Colles fracture

Description

Colles fracture: Extra-articular fracture of the distal radius with dorsal angulation of the distal fragment. Frequently associated with an ulna styloid fracture and volar angulation of the fracture apex

Colles fracture distal radius LITFL
Colles fracture

History

1705 – Frenchmen Jean-Louis Petit suggested that some carpal dislocations (luxations) were in fact fractures of the end of the radius. [1705;X:126-140]

1760Claude Pouteau independently described distal radius fracture rather than dislocation and hypothesised the characteristic dorsal angulation of the distal fragment.

1814Colles description of distal radius fractures occurred prior to X-ray. He contradicted previous belief that these injuries were dislocations of the carpus from the wrist. Colles further described early closed reduction technique and tin splinting immobilisation.

This fracture takes place at about an inch and a half above the carpal extremity of the radius, and exhibits the following appearances. The posterior surface of the limb presents a considerable deformity; for a depression is seen in the fore-arm, about an inch and a half above the end of this bone, while a considerable swelling occupies the wrist and metacarpus. Indeed, the carpus and base of metarcarpus appear to be thrown backward so much, as on first view to excite a suspicion that the carpus has been dislocated forward.

On viewing the anterior surface of the limb, we observe a considerable fulness, as if caused by the flexor tendons being thrown forwards. The fulness extends upwards to about one-third of the length of the forearm, and terminates below at the upper edge of the annular ligament of the wrist. The extremity of the ulna is seen projecting towards the palm and inner edge of the limb: the degree, however, in which this projection takes place, is different in different instances.

Colles, 1814:183

1847Smith elaborated upon Colles’ description of the distal radius angulation, stating that is was “downwards, forwards, and very slightly inwards” rather than “directly downwards” as Colles believed. Smith acknowledged the work of Petit and Pouteau work but believed Colles name should be related to the fracture [1847:132]. He even referred to Pouteau’s comment in his defining of the Colles fracture…

…there is no fracture the existence of which it is more easy to tell at a single coup d’oeil (look of the eye)

Smith 1847;140

1900 – The American surgeon Ernest Amory Codman (1869 – 1940) was the first to correlate Colles 1814 description with x-ray appearances of the fracture in 1900. He divided distal radius fractures into ten (X) Classes. The ‘typical Colles fracture – Class VIII‘ occurred in 46% of the 140 x-rays examined [BMSJ 1900;305-308]


Associated Persons


Alternative names

  • Pouteau fracture (commonly used in France).
  • Dinner fork deformity; bayonet deformity

Controversies

As per Stiglers law, Colles was not the first to describe the fracture he is anonymously affiliated with…

Codman’s 1900 classification of distal radius fractures following the introduction and x-rays and ‘skiagrams’ makes for good reading. He divided distal radius fractures into ten (X) Classes

  • Class I (Base styloid process of radius);
  • Class II (Inner angle of distal radius);
  • Class III (Transverse fracture distal to epiphyseal line);
  • Class IV (Salter-Harris III);
  • Class V (Salter-Harris I);
  • Class VI (Salter-Harris II);
  • Class VII (Salter-Harris V);
  • Class VIII (typical Colles fracture);
  • Class IX (stellate fracture with longitudinal fissures);
  • Class X (‘reversed Colles fracture’ though looks more like a Barton fracture than a Smith fracture…)

References


eponymictionary CTA

eponymictionary

the names behind the name

Dr Josh Howard - wannabe future orthopod, finding myself in Australia | LinkedIn

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