Fracture, distal radius

• Colles’ fracture
• Colles fracture

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

• 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

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

Description

• 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)

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% to 45% of all pediatric fractures)

Demographics

• In pediatric population, higher frequency among boys than girls

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

Imaging

• X-ray for fracture, often limited view
• CT for detailed imaging
• MRI
• Ultrasonography may be used in pediatric population

• 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

• 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

• 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 ...