Colles fracture in short everything for viva
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Here is a complete viva-ready summary of Colles fracture, sourced from Rosen's Emergency Medicine, Tintinalli's, Pye's Surgical Handicraft, Pfenninger & Fowler, and Campbell's Operative Orthopaedics.
Colles Fracture - Complete Viva Notes
Definition
A transverse fracture of the distal radial metaphysis, within 2.5 cm of the articular surface, with:
- Dorsal displacement and angulation of the distal fragment
- Radial deviation / displacement
- Proximal impaction (radial shortening)
"The most common wrist fracture." - Pfenninger & Fowler's
Eponym & History
Named after Abraham Colles (1814) who described it before X-rays existed - purely a clinical description.
Mechanism
Fall on an outstretched hand (FOOSH) - the wrist is in extension/dorsiflexion at impact. Compression forces on the dorsal cortex produce dorsal comminution.
Epidemiology / Who Gets It?
- Most common in post-menopausal women (osteoporosis - considered a pathological fracture in osteoporotic bone)
- Bimodal: elderly women (low-energy falls) and young adults (high-energy trauma)
Classic Deformity: "Dinner Fork" / "Silver Fork"
The wrist profile from the lateral side resembles a dinner fork:
- Dorsal prominence of distal fragment
- Volar concavity proximally
- Associated prominent lower end of ulna (radial deviation)
X-ray Findings
PA (AP) view:
- Distal radial metaphyseal fracture with shortening
- Radial deviation of carpus
- Loss of radial inclination (normal ~22-23°)
- Fracture of ulnar styloid (present in ~60% of cases) - indicates disruption of the triangular fibrocartilage complex (TFCC)
- Possible intraarticular extension into radiocarpal or radioulnar joint
Lateral view:
- Dorsal angulation of distal radial articular surface (normally has 11-12° volar tilt - this is lost or reversed)
- Best view to assess degree of displacement
Associated Injuries
- Ulnar styloid fracture (60%) - from TFCC avulsion
- Median nerve injury (most common nerve, ~17%) - from contusion, traction, or swelling
- TFCC injury - source of long-term morbidity
- Scaphoid fracture (occasionally)
- Radioulnar joint disruption
Radiological Parameters - Memorize These
| Parameter | Normal | Acceptable post-reduction |
|---|---|---|
| Volar tilt (lateral) | +11 to +12° | 0° (neutral) minimum |
| Radial inclination (AP) | 22-23° | > 15° |
| Radial length | Radius longer than ulna | ≤ 5 mm shortening |
| Intraarticular step-off | 0 mm | < 2 mm |
Gartland & Werley Classification (1951) - For Viva
| Group | Type |
|---|---|
| Group 1 | Simple Colles fracture |
| Group 2 | Comminuted Colles, undisplaced intraarticular fragment |
| Group 3 | Comminuted Colles, displaced intraarticular fragment |
(From Campbell's Operative Orthopaedics 15th Ed)
Indicators of Instability (require surgical consideration)
- Dorsal angulation ≥ 20 degrees
- Radial shortening > 5 mm (≥1 cm)
- Intraarticular involvement
- Marked comminution
- Age > 60 with osteoporosis
- Dominant hand in high-demand patient
Management
Undisplaced / Stable fractures
- Double sugar-tong splint for 3-5 days → short-arm cast for 4-6 weeks
- Follow-up X-rays at 1, 2, and 6 weeks
Displaced fractures - Closed Reduction
Anesthesia options:
- Hematoma block - 22G needle inserted dorsally into fracture site, aspirate hematoma, inject 5-10 mL of 1-2% lidocaine. Easiest and effective.
- Bier block (IV regional anesthesia)
- Regional nerve blocks (median, radial, ulnar, brachial plexus)
- Procedural sedation (GA for complex/uncooperative)
Reduction technique:
- Apply traction (finger traps or manual) to disimpact the fragment
- Push distal fragment distally, volarly (anteriorly), and ulnarly
- Apply traction via thumb in line with forearm for ulnar deviation
- Minimal palmar flexion - extreme flexion is unnecessary and harmful (damages median nerve)
- Mold into dorsal plaster slab
Goal: Restore volar tilt (minimum neutral/0°), radial inclination, and radial length.
Post-reduction: Double sugar-tong splint (NOT circumferential cast for 24 hrs - edema risk). Orthopedic follow-up in 2-3 days.
Surgical (ORIF / percutaneous K-wires / external fixator)
Indications:
- Failed or unstable closed reduction
- Intraarticular fractures with >2 mm step-off
- Open fractures
- Neurovascular compromise
- Dominant hand in high-demand patient
Comparison with Related Fractures
| Feature | Colles | Smith's | Barton's |
|---|---|---|---|
| Displacement | Dorsal | Volar ("reverse Colles") | Volar articular fragment |
| Deformity | Dinner fork | Garden spade | - |
| Mechanism | FOOSH (extension) | Fall on flexed wrist | Fall on wrist |
| Articular | Usually extra-articular | Usually extra-articular | Intra-articular |
Complications
Early:
- Median nerve injury (most common nerve - carpal tunnel syndrome acutely)
- Vascular injury (rare)
- Tendon damage
Late (6-80% complication rate):
- Malunion (most common late complication) - "dinner fork" persists
- Carpal tunnel syndrome (delayed - most common late complication)
- Sudeck's atrophy / Complex Regional Pain Syndrome (CRPS / RSDS)
- Stiff, weak, painful wrist
- Rupture of extensor pollicis longus (EPL) tendon (at Lister's tubercle)
- Radioulnar joint instability
- Radiocarpal arthritis
- Shoulder-hand syndrome
Iatrogenic:
- Median nerve damage from splinting in extreme flexion
- Conversion to open fracture (thin skin over fracture)
Key memory: factors predicting disability = dorsal angulation ≥20° + radial shortening ≥5 mm
Pediatric Equivalent
In children, the equivalent is displacement of the lower radial epiphysis (Salter-Harris Type I/II physeal injury) - fragment displaces dorsally, similar mechanism. Only severe displacement needs reduction; 3 weeks in dorsal slab is sufficient.
Key Viva Points Summary
| Question | Answer |
|---|---|
| Definition | Transverse fracture distal radius within 2.5 cm of articular surface, dorsal displacement |
| Most common in | Post-menopausal osteoporotic women |
| Mechanism | FOOSH |
| Classic deformity | Dinner fork / Silver fork |
| Most common nerve injured | Median nerve |
| Most common associated fracture | Ulnar styloid (~60%) |
| Indicates TFCC injury | Ulnar styloid fracture |
| Anesthesia for reduction | Hematoma block (commonest), Bier block, regional |
| Position after reduction | Slight palmar flexion + ulnar deviation (NOT extreme flexion) |
| Immobilization | Dorsal slab → short arm cast 4-6 weeks |
| Unstable if... | Angulation >20°, shortening >5 mm, intraarticular, comminuted |
| Most common late complication | Malunion / CTS / CRPS |
| EPL rupture site | Lister's tubercle |
| Pediatric equivalent | Distal radial epiphysis displacement |
| Reverse Colles | Smith's fracture (volar angulation) |
| Classification | Gartland & Werley Groups 1-3 |
Sources: Rosen's Emergency Medicine; Tintinalli's Emergency Medicine; Pye's Surgical Handicraft 22nd Ed; Pfenninger & Fowler's Procedures for Primary Care; Campbell's Operative Orthopaedics 15th Ed (2026)
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