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PubMed · 15589920

Which Colles' fractures should be manipulated?

Sean Dixon·Patricia Allen·Gordon Bannister
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Abstract

Ninety-two patients with displaced Colles' fractures were followed prospectively after manipulation under regional anaesthesia. Radiographs were taken before and after manipulation and after 3 months when a functional assessment was also made. A correlation was sought between outcome and radiological measurements. Final radial shortening of 3mm or more was associated with a significantly worse functional outcome after 3 months (P < 0.001). Where the initial radial shortening was 3 mm or more, the probability of malunion was 65% whereas with less than 3mm, the probability of malunion was 28% (P < 0.001). With 5 mm or more of radial shortening at presentation, the probability of malunion was 73% (P < 0.01). The decision to manipulate remains a matter of judgement but a high failure rate renders simple manipulation and plaster cast fixation a poor treatment option in fractures with 5mm or more of radial shortening at presentation.

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Colles' FractureFractures, UnunitedHumansManipulation, OrthopedicProspective StudiesRadiographyRadiusTreatment OutcomeJournal Article

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BibTeXRIS

Sean Dixon, Patricia Allen, Gordon Bannister. 2005. Which Colles' fractures should be manipulated?. https://doi.org/10.1016/j.injury.2004.03.027

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PubMed2005

Simultaneous radial closing wedge and ulnar shortening osteotomy for distal radius malunion.

Closing wedge osteotomies are an attractive treatment option for distal radius malunion in patients with osteopenia. It does not require a separate-site bone graft, result-ing in decreased morbidity. However, this procedure has always been performed in combination with ulnar head resection to accommodate closure of corrective osteotomy and to address the issue of ulnocarpal abutment. Because ulnar shortening osteotomy is more physiological solution, it seemed advantageous to us to combine radial closing wedge osteotomy and ulnar shortening osteotomy. In this article, we present in detail our technique for treating patients with distal radius malunion. The patients are potentially osteopenic such as women aged over 45 years and are active at home, work, and/or recreation but are not involved in heavy physical work. Through volar approach an appropriate bone wedge is removed from the distal radius. A small volar T-plate is used to secure the osteotomized bone fragments. The aim of the radial osteotomy is to correct the dorsal angulation in the sagittal plane within a normal range of 1 degree to 2 degrees with reference to that of opposite wrist. Ulnar shortening osteotomy is performed by using transverse osteotomy and compression plating technique with an AO compression device. The ulnar variance is adjusted to neutral. Although the technique presented requires the surgeons to use careful plate and screw technique, early results have been encouraging, and patients with osteopenia can be treated successfully. Decreased grip strength which may be provoked by shorting of the forearm is acceptable.

Colles' Fracture↗
PubMed2004

[What wrist fracture did Pouteau actually describe?].

The so-called " Pouteau-Colles" fracture was never specifically described by Pouteau. This surgeon from Lyons wrote a paper published in his posthumous works in 1783. The author was allowed access to an original edition of the paper at the "Ancienne Ecole de Médecine Navale de Rochefort". When reading this paper, it seems that Pouteau described a great variety of different kinds of forearm fractures. His original contribution was to define the mechanism of injury as occurring during a fall on the outstretched hand as opposed to direct injury. Pouteau presents a hypothetical muscular theory of fracture pattern etiology, but one that is useful in the understanding of the displacemnt of the bone fragments. He questions the principal role attributed to sprains and luxations at this time in the differential diagnosis of forearm injury. He described four clinical signs to diagnose, at a glance, which bone was injured, the site of the fracture, its displacements and mechanism of inury. Pouteau also presented a precise method of reduction and an original system of immobilisation, able to accomodate secondary displacements and avoid complications that were not fully recognised at that time, namely compartment syndrome and nosocomial infection. Pouteau simply concludes with a question concerning the future methods needed to reduce bony collapse and to fill the bone defects. In order to render special homage to this visionary surgeon, the author propose to attribute to the nosologic entity "fore-arm bone fractures" the qualificative of "Pouteau's fractures", or to associate to every fracture of the fore-arm described by any other author the name of the Lyons surgeon!

Colles' Fracture↗