Makindo Medical Notes

Typically follows a fall on an outstretched hand, commonly seen in elderly patients with associated degenerative bone disease.

Clinical Features

• Deformity: Described as “dinner-fork” with swelling on the dorsal surface of the wrist.
• Neurological Assessment: Assess distal neurological function, focusing on the median nerve .

Neurological Function Overview

Nerve	Motor Function	Sensory Function
Median	Adduction, flexion, and opposition of the thumb (Thenar eminence).	Thenar eminence of the thumb.
Radial	Active wrist extension.	Radial border of the index finger.
Ulnar	Abduction and adduction of intrinsic hand muscles at the MCPJ.	Ulnar border of the little finger.

Vascular Assessment

Assess and document distal vascular function.

X-Ray Findings

• Fracture Features: Fracture of the distal radius with dorsal angulation of the distal fragment.
• Impaction: On AP view, the radial styloid should be 1cm distal to the ulnar styloid.
• Angulation: On lateral view, the normal joint line tips forward by 5°.

Management

• Adequate Analgesia: Ensure effective pain relief.
• Immobilisation:
• Apply a wrist splint.
• Use a broad arm sling for support.
• Referral: Patients not requiring manipulation should be referred to the virtual fracture clinic (VFC).

Indications for Manipulation

1. Displacement of ulnar styloid.
2. Impaction where the radial styloid is less than 1cm distal to the ulnar styloid.
3. Angulation where the joint line tips backward by more than 10° (15° from normal position).
4. Distal neurological deficit on examination.

Colles fractures are manipulated to preserve function. The threshold for manipulation is patient dependent. Patients unfit for general anaesthesia (GA) can have their fracture manipulated under procedural sedation. All patients requiring manipulation should be referred to the on-call orthopaedic service.