Muhammad Abdurrahman

Colles

Fracture is:

The original description was for

extraarticular fractures. Present usage of
eponym includes both extraarticular and
intraarticular distal radius fractures
demonstrating various combinations of
dorsal angulation (apex volar), dorsal
displacement, radial shift, and radial
shortening.
Clinically, it has been described as a
dinner fork deformity.

 Intraarticular

fractures are generally

seen in the younger age group
secondary to higher-energy forces;
concomitant injuries (i.e., to nerve,
carpus, and distal ulna) are more
frequent, as is involvement of both
the radiocarpal joint and the DRUJ

Smith fracture (reverse Colles fracture)

This describes a fracture with volar angulation
(apex dorsal) of the distal radius with a garden
spade deformity or volar displacement of the
hand and distal radius.
The mechanism of injury is a fall onto a flexed
wrist with the forearm fixed in supination.
This is a notoriously unstable fracture pattern; it
often requires open reduction and internal fixation
because of difficulty in maintaining adequate
closed reduction.

More than 90% of distal radius fractures

are of this pattern.

The mechanism of
injury is a fall onto a
hyperextended,
radially deviated
wrist with the
forearm in pronation.
younger patients high energy
older patients - low
energy / falls

Frykman
classification of
distal radius
fractures

Non Surgical
Surgical

Closed Reduction and Cast Immobilization

Indication

Extra articular
<5 mm radial shortening
dorsal angulation<5 or within20 of
contralateral distal radius

Technique
Under anesthesia
Hand is grasped and
traction is applied in
the length of bone
Distal fragment is
pushed into rightful
place while
manipulating wrist
into flexion, ulnar
deviation, and
pronation
Apply short arm cast

Evaluation

 Surgical

fixation

CRPP
External Fixation
ORIF

Indications:
Radiographic findings indicating instability (prereduction radiographs best predictor of
stability) displaced intra-articular fracture

volar or dorsal comminution

articular margins fractures
severe osteoporosis
dorsal angulation>5 or >20 of contralateral distal
radius
>5mm radial shortening
comminuted and displaced extra-articular fractures
progressive loss of volar tilt and loss of radial length
following closed reduction and casting
associated ulnar styloid fractures do not require
fixation

Technique
CRPP (Closed Reduction Percutaneous Pinning)
Kapandji intrafocal technique
Rayhack technique witharthroscopically assisted
reduction

 External Fixation
relies onligamentotaxisto
maintain reduction
place radial shaft pins under direct
visualization to avoid injury to
superficial radial nerve
nonspanning ex-fixcan be useful
if large articular fragment
avoid overdistraction(carpal
distraction < 5mm in neutral
position) and excessive volar
flexion and ulnar deviation
limit duration to8 weeks and
perform aggressive OTto maintain
digital ROM

 ORIF (Open Reduction Internal Fixation)

volar plating

volar platingpreferred overdorsal plating

volar plating associated with irritation of both flexor and extensor
tendors
rupture of FPL is most common with volar plates
associated with plate placement distal to watershed area, the most
volar margin of the radius closest to the flexor tendons
new volar locking plates offer improved support to subchondral bone

dorsal plating
dorsal plating historically associated withextensor tendon irritation
and rupture
dorsal approach indicated for displaced intra-articular distal radius
fracture with dorsal comminution

other technical considerations

can combine with external fixation and PCP

bone graftingif complex and comminuted
study showed improved results witharthroscopically assisted
reduction
volar lunate facet fragments may require fragment specific fixation to
prevent early post-operative failure

Terima kasih
Matur Nuwun
Arigatou Gozaimasu

Motions
Boney anatomy
Soft anatomy
Colles fracture site

Allows for flexion and extension to 0

Patients more comfortable
Better functional testing

Short term goals

Control pain
Reduce contractures
Reduce inflammation

Long term goals

Equal ROM
Equal strength
Allow patient to be psychologically ready to
return

Start with the fingers

PROM AAROM AROM
DIP, PIP, MCP flexion/extension

Radiocarpal
PROM AAROM AROM
Flexion, extension, supination, pronation, radial
deviation, and ulnar deviation

Minimal pain
Minimal to no swelling
ROM almost equal to uninvolved (20% less
than uninvolved)

Continue with ROM activities

Wrist stretching
Joint mobilizations

Start with grade I and II

Grade III and IV

Concave/Convex rules

Start isometric strengthening of the fingers,

wrist, elbow, and shoulder
Theraputty
Against table/wall

Pain free

Theratubing/Therabar strengthening
Theratubing- Light to heavy resistance
Flexion, extension, ulnar deviation, and radial
deviation
Not just for the wrist

Therabar
Supination and pronation

Full pain free range of motion equal to

uninvolved
Strength close to the uninvolved side (80%
of uninvolved)

Continue to perform wrist stretches

Begin more complex strengthening

Free weight
Wrist flexion/extension, radial/ulnar deviation, and
supination/pronation
Elbow flexion/extension exercises
Shoulder strengthening exercises

Work all three joints

D1 and D2 patterns
Pushup- on stable ground
Pushup- hands and BAPS board

Sport specific activities

Depend on sport and position in that sport

Pain free
Equal strength to uninvolved
Equal ROM to uninvolved
Athlete is confident they can return

Can begin right away in phase I

Depends on sport
FITT Principle

Frequency- 3x per week

Intensity- minimum 60% THR
Type- treadmill, elliptical, bike
Time - 20 minutes minimum

Joint contractures
Carpal tunnel syndrome
Tendon irritation
Loss of reduction