- General Discussion:
    - frx was described by Abraham Colles in 1814, originally described as low energy extra articular frx of distal radius occuring in elderly individuals;
          - frx is typically dorsally displaced and angulated;
    - mechanism:
          - fracture is also caused by a forced dorsiflexion of the wrist;
          - occurs in pts > 50 years of age who fall on out stretched hand;
          - dorsal surface undergoes compression while volar surface undergoes tension; 
    - incidence:
          - Incidence of Colles' Fracture in a North American Community
          - Incidence of distal forearm fracture in British men and women.
          - Fracture risk in the U.S. Medicare population.
          - Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong?
    - classification:
          - Frykman Classification
          - Melone Classification
          - Universal Classification
    - associated injuries: 
          - ulnar styloid frx
                 - Repair of the triangular ligament in Colles' fracture. No effect in a prospective randomized study.
                 - Effect of an Unrepaired Fracture of the Ulnar Styloid Base on Outcome After Plate-and-Screw Fixation of a Distal Radial Fracture
                 - Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures.

          - TFCC tear
                   - according to the report by Richards, et al (1997), TFCC tears occurred in 53% of extra-articular distal radius fractures vs
                            35% of intra-articular fractures; 
          - scapholunate dissociation:
                   - Intercarpal Ligament Injuries Associated with Fractures of the Distal Part of the Radius

- Physical Exam and Evaluation 

- Radiographic Findings:
    - x-ray appearance is that of a dorsally angulated fracture of distal radial metaphysis  (2-3 cm proximal to wrist joint),
           w/ or w/o associated frx of ulnar styloid;
           - initial frx line is almost always on volar side & is single line; 
    - determination of stability:
           - intra-articular component 
           - radial shortening 
           - dorsal angulation 
           - radial inclination 
           - distal radioulnar subluxation and/or ulnar styloid frx
                 - in stable extra-articular fractures, there will often be frx extension into the DRUJ, which is the most likely source of symptoms;
           - scapholunate dissociation:
                 - ref: Scapho-Lunate Diastasis: A Component of Fractures of the Distal Radius.  
           - comminution:
                 - dorsal surface is frequently comminuted;
                 - if comminution extends volar to midaxial plane of radius, then cast immobilization will frequently fail;
                 - expect increase in comminution w/ incr in amount of dorsiflexion;
                        - high-loading angles, (70-90 deg), have much more comminution than low loading angles of 20 to 40 deg;
                 - as noted in the study by Trumble, et al (1998), external fixation provided clear advantages in specific situations;
                        - in older patients, pain relief, grip strength, and ROM were significantly better when external fixation was used;
                        - in younger patients, external fixation provided consistently better results when there was comminution in 2 or more cortices;
                 - references:
                        - An effective treatment of comminuted fractures of the distal radius.
                        - Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation.

- Treatment:
     - Non Operative Treatment /  colles fracture reduction 
     - Percutaneous Pinning
     - External Fixators for Distal Radius Fractures 
     - ORIF of Intra-Articular Distal Radius Fractures

- Late Complications:
     - extensor pollicis longus rupture 
     - RSD
            - often RSD following colles fractures will result from over distraction of an external fixator;
            - in the presentation by Stoffelen D and Broos PL (15th Annual Meeting of the Orthopaedic Trauma Association 1999), the
                      authors found  use of calcitonin to be helpful in treating this disorder; 
            - vitamin C:
                      - Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures?
                      - Testing the Validity of Preventing Complex Regional Pain Syndrome With Vitamin C After Distal Radius Fracture

     - loss of reduction and secondary deformity;
     - median nerve compression; 
            - Predictors of Acute Carpal Tunnel Syndrome Associated With Fracture of the Distal Radius 
     - malunion 
     - distal radioulnar joint injury;
            - extension of Colles frx into the RU joint has a worse prognosis;
            - in stable extra-articular fractures, there will often be frx extension into the DRUJ, which is the most likely source of symptoms;
            - patients may note:
                   - weak grip;
                   - localized pain;
                   - loss of supination;
            - ref:  The Distal Radio-Ulnar Joint in Colle's Fracture.  

- References