Orthopaedics

Question 1

Define Colle’s fracture.

Answer 1

extra-articular transverse distal radius fracture (~2 cm proximal to the radiocarpal joint) with dorsal displacement ± ulnar styloid fracture

Question 2

Epidemiology of Colles fracture?

Answer 2

most common fracture in those >40 yr, especially in women and those with osteoporotic bone

Question 3

Mechanism of Colle’s fracture?

Answer 3

FOOSH

Question 4

What are the clinical features of a Colle’s fracture and what are the Ix?

Answer 4

• Clinical Features
  
  • “dinner fork” deformity
  • swelling, ecchymoses, tenderness
• Investigations
  
  • x-ray: AP and lateral wrist

Question 5

What is the Rx for a Colle’s fracture?

Answer 5

• goal is to restore radial height, radial inclination (22°), volar tilt (11°) as well as distal radioulnar joint stability and useful forearm rotation
• closed reduction (think opposite of the deformity):
  
  • haematoma block (sterile prep and drape, local anesthetic injection directly into fracture site) or conscious sedation
  • closed reduction: 1) traction with extension (exaggerate injury), 2) traction with ulnar deviation, pronation, flexion (of distal fragment – not at wrist)
  • dorsal slab/below elbow cast for 5-6 wk
  • x-ray x 1 wk for 3 wk and at cessation of immobilization to ensure reduction is maintained
• obtain post-reduction films immediately; repeat reduction if necessary, consider external fixation or ORIF if failure of adequate closed reduction.

Question 6

What are the complications of wrist fractures?

Answer 6

• most common complications are poor grip strength, stiffness, and radial shortening
• distal radius fractures in individuals <40 yr of age are usually highly comminuted and are likely to require ORIF
• 80% have normal function in 6-12 mo