the ulnar styloid process.
Radiological features:
 The dorsal tilt is the most characteristic displacement.
 The distal articular surface of the radius normally faces ventrally and after fracture faces dorsally
While examining a lateral X ray view of the wrist.
 Similarly a lateral tilt can be detected in the antero-posterior view.
Treatment:
 Usually conservative
 For undisplaced fracture immobilization in below elbow plaster cast for six weeks.
 For displaced fracture manipulative reduction with Colle’s cast.
Technique of closed manipulation:
 Muscles of forearm are relaxed by anaesthesia.
 To disimpact the fragments longitudinal traction
to the hand against the counter traction on the arm
above the flexed elbow.
 The distal fragment is pressed into palmer flexion and ulnar
deviation using the thumb of his other hand while the patient’s
hand is drawn into pronation.
 A plaster cast is applied below the elbow extending to the
Metacarpal heads.
 X ray is taken every week for the first 3 weeks to detect
re-displacement.
 Removed after 6 week with joint and muscle excercises.
 Fractures transfixed percutaneously using two K wires incorporated into the plaster
 Ligamentoraxis
 LCP (Locking Compression plate)
Complications:
1.Stiffness of joints
Commonest complication with shoulder,elbow,wrist joints are affected.
Prevented by actively mving joints.
2.Malunion:
Redisplacement within the plaster.Corrected by osteotomy.
3.Subluxation of inferior radio-ulnar joint:
Shortening of radius. Ulnar head becomes prominent. Wrist movement becomes painful.
Excision of lower end of ulna. (Darrach’s excision)
4.Carpal tunnel syndrome: Compression of the median nerve. Treatment is decompression.
5.Sudeck’s osteodystrophy:
Pain,stiffness,swelling with overlying skin stretched and glossy. Treatment is physiotherapy.
6.Rupture of extensor pollicis longus tendon: Rare complication which occurs due to loss of
blood supply to the tendon or due to friction. Tendon transfer.