1. Injuries of the forearm By : Dr. sanjeev

2. Normal wrist joint Fig : -

3. Normal wrist joint Fig : -

4. Colle’s fracture. describe by : - Abraham colle`s - 1814. Definition : - it is not just fracture lower end of radius but a fracture dislocation of the inferior radioulnar joint. Occurs about 2.5 cm above the carpal extremity of the radius. Commonest age group- Elderly.( 60 yrs) Women> Men. MOA – fall in outstretched hand. Force required to cause this fracture is 192 kg in women and 282 kg in men.

5. Colle’s fracture Fig : -

6. Colle’s fracture Fig : -

7. AP View Fig : - colle`s fracture

8. Clinical features.- Swelling. Pain. Dinner fork defomity, it is not found in all cases but seen only if there is a dorsal tilt or rotation of the distal fragment Examination- Distal neurovascular status. External injuries.

9. Dinner fork defomity Fig :

10. dorsal displacement of the distal fracture fragments.

11. Styloid process test : Normally, the radial styloid proces is lower by 1.3 cm when compaired to the ulnar styloid process. In colle`s both radial and ulnar styloid processes are at the same level and are found in all displacements of colle`s fracture. This is more reliable sign than dinner fork deformity

12. Distance between radial and styloid processes Fig :

13. Colle’s fracture Fig : -

14. Frykmann`s classification : Fracture lineDistal ulnar fracture Absent present 1.. Extra - articular 1 2 2. Intra – articular (involving RC joint only ) 3 4 3. Intra – articular (involving distal RU joint only ) 5 6 4. Intra – articular (both RC + inferior RU joints ) 7 8 RC = radiocarpal RU = radioulnar

15. Frykmann`s classification Fig :

16. Radiograpy : X – ray of the wrist : - AP and lateral views and lower end of the radius Displacement in a colle`s fracture : Dorsal displacement Dorsal rotation Lateral displacement Lateral rotation Impaction supination

17. Treatment : Conservative methods Operative methods CONSERVATIVE METHODS : - closed reduction under general anaesthesia (GA),or local anaesthesia (LA) - If the level of the styloid processes are restored back to normal, it indicates that the reduction has been achieved satisfactorily. - limb is immobilised by colle`s cast and a check radiograph is taken - Removed after 6 – 8 weeks - physiotherapy

18. 6 immobilisation method : Below elbow cast (10 – 20 degree palmar flexon, 15 – 20 degree ulnar deviation ) COLLE`S CAST ABOVE ELBOW CAST IN SUPINATION ABOVE ELBOW CAST IN PRONATION. ABOVE ELBOW CAST IN MID- PRONATION. COTTON LODER`S POSITION( WRIST FULLY FLEXED). EXTERNAL FIXATORS

19. Colle`s cast It is a below elbow cast in supination and ideally it has to meet the following 4 criteria :- Firm fit at the dorsum Firm fit at the volar fracture apex Just snuggly fitting at the forearm Metacarpophalangeal joints should be free to move

20. Colle`s cast

21. Acceptable limits of colle`s fracture: A dorsal tilt of less than 10 degrees A radial shorteing of less than 5 mm. OPERATIVE METHODS : INDICATION : Impaction Median nerve intrapment

22. Cont.. Fig : -

23. Surgical methods : 1. Closed reduction and percutaneous pinning with k – wires 2. Open reduction and plate fixation.

24. Complication Early complication : Unstable reduction Medial or ulnar nerve stretched Post reduction swelling Compartmental syndrome Anaesthesia problem Injury to proximal segment of the bone during reduction Late complication : Malunion Rupture of extensor pollicis tendon Frozen shoulder Carpel tunnel syndrome Nonunion Sudeck`s osteodystrophy

25. COLLE`S FRACTURE - Why is it called fracture of 6…? Common at 60 years Force required to cause colle`s fracture are multiples of 6 6 classical displacements 6 method of fracture immobilisation 6 important early and late complications 60 per cent cases have fracture ulnar styloid

26. Smith’s Fracture. Reverse of colle’s fracture. Wrist fracture in which the distal end of the radius is displaced forwards. Mechanism of injury : Fall on the back of the dorsum of the hand Fall on the forearm in supination Direct blow to the flexed hand

27. Colle`s and smith`s fracture Fig : -

28. Clinical features : - Pain Swelling Deformity Loss of wrist function Deformity is opposite to that of colle`s fracture and is called the garden shaped deformity. Radiography : - AP view of the wrist

29. Complication : Complication of colle`s Treatment : - Closed reduction and immobilisation in a long arm cast with forearm in supination and wrist in extension. Unstable fractures : - Fixation with k – wire or open reduction and plate fixation.