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Colle’s Fracture

  1. Colle’s fracture is fracture of lower end of radius at its cortico cancellous junction (~2.5cm / 1.5 inch above the distal articular surface) mostly occuring in post menopausal osteoporotic elderly women; as a result of fall on outstretched hand, with wrist in extension .
  2. It is most common of all fractures in older people.
  3. Mechanism of Injury & Displacements of Colle’s Fracture
    1. On falling on to the out stretched hand with wrist in extension, the thenar eminence takes the brunt of force.
    2. This results in fracture of lower end of radius, rotating it in to supination with the centre of rotation at the ulnar styloid. If the force continues the ulnar styloid is avulsed and triangular —fibro- cartilage- complex (TFCC) is injured.
      1. Dorsal displacement - Dorsal tilt
      2. Lateral displacement- Lateral tilt
      3. Impaction (Proximal shift)
      4. Supination (Best seen in CT Scan)



Dinner fork deformity

Colle’s Fracture reduction

 Pronation, Ulnar deviation & Palmar angulation. (PUP)


That’s why position of immobilization on in colle’s fracture is Pronation, Ulnar deviation & Palmar angulation.(PUP)

  1. Complications of Colle’s Fracture
    1. Joint Stiffness
      1. Finger stiffness is most common complication.
      2. Wrist, elbow, and shoulder are other joints to become stiff.
    2. Malunion is the 2” most common complication and it leads to dinner fork deformity.
    3. Sudeck’s osteodystrophy / Reflex sympathetic dystrophy.
      1. It is quite common but seldom progress to full blown picture of sudeck’s atrophy.
      2. Colle’s fracture is the commonest cause of sudeck’s dystrophy in upper limb.
    4. Shoulder Hand Syndrome: may be related to sudeck’s dystrophy. It is characterised by a swollen, painful, stiff hand and a frozen shoulder. The patient refuses to use the upper limb and there is probably always a psychological basis, a mental amputation, having been performed by the patient.
    5. Rupture of extensor pollicis longus tendon.
    6. Carpal tunnel syndrome causing median nerve compression.
    7. Carpal instability
    8. Triangular-fibro cartilage — complex (TFCC) injury and subluxation of inferior radioulnar joint.
    9. Delayed union and nonunion are extremely rare.

Reflex Sympathetic Dystrophy (RSD) / Sudeck’s Osteoneuro Dystrophy / Algodystrophy / Complex regional pain syndrome (CPRS-1)

  1. It is a group of vague painful conditions observed as a sequelae of trauma. The trauma is some times relatively minor and signs and symptoms are out of proportion of the trauma.
  2. It is characterized by pain, hyperaesthesia, swelling, stiffness, discolouration, and trophic changes wihich are out of proportion to the inciting event

  1. The most characteristic symptom is pain out of proportion to the inciting event in both severity and duration. It is often burning in character. Hence the term ‘Causalgia’ which means burning pain.
  2. Due to hypeaesthsia to light touch, patients often withdraw when one attempts to examine the affected extremity Swelling is the most consistent physical finding.
  3. Stiffness and discolouration of skin (red, blue &/or pallor) are other classic signs.
  4. Trophic skin changes i.e. skin is shiny, thin with loss of normal wrinkles and creases are characteristically seen late.
  5. The most common radiographic finding is localized osteopenia because of increased blood flow to the bone
  6. Prognosis is directly related to the time to diagnosis and initiation of therapy. The goal is to break abnormal sympathetic reflex and to restore motion.
  7. Vitamin C is found useful in prevention of RSD.
  8. The abnormal sympathetic response is interrupted by the use of sympatholytic drugs eg. a - adrenergic blockers, local somatic nerve blocks, (Bier’s block, axillary block), stellate ganglion blocks, or surgical sympathetectomy
  9. Active and passive range of motion should be performed to the level of discomfort but not pain
  10. Recovery is prolonged & painful both for patient and surgeon. 3 years usually elapse before the bones are remineralized & it is rare that full range of movements returns.

Smith’s Fracture

  1. Fracture of distal third of radius with palmar (anterior or ventral) displacement & tilt. Hence it is called reverse Colle’s fracture
  2. Garden spade deformity.
  3. Ventral (anterior or palmar) displacement & tilt
  4. CR & immobilization in AE cast with forearm in supination and wrist in extension

Extra Edges


Distal Radius Fractures

  1. Colle’s Fracture
    Fracture of distal metaphysis of radius, with dorsal displacement & angulation
  2. Smith’s Fracture
    Dorsally angulated fracture of distal radius, with the hand and wrist displaced volarly with respect to the forearm
  3. Barton’s Fracture
    A fracture dislocation in which the carpus and a rim of distal radius are displaced together. So it is a subluxation of inferior radio ulnar joint (wrist) because of a fracture through the articular surface of the carpal extremity of radius.
  4. Chauffeur’s Fracture
    A radial styloid fracture, which initially was sustained by person operating automobiles.

Chauffeur’s Fracture

Carpal Injuries

  1. Fracture Scaphoid
    1. Scaphoid is the most commonly fractured bone in the carpus, in adult as well as children. However unlike in adults and adolescents, the fracture is rare in young children. (because of cartilagenous nature of carpal bones in children).
    2. Scaphoid fracture is seen most commonly in males between the ages of 15 and 30. (adolscents & adults).
    3. Scaphoid may be divided into proximal, middle and distal thirds. The middle third is termed the waist. The scaphoid tubercle forms the distal volar prominence.



Scaphoid cast immobilization -glass holding

Fixation with Herbert screw (Headless)

  1. Middle third (Waist)fractures are most common accounting for - 70% of scaphoid fractures > proximal pole fracture (20%) > distal pole fracture (10%), in adults & adolescents.
  2. Distal pole avulsion type fracture is most common fracture type in children.
  3. Because the scaphoid articulates with four carpal bones & radius, most of its surface is composed of articular cartilage. Therefore, the vascular supply comes through a narrow non articular region in the waist. Most of the blood supply to the scaphoid enters distally, so blood supply of scaphoid diminishes proximally. This accounts for the fact that 1% of distal third, 20% of middle third, 40% of proximal third and 100% of proximal pole fractures result in avascular necrosis or non union of the proximal fragment.
  4. The patient is usually and adolescent boy or young adult who gives a history of falling on outstretched hand usually during active sports. Commonly the injury is misinterpreted as “just a sprain”. Like colle’s it is a supination — dorsiflexion injury.
  5. Fullness & tenderness in anatomical snuff box. Radial side wrist pain; passive dorsiflexion to the radial side is painful, grip is weak and release of grip gives transitory pain, resisted pinch between the thumb and index finger is uncomfortable. Proximal pressure along the axis of the thumb may be painful.
  6. Bone scan, trispiral tomography are other investigations; occult scaphoid fractures can be reliably diagnosed by MRI & nucleotide scan.
  7. Stable and undisplaced fractures are treated by scaphoid cast immobilization -glass holding
  8. A displaced fracture, by definition, is one with > 1 mm of step-off or >60°of scapholunafe or >15° of lunatocapitate angulation treated by percutaneous screw fixation or OR & IF by k — wires, compression screw or Herbert screw.


Scapholunate dissociation, Terry – Thomas sign

Cast Used In
Minerva Cast Cervical spine
Risser’s cast, Turn buckle cast Scoliosis
Shoulder spica Shoulder immobilization
U Slab, Hangign Cast Fracture shaft humerus
Colle’s cast Fracture lower end radius
Glass holding cast Fracture scaphoid
Hip spica Hip immobilization & fracture shaft femur
Cylinder (Tube Cast) Fracture patella
PTB cast Fracture tibia

Perilunate Dislocation

  1. Relative Incidence of Carpal Bone Fractures
  2. Scaphoid > Triquetral
  3. Wrist Dislocation
    1. Perilunate is the most common, wrist dislocation.
    2. The most common type of perilunate instability is trans scaphoid perilunate fracture dislocation.
    3. Median nerve is most commonly involved nerve.
    4. The most commonly used method of closed reduction is Tavernier’s maneuver.
Thumb- Carpo - Meta Carpal (CMC) Fracture Dislocations
The majority of thumb CMC joint injuries are fracture dislocations rather than pure dislocations. The majority of thumb metacarpal base fractures are intra articular. These intra- articular fractures are of two types- 


Bennett’s Fracture Dislocation

  1. It is partial articular fracture of 1st metacarpal base with trapezium-metacarpal joint dislocation
  2. The displacement is driven primarily by abductor pollicis longus and adductor pollicis.

Rolando’s Fracture Dislocation



It is complete articular fracture of base of 1st metacarpal. It involves whole articular surface with comminuted T or Y intra articular fracture.

SKIERS THUMB/Game Keeper’s Thumb

  1. It is sprain or rupture of ulnar collateral ligament (UCL) of first metacarpophalyngeal joint. It is the most common injury of MCP joint.
  2. This injury occurs when the thumb is forced into radial deviation stressing the ulnar collateral ligament. The interaction between the thumb and first web space with skie pole grips has been blamed for the associated of UCL rupture in this sport.
  3. When UCL tears from its phalangeal insertion, the adductor pollicis aponeurosis may become interposed between the retracted ligaments preventing healing of the ligament to the proximal phalanx with closed treatment (Stener’s lesion)
Game Keeper’s Thumb, UCL Tear


Zones & Pulleys of Hand


Lies Between


Distal to insertion of flexor digitorum superficialis


Between flexor crease of PIP joint and distal palmar crease


Between end of carpal tunnel & beginning of flexor-sheath


With in the carpal tunnel


Proximal to the carpal tunnel

Zones & Pulleys

Zone II- Situated between the opening of the flexor sheath (the distal palmar crease) and insertion of flexor superficialis (flexor crease of proximal interphalangeal joint) is known as ‘no man’s land’ or dangerous area of Hand. The results of flexor tendon repair is worst in this area because both superficial and deep tendons run together in a tight sheath and passes through the pulleys.
Flexor Tendon Sheath & Pulleys
  1. Fibrous pulleys-designated AI to A5 holds the flexor tendons to the phalanges and prevent bowstringing during movement.
  2. A1, 3 and 5 are attached to the palmar plate near each joint MP, PIP & DIP.
  3. A2 and 4 have a crucial tethering effect and must always be preserved or reconstructed.
  4. A1 pulley is involved in trigger thumb

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