ACR Codes: 4.4
In 1814 Abraham Colles of Dublin described this common fracture based upon its clinical findings. He stated "this fracture takes place at about an inch and an half above the carpal extremity of the radius" and continued to describe a depression of the forearm at this site and swelling over the wrist and metacarpals. He stated the carpus in the base of the metacarpus appeared to be "thrown backward" thus making him suspicious that the carpus had been dislocated forward.
Occurs primarily in older women, increasing in incidence after 45 years. Commonly occurs in conjuction with other fractures (hip, ulnar, radial head, proximal humerus)
-Etiology and Pathogenesis:
Caused by a fall on an outstretched hand on the thenar eminence, thus compressing the dorsal distal radius while providing tension on the anterior distal radius. As a result a compression fracture occurs with a transverse fracture of the anterior cortex.
-Radiologic findings:
AP view: transverse fracture of distal radius often comminuted
60% of the time an ulnar styloid fracture is apparent
Lateral view: Elimination or reversal of the radiocarpal angle (normally 10-15 degrees)
Distal radial fragment is displaced dorsally.
Frykman Classification: divides Colles' fracture into 8 subtypes based upon radiographic findings.
-Clinical Manifestations:
Clinically (as Colle described) there is marked wrist deformity and swelling. And when viewed from the side a dinner-fork deformity is seen (due to the posterior angulation of the hand and carpus)
-Differential Diagnosis:
Smith's Fracture: fracture of the distal radius, with the distal fragment displaced anteriorly
-Diagnosis: AP and lateral Xray
-Treatment: Closed reduction with casting of the hand in palmar flexion and ulnar deviation. Some recommend neutral position or supination.
Pain, limited range of motion, loss of grip strength, acute carpal tunnel syndrome can occur even after appropriate reduction.
Reference(s): Rogers, Lee ed. Radiology of Skeletal Trauma. 2nd ed. New York: Churchill Livingsone, 1992. pp. 841-842.
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Disease Topic 3162 
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