Colle’s fracture

 

Definition:

Fracture of the lower end of the radius within1-2 c.m from its lower articular surface associated with or without fracture of the ulner styloid process. Colle’s fracture is discovered by Abraham Colle’s on 1814.

 

 

 

 

Causes of colle’s fracture:

 

          It occurs due to direct or indirect trauma.

1.    Direct- By direct hit.

2.    Indirect-

a). Fall from height

b). Fall on outstreched hand.

c). Road Traffic Accident.

d). During play.

 

 

 

Clinical features of colle’s fracture:

 

A.    Symptoms:

1.    History of trauma.

2.    Pain.

3.    Swelling.

4.    Inability to move.

5.    Deformity.

6.    Abnormal shape.

7.    Painful restricted movement.

 

 

B.    Signs:

1.    Deformity.

2.    Dinner fork deformity.

3.    Dorsal angulation.

4.    Dorsal displacement.

5.    Radial deviation.

6.    Supination.

7.    Swelling on the wrist joint.

8.    Tenderness.

9.    Displacement may be palpable.

10.          Radial and ulner styloid process remain more or less in same level.

 

 

 

Management of colle’s fracture:

 

A.  Diagnosis and assessment:

1.    History of trauma taken.

2.    Skin injury skin intact, laceration.

3.    Medial and ulner nerve to be tested-

i). In case of median nerve injury-

Loss of sensation in index finger.

ii). In case of ulner nerve injury-

Loss of sensation in little finger.

4.    X-ray to confirm diagnosis-

It may be transverse with or without displacement.

 

 

B.   Medication:

a) Analgesic is to be given to reduce pain like-Inj. Diclofenac sodium.

b) Tab. Paracetamol may be given T.D.S after meal.

c) Antibiotic is to be given if there is any possibility of infection. Like cap- Cloxacillin 500 mg 1 cap 6 hourly.

 

 

C.    Specific treatment:

a) In case of deformity the choice of treatment is closed reduction and immobilization by colle’s plaster under G/A/

b) In case of undisplacement fracture. Only plaster cast or colle’s plaster should be given.

c) Check x- ray – If the x-ray is not acceptable position then second closed reduction should be tried under G/A as soon as swelling is subsided (usually within 7 days). If the swelling is not reduced measure to be taken to reduce oedema:

                              i) Elevate the limb POP cast.

                              ii) Active exercise of finger.

 

 

D.    Instruction to be given after plaster:

1.    Elevation of the limb for at least 24 hours.

2.    Active movement of the fingers.

3.    Do not wet the plaster.

4.    Report immediately if there is-

i) Any undue pain under plaster.

ii) Change of colour of skin, numbness, cold etc.

iii) Fever suggestive of infection.

5.    Skin at the edge of the plaster should be watched for development of pressure sore.

6.    To avoid any hard substances.

 

 

 

Complication o
f colle’s fracture:

 

1.    Stiffness of wrist and fingers.

2.    Malunion.

3.    Delayed union.

4.    Stiffness of shoulder joint.

5.    Osteoarthritis.

6.    Non-union of styloid process of ulna.

7.    Late rupture of the tendon.

8.    Sudeck’s atrophy.s.