Wrist Case Study 1: Colles Fracture

Anatomy & Pathology

Colles fracture – distal radial fracture most commonly occurring fracture in adults –
common type – upward and dorsal fracture – FOOSH – common in older people
assosciated with osteoarthritis – common in post menopausal woman – usually
spinted.

Initial bone repair , union -> 4-6 weeks

Consolidation -> 8-12 weeks – movement can commence

Subjective Examination
Where\What : distal radius – expect dull ache around wrists

When: 8 weeks

How: FOOSH

0-10 rating: decreasing

24 hour cycle: n/a

Better for: movement

Worse for: rest

Type of pain: was acute , sharp – ask patient, “any tingling”? median nerve
compression – now dull ache.

Past Medical History/ General History:

Red Flags and general concerns: weight loss – adverse outcomes : malunion , loss
of ROM

SH: seamstress

DH: check ?

Patients main outcome: return to work

Objective Examination

Working Hypothesis: check for ROM , malunion , decreased grip strength

& median nerve compression.

Advice & Consent: give and obtain

General Observations: using arm at all ?

Acute Observations:
Skin problem – problem at fracture – check if still an issue
Swelling – problem at fracture – check if still an issue
Posture – examine
Muscle bulk – check
Deformity – may have been a problem at fracture - check

Active Tests: have patient sitting opposite/corner

Flexion – possible shooting pain
Extension
Pronation
Supination

Passive Tests: feel for malunion

Flexion – possible shooting pain
Extension – may lack range – can be long term
Pronation & supination – may lack range – can be long term

Resisted Tests:
Loss of strength possible
Flexion
Extension
Pronation & Supination – weakness expected
Special Tests: check for median nerve entrapment
Tinels sign – if tingling made worse by tapping along median nerve
Phalens test – hold reverse prayer position for 1 min – tingy or worse is a +’ve sign

Functional Tests:
Dexterity test – grip ball , pick up key
Strength – lift large items
Endurance 0 lift large items repeatedly

Palpation:
Expect tenderness around radial head
Percussion checks for malunion – pressure , if displacement of radius elicts sharp
acute pain , there could be malunion

Measurements: measure grip with gripometer, measure any restriction in

ROM

Advice & Possible Treatment:

6 months from fracture , pt should have full functioning wrist , but may lack full
movement especially in extension and supination

treatment – NSAIDS, ice advise injury may be more painful after exam