Colles Fracture Research Articles

COLLES FRACTURE

Colles fracture is the fracture of distal radius occurring most commonly inelderly because of the osteoprotic bone. Objectives: To compare outcome in fracture treatedwith Colles Plaster Case and Colles Junctional Brace. Study Design: Observational Study.Period: February 2013 to August 2013. Setting: Department of Orthopedics Bainazir BhuttoShaheed Hospital, Rawalpindi. Methods: A study was conducted on 140 patients sufferingfrom Colles fracture in a period of 6 months. Patients were divided in 2 groups. In group Aconventional Colles cast for 6 weeks was administered and in group B Colles cast was replacedbe a functional brace after 2 weeks. Functional outcome was recorded in both groups at theend of 12 weeks. Functional outcome was analyzed as given on the performa. Results: Outof 140 patients 78(55.7%) were male with a mean age of 35.87.The total number of femalepatients were 62(44.3%) with a mean age of 46.10 The total number of patients that hadexcellent functional outcome at 6 weeks were 92 out of 140 patients. The excellent functionaloutcome was achieved in 57(40.7%) patients treated with colles brace. However, in patientstreated with colles cast the functional outcome was excellent in 35(25%) patients. Conclusions:The best functional outcome after the treatment of colles fracture is achieved by the use ofcolles functional brace.

A comparative study of closed reduction and plaster cast application versus Kirschner wire fixation in Colles fracture

Background: Colles fracture in adults is a common injury and considering that there is very limited knowledge about the best method of treatment, either conservative or surgical. There is insufficient evidence from comparisons tested within this study to establish the relative effectiveness of the two methods over one another but from a health policy and health care funders’ perspective it seems justifiable to apply least costly option for managing this common fracture in our country. Aim: To study the functional outcome following treatment of Colles fracture by using closed reduction and plaster cast application versus Kirschner wire fixation and to study the effectiveness and complications of both the procedure. Materials and Methods: 50 adult patients with fracture Colles were assigned in to two groups after informed consent. Both groups were investigated in usual manner.Group A: Cases treated with plaster cast application alone (n = 25).Group B: Cases treated with K-wire and plaster cast application (n = 25). The patients were followed up every four weeks till radiological union was seen. The assessment of results were made using the demerit score system of Gartland and Werley based on objective and subjective criteria, residual deformity and complications. Results: At 6 months postoperatively, According to Gartland and Werley Group A we had 5 (10%) excellent results, 12(24%) good results, 06(12%) fair results and 2 (4%) poor results. In group B, 5(10%) excellent results, 13(26%) good results, 07 (14%) fair results and none had poor results. Conclusion: From a health policy and health care funders’ perspective it seems justifiable to apply least costly option for managing this common fracture in our country. Key words: Colles fracture, Kirschner wire, Gartland and Werley

The Development of Pattern Recognition via Clinical Experience: A Preliminary Study

Introduction: Pattern recognition is a process whereby illness scripts are rapidly retrieved in response to attempting to recognize a clinical problem at hand. Although adeptness in clinical reasoning is not strictly related to years of clinical experience, pattern recognition as a part of such reasoning does require prior clinical experience if a repertoire of illness scripts is to be built up. Clinical experience provides the clinician with opportunities to link subjective description to objective findings and thus to appreciate the significance of changes in subjective findings. Objective: To investigate how pattern recognition develops through clinical experience. Method: 31 participants (10 undergraduate students and 21 clinicians) were surveyed via three rounds of questionnaires designed according to the Delphi technique to elucidate treatments for osteoarthritis of the knee and for Colles fracture after surgery. Consensus was considered achieved if 75% of the responses agreed. Result: For treatment of osteoarthritis of the knee, 72 items proposed by the students converged to 20 items, and 129 items proposed by the clinicians converged to 41. For postoperative care of Colles fracture, 41 items proposed by the students were reduced to 19 items while the clinicians honed 88 items down to 35 through three rounds of survey. Conclusion: The quasi-Delphi did enable both students and clinicians to achieve consensus. Whereas the students came up with relatively vague items, the clinicians described concrete problems that patients encounter. Such differences suggest instances of narrative and diagnostic reasoning that might be incorporated into physical therapy education.

Uso de risedronato na consolidação e formação do calo na fratura de Colles em mulheres na pós‐menopausa – Estudo Solid

ObjectiveThis open, randomized and blinded parallel‐group multicenter study evaluated the efficacy of Actonel® (35mg) plus calcium/vitamin D versus calcium/vitamin D alone for preserving bone mineral density (BMD) in postmenopausal women with Colles fractures. MethodsPatients with a Colles fracture for seven days were randomized to receive either Actonel® (35mg) once a week plus calcium/vitamin D (ACD group) or calcium/vitamin D alone (CD group). The patients were evaluated after 90 and 180 days of treatment. ResultsCompleted all the evaluations 59 ACD patients and 56 CD patients. At the end of the study, the BMD of the radius at the fracture location showed a negative change in the CD group (32.8%). The loss of BMD in the ACD group (20.8%) was slightly less than in the CD group. There was a difference in the proportions of patients with BMD losses at the end of the study period in the two treatment groups, in favor of the ACD group, although this was not statistically significant. There was no significant difference in radiological identification of callus formation between the treatment groups. In the majority of the patients, the callus could be radiologically identified after 90 days. ConclusionPostmenopausal women with Colles fractures who received risedronate sodium plus calcium/vitamin D did not show any significant difference in BMD loss in forearm fractures, in comparison with those who received calcium/vitamin D alone. Risedronate presented a tendency towards a protective effect regarding BMD loss due to immobilization. The time taken for fracture consolidation to be achieved was unaffected.

Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy.

Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied. Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated. Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to normal parameters. Neither age nor delay between fracture and osteotomy correlated. In the radiocarpal malalignment group a significant effect on the ERLF was observed. In the patients with dorsal plating 70% of the hardware had to be removed. Conclusion Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and carpal malalignment.

Developing a programme of patient ‘streaming’ in an emergency department

Orthopaedic and musculoskeletal injuries are commonly identified in the emergency department (ED). Whilst much orthopaedic trauma literature focuses on fractures of the proximal femur, raising key issues such as length of stay and timely discharge, the start of the patients' journey is just as important in ensuring an appropriate assessment and a smooth transition through each stage of care. In the UK targets have been set for proximal hip fractured patients to attend theatre within 48 hours of admission, if fit. Appraising such patients expediently on initial point of contact in the ED has demonstrated that a number of factors can impinge and delay the patients' progress. This said a large number of other orthopaedic and musculoskeletal self presenting patients rely on the same appropriate transition to suitable medical assistance. The emergency department triage system has been used in the UK in its latest format since 2001, yet elderly patients with painful Colles fractures find they wait for specialist attention in a linear queue, possibly over extended lengths of time. This short paper explores how 'streaming' patients in one local ED has improved waiting/treatment times, and identified the fact that in some months (December 2012), 1 in 3 attendees present with a musculoskeletal problem. Using audit data collected over the last four years the benefits of 'streaming' patients is evident.

SAT0483 Denosumab Compared with Alendronate in Osteoporotic Postmenopausal Women Previously Treated with Alendronate

BackgroundDenosumab is the first biological treatment for osteoporosis in postmenopausal women at high risk of fracture or who have failed, or are intolerant to other osteoporosis treatment.ObjectivesTo compare the effect...

Diabetes and osteoporosis: Action of gastrointestinal hormones on the bone

A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m(2)). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?

Ulnaire pijn na een polsfractuur

Ulnar sided wrist pain is frequently following a distal radius fracture. Of the patients with a Colles fracture 35% will develop ulnar sided wrist pain. The anatomy of the ulnar side of the distal forearm is complex and consists of the distal radioulnar joint, the distal ulna and the triangular fibrocartilagenous complex. Based on the anatomy, ulnar sided wrist pain can be divided into osseous, ligamentous, tendinous, neurological or vascular pathology. Thorough history taking, physical examination with additional specific tests and imaging support the diagnosis. Arthroscopy of the wrist is considered to be the gold standard in diagnosing ligamentous injuries and osteoarthritis of the radiocarpal joint. Considering the association of ulnar sided pain with distal radius fractures and accompanied soft tissue injuries, we advocate a multidisciplinary approach to this condition.

Displaced Colles fractures: Functional outcome following closed reduction and stabilization with percutaneous K-wires

Background: Displaced Colles fractures are generally treated by manipulation and below elbow cast application. Malunion is a common complication resulting in pain, mid carpal instability and post-traumatic arthritis. Fracture stabilization by percutaneous pinning is a simple, minimally invasive technique which helps prevent dislodgment of the fracture thereby minimizing complications. The study aims to assess the amount of collapse after closed manipulation and percutaneous pinning with K-wires and its correlation with the functional outcome of the wrist after union. Methods: A prospective study was conducted from October 2006 to November 2009. Fifty adults (27 female, 23 male) with an average age of 40.72 years with type II fractures underwent closed manipulation and percutaneous pinning with crossed K-wires as the primary procedure. Serial radiographs were taken to document the amount of collapse. The functional outcome was assessed using Mayo Wrist Score. Results: At the final follow up of 6 months the collapse in the mean dorsal angle was 1.15 and mean ulnar variance 0.51. Functionally 25 patients (53.19%) had excellent, 17 patients (36.17%) good and 5 patients (10.63%) had satisfactory or fair outcome. Conclusions: Displaced Colles fractures should be reduced and stabilized with percutaneous K-wires to achieve an excellent functional outcome. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8135 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 14-20

Diabetes y osteoporosis: acción de las hormonas gastrointestinales sobre el hueso

A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m2). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?

Opening Wedge Osteotomy for Distal Radius Malunion: Dorsal or Palmar Approach?

Background There are various technical variations to consider when performing a corrective osteotomy of a distal radius malunion. We chose two of the more commonly reported techniques and compared the results of volar (palmar) osteotomy and fixation with dorsal osteotomy and fixation. Method Within a continuous cohort of patients who had undergone corrective osteotomy for a malunited Colles fracture, two groups could be identified retrospectively. In 8 patients a dorsal approach was used. A structural trapezoidal graft, subtending the amount of correction, was inserted into the osteotomy gap and stabilization was performed with a thin round-hole mini-fragment plate. In 14 patients a palmar approach and a palmar fixed-angle plate was used for correction of the malunion and for angular stable rigid fixation of the two fragments. The osteotomy gap was loosely filled with nonstructural cancellous bone chips. A retrospective comparison of the two groups was performed to see whether the outcome was affected by the use of either operative technique.The demographics, the preoperative amount of deformity, range of motion, pain, and force were comparable for both groups. All osteotomies healed without loss of correction. After a minimal follow-up of one year, radiographic appearance, objective functional parameters were assessed and subjective data (Disabilities of the Arm, Shoulder, and Hand [DASH] score and special pain and function questionnaire) obtained. Results These data did not show statistical difference for the two groups except for the amount of final wrist flexion. This parameter was significantly better in patients who had palmar approaches and fixed-angle plates. Conclusion Corrective osteotomies of distal radius malunions can be done in either way. It might result in some better flexion, if performed volarly.

Endless passion for excellence: the life and work of Professor Shi-Wen Wang

Endless passion for excellence: the life and work of Professor Shi-Wen Wang

Comment on Lee et al.: A comparative study of Colles’ fractures in patients between 50 and 70 years of age: percutaneous K-wiring versus volar locking plating

We read with interest the paper by Lee et al. [1] who compare two operative techniques for the treatment of displaced Colles' fractures with scant reference to closed manipulation and plaster immobilisation, which should be the mainstay of treatment for these fractures. Surgical intervention is occasionally required when closed reduction cannot be achieved or maintained but it is the exception rather than the rule. The authors state that patients were admitted to hospital for between one and five days, which represents a considerable expenditure in a climate of escalating medical costs. This is in addition to the expense of 30 to 60+ minutes operating time plus the cost of the locking plate or K-wires and image intensification. They conclude that volar locked plates are the best option for these fractures. We strongly disagree with this assertion and would recommend closed reduction under local/regional anaesthetic followed by four to five weeks immobilisation in a moulded, padded cast with check radiographs at one and two weeks. The patients can usually be treated as day cases with vastly reduced costs and risks. There is little evidence that surgery reliably improves the outcome of these injuries and it is increasingly recognised that the degree of deformity of the distal radius on postoperative radiographs does not correlate well with patient satisfaction and function especially for older patients. Any comparison of treatment methods for Colles fracture must consider closed treatment as one of the options. Grey Giddins, Anthony J Hall

Replicating a Colles fracture in an excised radius: Revisiting testing protocols

A distal radius fracture in middle-age and older adults is often considered a sentinel indicator of osteoporosis. Mechanical testing of cadaveric specimens is often used to quantify bone strength and develop insight for relating in-vivo measures to fracture force. Mechanical testing protocols using an intact forearm have been successful at replicating a Colles fracture, however, excised isolated radius protocols based on the intact forearm testing protocol have not been as successful. One protocol originally designed to replicate the physiological condition of a fall on an outstretched hand was reproduced in our laboratory, yet surprisingly the produced distal radius fracture patterns were not consistent among specimens nor was dorsal angulation of the distal fragment that is characteristic of a Colles fracture observed. The purpose of this study was to perform a mechanics-based analysis of the excised radius loading protocol in order to quantify the imposed and internal forces on the radius. An idealized beam model of the excised radius revealed that in the area of the distal radius where Colles fractures occur, 99.99% of the maximum strain on the bone outer surface was the result of pure compressive loading. This loading condition is in direct contrast to the accepted mechanics of a Colles fracture, which is characterized as a metaphyseal bending fracture with the volar cortex failing due to tensile stresses and the dorsal cortex exhibiting compression and comminution. The results suggest that additional research, particularly related to overcoming the difficulties of reliably supporting and applying a force to the distal end of the radius, is necessary for clinical fracture patterns to be reliably reproduced with an excised radius mechanical testing protocol.

Enfermedad cardiovascular, osteoporosis y riesgo de fractura

A 60-year-old man, who did administrative work, consulted for evaluation of the presence of osteoporosis. He smoked ten cigarettes a day and drank alcohol occasionally. Eight years ago he suffered a Colle's fracture in his right arm after an incidental fall, which resolved without complications. His mother had a hip fracture when she was 78 years old. The patient weighed 89.4 kg and his height was 165cm (BMI 38 kg/m2). The DXA showed a T-score –2.4 at lumbar spine and –1.9 at femoral neck. He had suffered a myocardial infarction one year ago and is presently taking statin, a beta-blocker and enalapril. In summary, this is a male with a background of fracture due to fragility, with lumbar BMD close to those established as diagnostic of osteoporosis and he also has cardiovascular disease. How should this patient be evaluated and treated?

Supracondylar Radial Nerve Block for Treatment of Distal Radius Fractures in the Emergency Department

Background Patients with acute distal radius fractures are frequently treated in the emergency department (ED) with closed reduction and splinting. Many of the anesthesia methods frequently employed may either lack efficacy or require additional monitoring and resources. Case Report An 18-year-old woman presented to the ED with a dorsally angulated distal radius fracture (Colles fracture). As an alternative to procedural sedation, an ultrasound-guided block of the radial nerve proximal to its bifurcation into the deep and superficial branches was performed. The resulting anesthesia was adequate to reduce and splint the fracture with minimal discomfort for the patient. Conclusion Ultrasound-guided supracondylar block of the radial nerve proximal to the origin of the deep and superficial branches provides safe and efficacious anesthesia for distal radius fracture reduction in the ED.

Estimulación magnética en fracturas de Colles

Objective To analyse the results of the use electromagnetic therapy in patients with recent Colles fractures. Design Prospective, comparative and case/control study. Material and methods The study was conducted in the Ernesto Guevara Polyclinic in Niquero city, province of Granma (Cuba), from September 2009 to April 2010. Two groups were randomly chosen from all the patients with recent Colles fracture. Both were treated conventionally, but one of them (the study group) was also treated with electromagnetic therapy for the following 30 days. At the end of treatment, the groups were compared, statistical tests were applied and conclusions reached. Results The results were positive in the study group, as by using electromagnetic therapy, the clinical and radiological consolidation was complete in the 93.3% of patients, earlier than the patients who followed only the conventional treatment. Conclusions We conclude that the use of low frequency magnetic field improves the treatment of recent Colles fractures, and this treatment can be applied within primary care.

The Hematoma Block an Effective Alternative for Fracture Reduction in Distal Radius Fractures

An alternative to general anesthesia was tested against hematoma block by a double-blind, randomized clinical trial in reduction of Colles fracture. 96 patients more than 18 years old with displaced fractures of distal radius were selected from 2007-2009 on the basis of: 1) informed consent; 2) no contraindication to any method of analgesia; 3) no associated injury. Patients were randomized into 2 equal groups. The A group received Propofol intravenously, whereas the B group received 10 ml of 2% Lidocaine Hydrochloride into the fracture hematoma. Fractures are reduced under acceptable criteria. Pain measured by Visual Analogue Scale (VAS) was recorded before, during, and after reduction. Time to Emergency department, to manipulation and to hospital discharge is measured. In radiographic before, after reduction and a week later the radial tilt, ulnar migration and dorsal tilt are measured. Loss of these parameters were study statistically data analysis by KW statistics. 96 patients with displaced fractures of distal radius at mean age 54.3 (19-84) years old, M/F rate 37/59, left/right hand 37/58., from 2005-2008. VAS during reduction was 0 in group A and 0.97 +/- 0.7 in group B and VAS after reduction was 2.72 +/- 0.7 in group A and 2.25 +/- 0.2 in group B. Time to reduction was 2.63 +/- 0.96 hr in A and 0.90 +/- 0.47 hr in B After a week, 21 fractures lose reduction in group A and 22 in group B. Hematoma block by local anesthetic is a safe and effective alternative to intravenous general anesthesia in reduction of Colles fracture.

One case of malunion after colles fracture treated by intramedullary nail; A case report

One case of malunion after colles fracture treated by intramedullary nail; A case report