Know About Juvenile Colles? Fracture

Posted by Siiora on September 18th, 2018

Types of injury

In most cases two types of injuries can take place.

        I.            Epiphyseal separation: There may be fracture separation of the epiphysis.

A triangular piece of metaphysis is separated along with the epiphysis.

     II.            Crushing injury of epiphysis: Theepiphysis can be crushed and fragmented.

 

Complication

Growth disturbance of the radius may develop. This is more likely to occur following a crushing injury as a result of premature fusion. The ulna proceeds to develop normally while the radius lags behind. This results in the development of bowing of the ulna and the end product is a deformed forearm.

TREATMENT

Displaced epiphysis is reduced on the same principle as the Colles’ fracture. Immobilization is maintained for a period pf 6 weeks. The case should be followed for a long period, with check x-rays at intervals of 5-6 months to detect any hazard of epiphyseal injury.

SMITH’S FRACTURE OR REVERSED COLLES’ FRACTURE

This is a transverse fracture at the distal end of the radius with anterior shift of the fracture segment. This type of lesion is comparatively rare.

MECHANISM OF INJURY

This is the result of direct violence on the posterior aspect of the distal end of the radius. It can also develop after a fall on a hyperflexed wrist.

X-RAY

The fracture line passes in a transverse direction and the distal fragment is displaced anteriorly and laterally.

TECHNIQUE OF REDUCTION

       I.            Traction: Traction and counter-traction are applied by holding the hand and forearm. During this procedure the forearm of the patient is maintained in a supine position.

     II.            Reduction: Reduction is obtained by applying pressure on the distal end of the radius directed posteriorly while supporting the back of the wrist-joint with the other hand. Any lateral shift is corrected by pressure.

  III.            Immobilization: Immobilization is maintained by applying a plaster cast with the hand in the supine position. The wrist-joint is placed in a slightly dorsiflexed and ulnar deviated position. The plaster extends from above the elbow up the heads of the metacarpal bones. The elbow is maintained at an angle of 90⁰.

 

AFTER CARE

This is based on the same principle as the Colles’ fracture.

FRACTURE OF THE RADIAL STYLOID PROCESS

The radial styloid process may sustain fracture due to lateral compression force.

NATURE OF INJURY

It is important to recognize the nature of lesion. The fracture line is oblique and the segment may be undisplaced, moderately displaced or of a severely displaced variety. The fracture involves the articular surface of radius and any defective union will lead to instability of the wrist-joint.

REDUCTION

Displaced fracture is reduced under general anesthesia. Traction is applied and the displacement is reduced by applying pressure over the fracture segment.

IMMOBILIZATION

A short arm plaster is applied which extends up to the heads of the metacarpal bones with the forearm in mid-prone position.

MARGINAL FRACTURE OF RADIUS

Marginal fracture may involve the anterior or posterior margin of the distal end of radius. This type of fracture happens following hyperflexion or hyperextension injury of the wrist-joint.

IMMOBILIZATION

Most of these fractures unite after being immobilized in short arm plaster for a period of 6 weeks. The basic principles of management are the same as that of Colles’ fracture.

The article is edited by Siora Surgicals team. Siora is an orthopedic implant importer in Indonesia.

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