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Condition/Disorder Synonym

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  • Colles' fracture

  • Colles fracture

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ICD-9-CM Codes

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  • 813.14 Colles' fracture closed

  • 813.51 Colles' fracture open

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ICD-10-CM Codes

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  • S52.539A Colles' fracture of unspecified, radius, initial encounter for closed fracture

  • S52.539B Colles' fracture of unspecified radius, initial encounter for open fracture type I or II

  • S52.539C Colles' fracture of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC

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Preferred Practice Pattern

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Key Features

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Description

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  • Fracture

  • Any defect in continuity of the distal radius

  • Displaced (distal radius is moved on either side of the fracture) or non-displaced (distal radius has not moved)

  • Closed (skin intact) or open (skin breached)

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination

  • May not be fracture, but distal radioulnar subluxation/dislocation, wrist sprain

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General Considerations

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  • Radius is the most commonly broken bone in the arm

  • Most common fracture site in children (35.8% to 45% of all pediatric fractures)

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Demographics

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  • In pediatric population, higher frequency among boys than girls

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Clinical Findings

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Signs and Symptoms

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  • Pain

  • Point tenderness

  • Edema

  • Ecchymosis

  • Visual wrist deformity

  • Loss of general function

  • Loss of active mobility

  • Muscle guarding with passive movement

  • Crepitus

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Functional Implications

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  • Pain with weight bearing on involved forearm and hand

  • Pain with vertical positioning of arm at side

  • Pain with all movements (passive, active)

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Possible Contributing Causes

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  • Osteoporosis

  • Mechanisms of injury

    • Fall on outstretched hand with the wrist in extension

    • Direct impact

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Differential Diagnosis

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  • Distal radioulnar subluxation or dislocation

  • Wrist sprain

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray for fracture, often limited view

  • CT for detailed imaging

  • MRI

  • Ultrasonography may be used in pediatric population

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Findings and Interpretation

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  • Pain and crepitus with passive or active ROM in wrist and forearm

  • Visible wrist deformity

  • Upper extremity held in protective position to avoid gravitational distraction of joint

  • Muscle guarding with all movements

  • Inability to actively perform wrist movements or forearm pronation/supination secondary to pain

  • If vascular structures involved, affected hand will appear cool, pale, diminished palpable pulse

  • If neurologic structures involved, individual will report numbness, decreased ability to move affected hand

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Referrals/Admittance

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  • To hospital for imaging: x-ray or CT

  • To physician for medication: NSAIDs or opioid for pain management

  • To orthopedist for immediate consult if

    • Non-displaced fractures or displace fractures that may be reduced are treated non-operatively

      • Immobilization splint, ...

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