• Colles’ Fracture

• Smith’s Fracture
• Barton’s Fracture
• Described by Abraham
Colles in 1814.
• It is the most common of all
fractures in elderly.
• Usually in older women.
• Fall on a out stretched hand.
 Colles’ Fracture
It is a Transverse fracture of the distal end of the
radius at its Cortico-Cancellous Junction with
typical Dorsal Displacement of the distal
fragment.
Relevant Anatomy
• Distal end of the radius
articulates with the carpal
bones and the ulna
• Normally the articular
surface of radius faces
ventrally and medially.
• Tip of radial styloid is 1cm
distal to the tip of the ulnar
styloid.
Mechanism of Action
• History of fall on an
outstretched hand
• Force is applied in the length
of the forearm with the wrist
in extension
• Fracture occurs transversely
at the cortico-cancellous
junction.
The distal fragment collapses into-
• Dorsal Displacement
• Dorsal Tilt
• Lateral/Radial Displacement
• Lateral/ Radial Tilt
• Supination
• Impaction of Fragments

Also associated with extension and shortening.

 Associated injuries
• Fracture of styloid process of ulna
• Rupture of the Ulnar collateral ligament
• Rupture of the triangular Fibro-cartilage complex
(TFCC) of ulna.
• Rupture of the interosseos, radio-ulnar ligament
causing radio-ulnar subluxation.
 Clinical Features
• Pain, tenderness, swelling and irregularity of the
lower end of radius.
• “Dinner Fork Deformity”
• Radial styloid comes at the level of the ulnar
styloid.
Dinner Fork Deformity
 Radiological findings
• Transverse fracture of the distal end radius at cortico-
cancellous junction.
• The distal fragment shows –
a)Dorsal tilt & displacement – Lateral View
b)Lateral tilt & Displacement – AP View
• Maybe associated with communition or broken
ulnar styloid process.
Dinner Fork Deformity
 Treatment

Undisplaced Displaced Communited

Fractures Fractures Fractures

1. Transfixed
Closed using two K-
Immobilization in Manipulation Wires within the
below elbow reduction plaster
plaster cast for 6 followed by 2. External fixator
week immobilization in 3. Locking
Colles’ Cast compression
plate
Closed reduction and
manipulation

• Under general or
regional anesthesia.
• “Shaking Hand
Position”
a.Firm longitudinal
traction to disimpact.
b.Distal fragment into
palmar flexion and
Ulnar deviation.
 Colles’ Cast
• Colles’ Cast is used to immobilize undisplaced or
reduced fracture.
• It is below elbow cast with
a.Palmar Flexion
b.Ulnar Deviation
a.

b.
 Complications
Early Late
• Circulatory Problems • Malunion
• Carpal tunnel • Delayed Union and
syndrome – Median Non-union
Nerve injury • Stiffness
• Reflex sympathetic • Extensor Pollicis
dystrophy Longus Tendon
• TFCC injury rupture
• Subluxation of
inferior radio ulnar
joint
 Smiths Fracture
• Reverse of Colles’ Fracture
• Ventral tilt and displacement of the Distal
fragment
• Clinical features - “Garden Spade Deformity”
• X-Ray – Ventral tilt and displacement

• Treatment-
Conservative - closed reduction and proper cast
immobilization for 6 weeks.
Surgical - K-wire or plate is used.
 Barton’s Fracture
• Intra- Articular fracture of distal radius.

• Depending upon the type of displacement-

a)Volar Barton’s (Anterior type)
b)Dorsal Barton’s (Posterior type)
• Extends from articular surface of the radius to either
its anterior and posterior cortices.
• The small distal fragment is displaced along with the
carpals.

• Treatment
a) Closed Reduction and Plaster Cast
b) Internal Fixation by Plate or K-wire
 Apley’s System of
Orthopaedics and Fractures
– 9th edition

Essential Orthopaedics –
Maheshwari & Mhaskar
– 5th edition