| 词条 | Colles' fracture |
| 释义 |
| name = Colles' fracture | synonyms = Colles fracture, Pouteau fracture[1] | image = Collesfracture.jpg | width = | alt = | caption = An X-ray showing a Colles' fracture | pronounce = | field = Emergency medicine, orthopedics | symptoms = Pain, swelling, deformity, bruising[2] | complications = | onset = Sudden[2] | duration = | types = | causes = Fall on an outstretched hand[2] | risks = Osteoporosis[2] | diagnosis = X-rays[2] | differential = | prevention = | treatment = Cast, surgery[7] | medication = | prognosis = Recovery over 1 to 2 years[2] | frequency = ~15% lifetime risk[7] | deaths = }} A Colles' fracture is a type of fracture of the distal forearm in which the broken end of the radius is bent backwards.[1] Symptoms may include pain, swelling, deformity, and bruising.[1] Complications may include damage to the median nerve.[2] It typically occurs as a result of a fall on an outstretched hand.[1] Risk factors include osteoporosis.[1] The diagnosis may be confirmed with X-rays.[1] The tip of the ulna may also be broken.[3] Treatment may include casting or surgery.[7] Surgical reduction and casting is possible in the majority of cases in people over the age of 50.[4] Pain management can be achieved during the reduction with procedural sedation and analgesia or a hematoma block.[4] A year or two may be required for healing to occur.[1] About 15% of people have a Colles' fracture at some point in time.[7] They occur more commonly in young adults and older people than in children and middle-aged adults.[5] Women are more frequently affected than men.[5] The fracture is named after Abraham Colles who described it in 1814.[5] ClassificationThe term Colles fracture is classically used to describe a fracture at the distal end of the radius, at its cortico-cancellous junction. However, the term now tends to be used loosely to describe any fracture of the distal radius, with or without involvement of the ulna, that has dorsal displacement of the fracture fragments. Colles himself described it as a fracture that “takes place at about an inch and a half (38mm) above the carpal extremity of the radius” and “the carpus and the base of metacarpus appears to be thrown backward”.[6] The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm. Colles' fractures can be categorized according to several systems including Frykman, Gartland & Werley, Lidström, Nissen-Lie and the Older's classifications. CausesThe fracture is most commonly caused by people falling onto a hard surface and breaking their fall with outstretched hand (FOOSH)–falling with wrists flexed would lead to a Smith's fracture. Originally it was described in elderly and/or post-menopausal women. It usually occurs about three to five centimetres proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic "dinner fork" or "bayonet" like deformity. Colles fracture is a common fracture in people with osteoporosis, second only to vertebral fractures. DiagnosisDiagnosis can be made upon interpretation of anteroposterior and lateral views alone.[7] The classic Colles fracture has the following characteristics:[8]
Other characteristics:[10][7]
TreatmentManagement depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone. The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. There is some evidence that immobilization with the wrist in dorsiflexion as opposed to palmarflexion results in less redisplacement and better functional status.[11] Significant angulation and deformity may require an open reduction and internal fixation or external fixation. The volar forearm splint is best for temporary immobilization of forearm, wrist and hand fractures, including Colles fracture. There are several established instability criteria: dorsal tilt >20°, comminuted fracture, abruption of the ulnar styloid process, intraarticular displacement >1mm, loss of radial height >2mm. A higher amount of instability criteria increases the likelihood of operative treatment. Treatment modalities differ in the elderly.[12] Repeat Xrays are recommended at one, two, and six weeks to verify proper healing.[3] PrognosisRecovery time depends on the degree of bone displacement, the number of bone fragments, whether or not the break is "intra-articular" (involves the wrist joint), as well as the person's age, gender, and medical history, and may range from two months to a year or more for complete recovery.[1] EpidemiologyColles fractures occur in all age groups, although certain patterns follow an age distribution.
HistoryThe Colles fracture is named after Abraham Colles (1773–1843), an Irish surgeon, from Kilkenny who first described it in 1814 by simply looking at the classical deformity before the advent of X-rays.[13] Ernest Amory Codman was the first to study it using X-rays. His article, published in the Boston Medical and Surgical Journal, now known as The New England Journal of Medicine, also developed the classification system.[14][15] See also
References1. ^1 2 3 4 5 6 7 8 9 10 11 12 {{cite web|title=Distal Radius Fractures (Broken Wrist)|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00412|website=orthoinfo.aaos.org|accessdate=12 October 2017|date=March 2013|deadurl=no|archiveurl=https://web.archive.org/web/20170702084652/http://www.orthoinfo.aaos.org/topic.cfm?topic=A00412|archivedate=2 July 2017|df=}} 2. ^1 {{cite web|title=Distal forearm 23-A2.2 CRIF|url=https://www2.aofoundation.org/wps/portal/surgery?showPage=redfix&bone=Radius&segment=Distal&classification=23-A2.2&treatment=&method=CRIF%20-%20Closed%20reduction%20internal%20fixation&implantstype=K-wires%20and%20cast&approach=&redfix_url=1428651445110&Language=en|website=www2.aofoundation.org|accessdate=13 October 2017|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20171013172626/https://www2.aofoundation.org/wps/portal/surgery?showPage=redfix&bone=Radius&segment=Distal&classification=23-A2.2&treatment=&method=CRIF%20-%20Closed%20reduction%20internal%20fixation&implantstype=K-wires%20and%20cast&approach=&redfix_url=1428651445110&Language=en|archivedate=13 October 2017|df=}} 3. ^1 {{cite book|last1=Pfenninger|first1=John L.|last2=Fowler|first2=Grant C.|title=Pfenninger and Fowler's Procedures for Primary Care E-Book: Expert Consult|date=2010|publisher=Elsevier Health Sciences|isbn=1455700924|page=1292|url=https://books.google.ca/books?id=loI3ZhC4UN4C&pg=PA1293|language=en|deadurl=no|archiveurl=https://web.archive.org/web/20171013224533/https://books.google.ca/books?id=loI3ZhC4UN4C&pg=PA1293|archivedate=2017-10-13|df=}} 4. ^1 {{cite journal|last1=Oussedik|first1=S|last2=Haddad|first2=F|title=Manipulation and immobilization of Colles' fractures.|journal=British journal of hospital medicine (London, England : 2005)|date=September 2005|volume=66|issue=9|pages=M34-5|doi=10.12968/hmed.2005.66.Sup2.19718|pmid=16200794}} 5. ^1 2 3 4 5 6 {{cite journal|last1=Blakeney|first1=WG|title=Stabilization and treatment of Colles' fractures in elderly patients.|journal=Clinical Interventions in Aging|date=18 November 2010|volume=5|pages=337–44|doi=10.2147/CIA.S10042|pmid=21228899|pmc=3010169}} 6. ^Colles A 2006 On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:181. Clin Orthop Relat Res 445:5-7. 7. ^1 {{Cite book|url=https://www.worldcat.org/oclc/876669045|title=Orthopedic imaging : a practical approach|last=Adam,|first=Greenspan,|others=Beltran, Javier (Professor of radiology),|isbn=1451191308|edition=Sixth|location=Philadelphia|oclc=876669045}} 8. ^{{cite web|url=http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|title=Colles' fracture|last=GP Notebook|first=|authorlink=|date=|work=|publisher=|format=|doi=|accessdate=2009-02-21|coauthors=|deadurl=no|archiveurl=https://web.archive.org/web/20110613225247/http://www.gpnotebook.co.uk/simplepage.cfm?ID=1584070660|archivedate=2011-06-13|df=}} 9. ^Solomon et al., Apley's system of orthopaedics and fractures, 9th ed., p.772 10. ^{{Cite book|url=https://www.worldcat.org/oclc/706805938|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=9780892035793|location=Rosemont, Ill.|oclc=706805938}} 11. ^{{cite web|url=http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|title=Adult Distal Radius Frx: Non Operative Treatment - Wheeless' Textbook of Orthopaedics|format=|work=|accessdate=|deadurl=no|archiveurl=https://web.archive.org/web/20110423051431/http://www.wheelessonline.com/ortho/distal_radius_frx_position_of_immobilization|archivedate=2011-04-23|df=}} 12. ^{{cite journal|last=Blakeney|first=William|title=Stabilization and treatment of Colles’ fractures in elderly patients|journal=Clinical Interventions in Aging|date=November 2010|pages=337–44|doi=10.2147/CIA.S10042|pmid=21228899|volume=5|pmc=3010169}} 13. ^{{WhoNamedIt|synd|2152}} 14. ^{{Cite book| publisher = Saunders| isbn = 978-0-7216-8461-1| last = Mallon| first = Bill| title = Ernest Amory Codman : the end result of a life in medicine| location = Philadelphia| year = 2000}} 15. ^{{Cite journal| doi = 10.1056/NEJM190009271431301| issn = 0096-6762| volume = 143| issue = 13| pages = 305–308| last = CODMAN| first = E. A.| title = A Study of the X-Ray Plates of One Hundred and Forty Cases of Fracture of the Lower End of the Radius| journal = The Boston Medical and Surgical Journal| year = 1900}} External links{{Medical resources| Synonyms = | ICD10 = {{ICD10|S|52|5|s|50}} | AO = 23-A2.2 | MeSH1 = 68003100 }}
2 : Bone fractures|RTT |
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