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Navigating the Challenge of a Broken Wrist: Understanding Colles Fracture

colles fracture hand therapy london

A broken wrist, particularly a Colles fracture, is a common injury. This article delves into the complexities of wrist fractures, with a focus on the Colles fracture, to demystify the condition and provide valuable insights into its management. Whether you’re a patient, a caregiver, or simply curious, understanding the intricacies of this injury can empower you to make informed decisions about care and recovery.

Article Outline

  1. What is a Colles Fracture?
  2. Anatomy of the Hand and Wrist
  3. How Common is a Colles Fracture?
  4. What Causes a Colles Fracture?
  5. What are the Main Symptoms of a Colles Fracture?
  6. How is a Colles Fracture Diagnosed?
  7. Will I Need a Hand and Wrist Scan?
  8. How Can a Physiotherapist Treat a Colles Fracture?
  9. Do I Need to See a Consultant for a Colles Fracture?
  10. What Treatments Can I Get from a Consultant for a Colles Fracture?

Detailed Exploration

What is a Colles Fracture?

A Colles fracture, named after the surgeon Abraham Colles, is a specific type of wrist fracture involving the distal radius. It is a common fracture of the distal radius, close to the wrist, typically resulting from a fall on an outstretched hand. It accounts for 17.5% (just over one-sixth) of all adult fractures attending A&E. Characterised by a backward displacement of the wrist and hand, it’s distinguished by the “dinner fork” deformity. 

Anatomy of the Hand and Wrist

The wrist comprises two main bones: the radius and the ulna, with the radius being the most commonly fractured in wrist injuries. The complexity of the wrist’s structure, including its ligaments and joints, makes it susceptible to injury but also crucial for hand movement and functionality.

How Common is a Colles Fracture?

Colles fractures are among the most common types of fractures, especially in older adults with osteoporosis. It accounts for around 90% of all distal radial fractures. For older populations, the increased incidence of falls and the higher prevalence of osteoporosis means a fracture occurs more easily in these age groups. 

Interestingly, the ratio of female to male sufferers is 4 to 1, this is likely due to the increased risks associated with osteopenia and osteoporosis in post-menopausal women. The overall incidence of distal radius fractures, including Colles’ fractures, is estimated to be around 195 to 250 per 100,000 person-years. However, for individuals aged 65 and older, the incidence rate increases sharply, especially in women. Around 2/3rds of the fractures looked at in a study (2) over 5 years occurred in both sexes above the age of 55.

The prevalence of these injuries highlights the need for awareness and effective treatment strategies to manage the significant impact they have on individuals’ lives.

What Causes a Colles Fracture?

The primary cause of a Colles fracture is a forceful impact to the wrist, often from a fall. In the case of a Colle’s fracture, then the wrist is usually forced backwards palm facing the floor. This is termed a fall onto an outstretched hand (FOOSH). We often see this in any impact injuries, such as slipping on ice, falling off a bicycle, sports injuries, and car accidents. 

If the individual has fallen on the wrist in the opposite direction where the palm is forced down towards the wrist, this can result in a Smith fracture. 

What are the Main Symptoms of a Colles Fracture?

Immediate pain and swelling on the thumb side of the wrist and a noticeable deformity are hallmark symptoms of a Colles fracture. Recognising these signs is crucial for timely and effective intervention, which can significantly influence the recovery outcome.

How is a Colles Fracture Diagnosed?

Diagnosis typically involves a physical examination assessing for swelling, redness and deformity. Imaging in the form of X-rays is used to confirm initially if there is a fracture present. Then the fracture type, the location of the fracture and the degree of displacement can also be assessed. Understanding the diagnostic process helps patients navigate their care journey more effectively.

We also often see Colles associated with ulnar styloid fracture, as this little spur of bone extends into the wrist joint. 

Will I Need a Hand and Wrist Scan?

Imaging is essential in diagnosing Colles fractures and planning their management. Imaging such as X-Ray and CT scans can be used to assess complex fractures. In the case of a comminuted fracture, an intra-articular fracture or an open fracture, the likelihood of more detailed scans being used is much higher. While an undisplaced fracture that is an extra-articular fracture can be treated non-surgically.

How Can a Physiotherapist Treat a Colles Fracture?

Rehabilitation with a Hand Specialist Therapist can significantly improve outcomes after a Colles fracture. 

Treatment of Colles fracture would usually include:

  • Physiotherapy: Begins after immobilisation to restore motion, strength, and function.
  • Home Exercises: Essential to return the wrist and hand function.
  • Monitoring: Regular check-ups to monitor progress and prevent complications like stiffness or loss of function. 

Our team of Advanced Specialist Hand Therapists are here to guide you through your recovery. You can book to see one of them by contacting our Reception team on 02074046343 or [email protected].

Do I Need to See a Consultant for a Colles Fracture?

In the management of unstable distal radius fractures or complications, specialist care may be necessary. However, the incidence of needing surgery for Colles fracture depends on the severity of the deformity of the wrist. A large study (1) looking at how many surgeries were undertaken over a 15-year period in Italy showed only 14.8 per 100000 adult population.

There are also several complications that may mean you end up having to see a consultant. These complications can include:

  • Malunion: Improper healing leading to deformity.
  • Nonunion: Failure of the bone to heal.
  • Stiffness and Loss of Motion: Particularly in the wrist and fingers.
  • Carpal Tunnel Syndrome: Compression of the median nerve due to swelling.
  • Complex Regional Pain Syndrome (CRPS): Chronic pain condition that can develop after the injury.

What Treatments Can I Get from a Consultant for a Colles Fracture?

The treatment plan depends on the fracture’s severity and the patient’s overall health and activity level.

  1. Non-surgical Treatment:
    • Closed Reduction: If the fracture is displaced, the bone fragments are manually realigned.
    • Casting/Splinting: A splint or cast immobilises the wrist to allow healing, typically for 6–8 weeks.
    • Follow-up X-rays: Ensure proper alignment during the healing process.
  2. Surgical Treatment:
    • Open Reduction and Internal Fixation (ORIF): Used for significantly displaced or unstable fractures. It involves realigning the bone fragments and fixing them with screws, plates, or pins.
    • External Fixation: Involves stabilising the fracture with a frame outside the body connected to pins inserted into the bone.

Conclusion: Key Takeaways

  • A Colles fracture is a common but complex wrist injury requiring timely and appropriate management.
  • Recognising the symptoms and understanding the causes of Colles fractures can aid in prevention and early intervention.
  • Diagnosis often involves physical examination and imaging, with treatment ranging from physiotherapy to surgical intervention, depending on the fracture’s severity.
  • Rehabilitation is crucial for restoring wrist function and preventing long-term complications.
  • Consulting with healthcare professionals, including physiotherapists and orthopaedic specialists, is key to a successful recovery.

Understanding Colles fractures provides insights into the broader challenges of managing wrist injuries, emphasising the importance of comprehensive care and rehabilitation for optimal recovery. Our team of Advanced Specialist Hand Therapists are here to guide you through your recovery. You can book to see one of them by contacting our Reception team on 02074046343 or [email protected].

References

1. Longo, U.G.; De Salvatore, S.; Mazzola, A.; Salvatore, G.; Mera, B.J.; Piergentili, I.; Denaro, V. Colles’ Fracture: An Epidemiological Nationwide Study in Italy from 2001 to 2016. Int. J. Environ. Res. Public Health 202320, 3956. https://doi.org/10.3390/ijerph20053956

2. Saeed, M.A.; Muaaz, H.; Saqib, H., et al. “Incidence of Colles Fracture (5 years Experience)” (2024) Medical Forum Monthly, 31(2). Available at: https://medicalforummonthly.com/index.php/mfm/article/view/2192 

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