CASE PRESENTATION OF TYPE COLLES’ FRACTURE

CASE PRESENTATION OF 

TYPE COLLES’ FRACTURE

INTRODUCTION:

           This (Colles’ Fx) kind of fracture is very common. In fact, the radius is the most commonly broken bone in the arm. The break usually happens when you fall and land on your outstretched hands. It can also happen in any other types of fracture. Sometimes, the other forearm bone (ulna) is also broken. When this happens, it is called as a distal ulna fracture.

           This fracture was described by an Irish surgeon and anatomist, Abraham Colles, in 1814; hence the name, Colles’ fracture.

ANATOMY:

CLASSIFICATION:

Frykman classification is based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture.

AO classification:

 PATIENT INFORMATION:

Ø  Patient - ‘X’

Ø  Age - 63 years/ Female

Ø  Date of Admission: 10/01/2019

Ø  Date of Surgery: 16/01/2019

CHIEF COMPLAINT:

    The patient had pain, swelling, and tenderness over the left distal part of the forearm (wrist). The patient had restricted left wrist movements and inability to use since fall (08/01/2019).

HISTORY OF PRESENT ILLNESS:

    The patient had restricted left distal part of forearm (wrist) movements and inability to use left distal part of forearm since fall. The patient gave a history of slip and fall in the street. Since then patient complaints of pain, swelling, range of movements restricted.

            After the injury patient went to the nearby hospital, treated conservatively (analgesics and cast). The patient had no relief, came to our hospital for further management. The patient was examined by traumatologist and got admitted in the traumatology department. X-ray was taken and it showed a communited fracture distal radius and fracture styloid process with displacement.

v Previous Injury: The patient gave a history of brain injury after an accident in 2017.

v Developmental History: No any developmental histories

v Drug History: No known drug allergies. The patient is on treatment for CVS.

v Past Medical History: The patient gave a past medical history of Ischemic heart diseases, Cardiosclerosis, Arterial Hypertension II, Risk III.

No DM; No Asthma; No thyroid disease.

v Past Surgical History: Removal of the tumor from the parietal bone in 2017. No, any blood transfusion.

ON EXAMINATION:

Patient is conscious, oriented.

Vital Signs:

·       BP – 130/80 mmHg

·       PR – 80/min

·       SPO2 – 98%

LOCAL EXAMINATION:

·       Pain and Swelling over the left distal part of the forearm are present.

·       Tenderness and Crepitus over the left distal part of the forearm are present.

·       The range of Motion of left distal part of the forearm is restricted.

·       Any attempted movements painful.

·       Active finger movements present.

·       Distal pulse present.

X-RAY FINDING:

On 08/01/2019:

On 10/01/2019 (after getting admitted in our hospital with cast):

TREATMENT:

There are different types of treatments for this kind of fractures.

Ø  Nonoperative – Cast.

Ø  External Fixator. (operative)

Ø  Closed reduction – K-wire fixation with cast/ex-fix. (operative)

Ø  Open reduction internal fixation (ORIF) – Palmar bridge plate. (operative)

For this patient, we chose ORIF with plate and screws (operative method) because

·       Unacceptable shortening / dorsal inclination.

·       Extensive metaphyseal comminution

PREPARATION:

Patient in Supine position: Position the patient supine and place the forearm table.

SKIN INCISION:

Palmar Approach:

         

          

        

POSTOPERATIVE X-RAY:

AP view:                                                                  LAT view:

             

CLASSIFICATION:

Ø  According to AO Trauma Classification – 23.A3

Ø  According to Frykman Classification – 2

 CONCLUSION:

Ø  Early surgery, good anatomical reduction, and internal fixation help to recover the full range of movements. POP cast has been given to stabilise the ulnar styloid process  

Ø  Stability is RESTORED.

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