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171: COLLES FRACTURE

Jennifer Cabrera, DPT, GCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYM

  • Colles’ fracture

ICD-9-CM CODES

  • 813.41 Colles fracture closed

  • 813.51 Colles fracture open

ICD-10-CM CODES

  • 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

PREFERRED PRACTICE PATTERN

  • 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture1

PATIENT PRESENTATION

A 65-year-old woman tripped on a rug in her home and fell on her outstretched hand with her wrist dorsiflexed (extended). She felt immediate pain in her wrist and has difficulty moving her wrist or hand. She has been postmenopausal for 15 years and has never taken hormone replacement therapy or bisphosphonates. She presented with pain and swelling in her wrist. Her arm had a “dinner fork” deformity. Radiographs showed a distal radius fracture (Colles fracture). There was dorsal angulation seen on the lateral view.2

KEY FEATURES

Description

  • Fracture3

  • Any defect in continuity of the distal radius

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

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

Essentials of Diagnosis

  • Diagnosis usually made by clinical examination

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

General Considerations

  • Radius is the most commonly broken bone in the arm

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

Demographics

  • In pediatric population, higher frequency among boys than girls

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain

  • Point tenderness

  • Edema

  • Ecchymosis

  • Visual wrist deformity

  • Loss of general function

  • Loss of active mobility

  • Muscle guarding with passive movement

  • Crepitus

Functional Implications

  • Pain with weight bearing on involved forearm and hand

  • Pain with vertical positioning of arm at side

  • Pain with all movements (passive, active)

Possible Contributing Causes

  • Osteoporosis

  • Mechanisms of injury

    • Fall on outstretched hand with the wrist in extension

    • Direct impact

Differential Diagnosis

  • Distal radioulnar subluxation or dislocation

  • Wrist sprain

MEANS OF CONFIRMATION OR DIAGNOSIS

Imaging

  • X-ray for fracture, often limited view4

  • CT for detailed imaging4

  • MRI

  • Ultrasonography may be used in pediatric population

FIGURE 171-1

Colles fracture. The classic dinner-fork deformity is demonstrated in this photograph. The distal forearm is displaced dorsally. (From Knoop KJ, Stack ...

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