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Colles’ wrist fracture

Definition

Colles' fracture is a break across the end of the main bone of the forearm (the radius). A Colles' fracture causes the wrist to become extended and shortened.

Alternative Names

Transverse wrist fracture; Dinner-fork deformity of the wrist

Considerations

Wrist fractures are common among children and the elderly.

• Children's bones are soft and tend to get buckle (torus) fractures. These are incomplete fractures on one side of the bone.
• Because bones become brittle with age, a complete fracture is more likely in adults and among the elderly. This is called a Colles' fracture.

Fractures that are not severe may be placed in a splint and sling, or a lightweight, fiberglass cast.

If the bone is no longer straight because of the fracture, it must be reduced (straightened).

• The health care provider may be able to use local anesthesia and reduce the fracture.
• In other cases, surgery may be needed. The break may need to be fixed with a plate and screws, pins, or other metal or plastic hardware.

Older people with Colles' fractures often fail to regain full mobility of the wrist joint. Carpal tunnel syndrome may occur as an early or late complication of the injury. Chronic pain may result from injury to the ligaments or the joint surface of the wrist.

Causes

This injury usually occurs when a person attempts to break a fall by throwing the hands and arms out in front of them. The hands meet the ground with the body weight behind them. The radius and ulna (the bones in the forearm) may buckle or break just above the wrist.

This injury is more likely to happen during sports such as rollerblading, skateboarding, running, or any other activity in which a forward fall can occur while a person is moving at a higher speed.

Bones become more brittle (from osteoporosis) in adults ages 50 - 60 and older. Older adults are more likely to fracture a bone, even while walking slowly.

Symptoms

• Change in the shape or angle of the forearm just above the wrist
• Inability to hold or lift heavy objects
• Wrist pain
• Swelling just above the wrist

First Aid

• Reassure the injured person.
• Place the hand and wrist in a splint in a normal resting position.
  • Place a rigid splint on the underside of the wrist, hand, and forearm.
  • Place a padded object such as a sock, wadded cloth, or rolled elastic bandage in the palm.
  • Wrap the wrist, hand, splint, and padded object. Do not wrap too tightly, and keep the fingertips uncovered.
• Elevate the wrist or place it in a sling.
• Use an ice pack over the wrist to help reduce swelling.
• Bring the person to an urgent care center or emergency medical facility.
• Do NOT attempt to move or straighten the wrist or hand.

Do Not

The hand or the wrist should not be moved or straightened.

Call immediately for emergency medical assistance if

Prevention

• Eat a well-balanced diet with adequate amounts of calcium.
• Exercise regularly to slow or prevent problems with the muscles, joints, and bones.
• Install railings or use aids such as a cane or walker to help prevent falls.
• Remove any obstacles that may cause a person to trip or fall (such as loose rugs).
• Use protective equipment during high-risk sports, such as rollerblading.

Women and men over age 50 should ask their health care provider whether they need bone mineral density (BMD) testing to check for thinning of bone tissue (or osteoporosis).

References

Woolfrey KGH, Woolfrey MR, Eisenhauer MA. Wrist and forearm. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 48.

Mercier LR. The forearm, wrist, and hand. In: Mercier LR, ed. Practical Orthopedics. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 7.