Generality
The Colles fracture is the characteristic fracture of the distal end of the radius; radium is one of the two bones that make up the skeleton of the forearm and its distal end is the bone section closest to the hand, also involved in the important wrist joint.
X-ray of a Colles Fracture. From Wikipedia.org
At the origin of most cases of Colles fracture, there are falls forward with the arms and hands extended, as if to protect oneself from the impact with the ground or the floor.
The most important risk factors include advanced age, childhood age, osteoporosis, and vitamin D and / or calcium deficiencies.
The typical symptoms and signs of a Colles fracture consist of: pain, swelling and hematoma.
For an accurate diagnosis, the following are essential: physical examination, medical history and X-ray examination.
Treatment includes generic therapy and specific therapy. Specific therapy may be: conservative, if the fracture is not severe, or surgical, if the fracture is severe.
What is the Colles fracture?
Colles fracture is the term used by doctors to indicate all fractures of the distal end of the radius .
Together with the ulna, the radium constitutes the skeleton of the forearm ; its distal end (or distal epiphysis) is the bone portion closest to the hand and comprising the articular surface which, combined with the bones of the scaphoid and semilunar carpus, forms the so-called articulation of the wrist .
ORIGIN OF THE NAME
The Colles fracture is so named in honor of Abraham Colles, the Irish surgeon who, in 1814, described for the first time the aforementioned type of bone injury, without using the help of X-rays (not yet invented!).
The description of the Colles X-ray fracture came about thanks to Ernest Amory Codman.
SYNONYMS
In the medical-pathological field, the Colles fracture is also known by other names, including: fracture of the distal radius, transverse fracture of the wrist, fracture "at the back of a fork" and fracture "bayonet".
Causes
Falling forward with outstretched arms and hands, as if to protect oneself from the impact with the surface, is the main cause of Colles fracture.
Among the less common causes of Colles fracture, the continuous repetition of a gesture or a stressful movement with the wrist and forearm deserves a mention: in these situations, the Colles fracture is an abuse due to abuse (in English it is “ overuse ").
RISK FACTORS
If the traumatic circumstances arise, anyone can develop a Colles fracture.
However, statistics in hand are risk factors for Colles fracture:
- Advanced age . With old age, the bones of the human being tend to weaken and, for this reason, to be more prone to fractures.
- The age of childhood . The skeletal system of children is not as strong as that of adults. Therefore, young subjects are victims of bone fractures more easily.
- The presence of osteoporosis . Osteoporosis is a systemic disease of the skeleton, which causes a strong weakening of the bones. This bone weakening predisposes to the development of fractures.
- The practice of sports activities, such as skiing, ice skating, etc., during which it is common to fall accidentally.
- Inadequate intake of calcium and / or vitamin D. Calcium and vitamin D are essential for good skeletal health. The deficiency of one of these two leads to bone fragility and a tendency to break.
Colles fracture is particularly common among people suffering from osteoporosis. On the basis of some statistical surveys, in fact, in subjects with osteoporosis its occurrence would be second only to vertebral fractures.
TYPES
Pathology doctors classify Colles fracture episodes based on how and where the distal end of the radius is broken.
According to these parameters, there would be at least 4 types of Colles fracture :
- The open Colles fracture : all Colles fractures are open in which the distal end of the radius, once broken, protrudes from the skin due to the laceration of the latter.
- The comminuted Colles fracture : all Colles fractures are comminuted in which the distal end of the radius breaks in several different points. A synonym of comminute is multi-fragmented.
- The intra-articular Colles fracture : all the Colles fractures are intra-articular, where the distal end portion (articular surface) that interacts with the scaphoid and the lunate and forms the articulation of the wrist.
- The extra-articular Colles fracture: all Colles fractures are extra-articular in which the rupture of the distal end of the radius does not alter the normal anatomy of the wrist joint.
Symptoms, signs and complications
Colles fracture episodes cause a lot of pain, so much so that those who are victims of it cannot grasp or hold objects.
Other typical clinical manifestations of Colles fractures are: the swelling between the radio and the wrist and the presence of hematoma between the radio and the wrist.
COMPLICATIONS
Many years after a Colles fracture, patients may develop a nerve compression syndrome, known as carpal tunnel syndrome, or they may have difficulty moving their wrist.
Diagnosis
For an accurate diagnosis of Colles fracture, a physical examination, anamnesis and an X-ray examination of the painful upper limb are indispensable.
Therapy
The treatment of a Colles fracture includes a generic therapy, valid in any case, and a specific therapy .
Depending on the severity of the fracture, specific therapy may be conservative (or non-surgical) or surgical .
Once the bone has been welded, a cycle of physiotherapy is planned, to restore the strength and muscle elasticity of the muscles of the forearm and which govern the movements of the wrist joint.
GENERIC THERAPY
Among the therapeutic indications valid for all cases of Colles fracture, are: the rest of the upper limb with bone fracture, immobilization of the wrist joint, application of ice in the sore point, administration of paracetamol or ibuprofen (an NSAID) against pain and elevation of the painful upper limb, in order to reduce swelling or prevent it from getting worse.
CONSERVATIVE TREATMENT
Conservative treatment is indicated for all those cases in which the Colles fracture is not serious.
It consists of the application of a plaster between the hand and forearm, a plaster that the patient must hold until the fractured bone is welded.
If the fracture is slightly displaced - but still slight - it may be necessary to use the reduction procedure for manipulation . The reduction of fracture by manipulation serves to restore the original position of the fractured bone. This promotes the healing process.
SURGICAL TREATMENT
Surgical treatment is indicated for all those cases where the Colles fracture is severe.
The operation consists of an operation through which the operating surgeon system, in their original position, the fractured bone sections and applies, on the latter, a series of screws and pins.
The screws and pins serve to keep the fractured bone sections close to each other, thus promoting welding.
After the completion of the aforementioned surgical intervention, the application of a plaster to immobilize the fractured limb is foreseen between the hand and forearm.
HEALING TIMES
Complete recovery from a Colles fracture can take up to a year.
Patients must wear plaster for at least 6 weeks, after which they must pay close attention to the activities performed. In fact, all heavy manual activities are not recommended for at least 3-6 months, depending on the severity of the fracture.
Despite the successful healing, it is possible that the site of the fracture will still cause pain over time. Generally, this feeling is dull.
Prognosis
The prognosis in case of Colles fracture depends on the timeliness of the treatment and the severity of the fracture.
Timely treatment and non-severe fracture have a positive impact on prognosis; conversely, a late treatment and a severe fracture have a negative influence.
Prevention
Take the right amounts of calcium and vitamin D, perform physical exercise continuously so as to possess resistant bones and a strong muscular apparatus and wear all the protections provided during the activities in which it is possible to fall with hands and arms extended forward are the main countermeasures, indicated by doctors, to reduce the risk of the onset of a Colles fracture.
