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
1760 – Claude Pouteau independently described distal radius fracture rather than dislocation and hypothesised the characteristic dorsal angulation of the distal fragment.
1814 – Colles 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]
1847 – Smith 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 Earnest 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]
- Jean-Louis Petit (1674–1750)
- Claude Pouteau (1724–1775)
- Abraham Colles (1773 – 1843)
- Robert William Smith (1807-1873)
- Ernest Amory Codman (1869–1940)
- Pouteau fracture (commonly used in France).
- Dinner fork deformity; bayonet deformity
- As per Stiglers law, Colles was not the first to describe the fracture he is eponymousaly affiliated with
- Codman’s 1900 classification of distal radius fractures following the introduction and x-rays and ‘skiagrams’ makes for good reading. The paper describes and demonstrates – 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 X (‘reversed Colles fracture’ though looks more like a Barton fracture than a Smith fracture…) [BMSJ 1900;305-308]
- Petit JL. L’art de guérir les maladies des os Traité des maladies des os. Paris: Cavellier 1705 [A treatise of the diseases of the bones – translated 1726] Commentary on distal radius fractures [1705;X:126-140]
- Pouteau C. Mélanges de chirurgie. Paris. 1760
- Colles A. On the fracture of the carpal extremity of the radius. The Edinburgh medical and surgical journal. 1814;10:182-186. [Clin Orthop Relat Res. 2006;445:5-7. PMID 16601406]
- Smith RW. On Fractures of the Bones of the Fore-arm in the Vicinity of the Wrist Joint. In: A Treatise on Fractures in the Vicinity of Joint and on Certain Forms of Accidental and Congenital Dislocations. Dublin: Hodges Smith. 1847:129-175
- Codman EA. A Study of the X-Ray Plates of One Hundred and Forty Cases of Fracture of the Lower End of the Radius. The Boston Medical and Surgical Journal. 1900;143(13): 305-308.
the person behind the name