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  • Colles’ fracture
  • Colles fracture

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  • 813.14 Colles’ fracture closed
  • 813.51 Colles’ fracture open

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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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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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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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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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  • 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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  • 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, casting
    • Severely displaced fractures treated operatively via
      • Open reduction internal fixation
      • External fixation

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  • Inability to
    • Perform ADLs with involved upper extremity
    • Bear weight on involved forearm and hand
    • Write with involved hand (especially if dominant hand affected)
    • Grab a cup secondary to pain and muscle weakness

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