Pediatric Orthopedic Surgeons treating Colles Fracture

COLLES FRACTURE

A Colles fracture defines a break in the radius bone — close to the wrist. It was named for the surgeon who first described it. Typically, the break appears about an inch (2.5 centimeters) below where the bone joins the wrist. Pediatric orthopedists consider a Colles fracture as a common fracture that happens more often in women than men.

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Colles Fracture 

Colles FractureWhen the radius bone in your forearm fractures near the wrist, it results in a Colles wrist fracture. Other names for it include transverse wrist fracture, dinner-fork wrist deformity, and distal radius fracture. The radius is the bigger of the two major bones in the forearm. The end of the radius closest to the wrist is the distal portion. When your child suffers from a Colles wrist fracture, the distal end fractures, which may result in an unnatural bend in the wrist. This injury causes pain. The wrist will swell, and your child might not hold or grasp an object without pain. Bruising might occur as well. Young children, with fragile bones may incur this sort of fracture.

Surgery can effectively cure it; however, recuperation could take a while. Colles fractures typically happen following a fall onto an extended hand. When your child extends his or her hand when falling, the force may affect the tiny bones that make up the hand and wrist, especially two bones called the lunate and scaphoid. Your child’s radius becomes impacted and breaks at the dorsal end, which is located close to the wrist. This fracture normally occurs an inch or so from the end of the radius, and it tilts the damaged bone upward.

Symptoms

The following are typical signs of a Colles fracture:

  • Pain
  • Swelling
  • Bruising
  • Tenderness
  • Deformed dangling at the wrist

QUESTIONS AND ANSWERS

What is a Colles fracture in a child, and how does it occur?

A Colles fracture is a specific type of wrist fracture characterized by a break in the radius bone, which is one of the two bones in the forearm. In children, this fracture can occur due to a fall on an outstretched hand or a direct impact on the wrist during activities such as sports or play. The force placed on the wrist can cause the radius bone to break near the wrist joint, resulting in a Colles fracture.

What are the common symptoms of a Colles fracture in a child?

The symptoms of a Colles fracture in a child may include severe pain, swelling, bruising, tenderness, and difficulty moving or using the wrist. The child may have a visibly deformed or angulated wrist due to the fracture. In some cases, there may be a noticeable “dinner fork” deformity where the wrist appears bent upward.

How is a Colles fracture in a child diagnosed and treated?

Diagnosis of a Colles fracture in a child involves a physical examination, medical history review, and imaging studies such as X-rays or, in some cases, a CT scan. Treatment typically includes immobilizing the wrist with a cast or splint to allow the fracture to heal. The child may need to avoid using the injured hand and wrist during the healing period. Pain management, physical therapy, and follow-up appointments with a pediatric orthopedic specialist are crucial components of the treatment plan to monitor healing progress and ensure proper recovery.

When children break bones, parents need to take them to the very best doctors.  At the Medical City Children’s Orthopedics and Spine Specialists, we are the best.  We specialize in children and their bones.

Causes

If your child reaches out to break a fall, your child can incur a Colles fracture. Additionally, it may take place in an auto accident. The following are also potential situations that lead to children breaking bones.

  • Suffer osteoporosis, a bone-weakening disorder.
  • Possess a lack of agility and poor balance, or have little muscular mass or inadequate muscle strength.
  • All). Take a stroll, engage in other ice- or snow-related activities, or engage in motion-intensive sports like in-line skating and skiing.
  • Have insufficient vitamin D or calcium consumption.

Diagnosis

If a child’s arm hurts so much that it just hangs, the parents should take the child to see a doctor. If there is no deformity and the wrist is not particularly painful, parents could postpone seeing a doctor until the next day. Before a doctor can inspect it, it is advised to apply an ice pack to the wrist and keep it elevated. Before swelling happens, parents need to remove any rings from the child’s fingers. To determine whether any of the frequent causes of Colles fractures have happened, the doctor will inquire about the child’s activities. After that, they’ll look to see whether there are any blood vessels and nerves that have been injured. Doctors use the X-ray to diagnose fractured bones.

When it comes to understanding distal radius fractures, they are primarily classified into three distinct types, each with unique characteristics:

Type I

  • Commonality: This is the most common type, making up roughly 85% of all cases.
  • Description: Known as an extra-articular fracture, it occurs through the distal radius. Because it doesn’t extend into the joint, it is often easier to treat.

Colles Fracture Type II

  • Prevalence: Less frequent than Type I, this type comprises about 13% of cases.
  • Identification: Identified as an intra-articular oblique fracture, it extends into the joint. This type is also called a reverse Barton fracture and typically requires more complex management due to its involvement with the joint surface.

Type III

  • Prevalence: The rarest among the three, this type accounts for less than 2% of fractures.
  • Description: Known as a juxta-articular oblique fracture, it is located near the joint. Its rarity makes diagnosis and treatment a specialized task.

By understanding these classifications, medical professionals can provide targeted treatment plans.

Differential Diagnoses and Associated Injuries with Colles Fractures

When evaluating a Colles fracture, it’s crucial to consider various differential diagnoses and associated injuries that might complicate the treatment and recovery process. Here’s a detailed breakdown:

Common Associated Ligament Injuries

  • Scapholunate Ligament Tear: This injury involves the tearing of the ligament connecting the scaphoid and lunate bones, which can lead to instability in the wrist.
  • Triangular Fibrocartilage Complex (TFCC) Injury: Often seen in conjunction with fractures of the ulnar styloid, TFCC injuries can affect the connection and function of the wrist bones on the ulnar side.
  • Carpal Ligament Injuries: The most frequent is Scapholunate Instability, often accompanied by tears to the lunotriquetral ligament, leading to wrist instability.

Nerve and Tendon Injuries

  • Median Nerve Damage: This can result from direct trauma or swelling, causing numbness or tingling in the hand and fingers.
  • Extensor Pollicis Longus (EPL) Tendon Rupture: Though rare, prolonged friction or trauma can cause an attritional rupture, typically resolved with an Extensor Indicis Proprius (EIP) tendon transfer.

Fractures and Joint Issues

  • Ulnar Styloid Fracture: This fracture near the wrist can complicate stability and affect proper healing.
  • Distal Radial Ulnar Joint (DRUJ) Instability: Instability here can affect forearm rotation and function, requiring careful evaluation and management.
  • Galeazzi Fracture: Highly associated with fractures of the distal third of the radial shaft, this condition involves dislocation at the distal radioulnar joint.

Other Considerations

  • Compartment Syndrome: Although less common, it’s a critical condition that must be recognized early to prevent severe complications.

Understanding these potential injuries helps in tailoring a treatment strategy that ensures a comprehensive recovery path for patients with Colles fractures. Proper diagnosis and management of these associated injuries are essential to prevent longstanding complications.

Treatment Options

When treating a Colles fracture, the doctor’s goal is to put all the fractured bones back where they belong and keep them there until the fracture heals. There are several ways to accomplish this. Doctors use the following primary factors in considering how to treat the child:

  • Type and extent of the damage
  • The person’s age
  • Their activity levels

If the bones do not align properly, the doctor will recommend surgery. Your orthopedic surgeon places the bones into the appropriate position during this treatment, and one or more of the following is then used to maintain the bones in place:

  • Metal pins.
  • Plates.
  • Screws.
  • An external fixator

Physical Therapy

Parents may need to consult a physical therapist or occupational therapist, depending on the seriousness of their child’s injuries. Your doctor will provide exercises to assist your child’s wrist to restore strength and its usual range of motion.

At Home

Immobilizing your child’s wrist in a splint is the most crucial initial therapy. Parents may just support it by wrapping a magazine around their wrist. To stop the wrist from swelling and to stimulate healing, raise it above the level of your heart. Applying an ice pack to the wound also lessens swelling. Pain relief is possible with over-the-counter drugs like acetaminophen and ibuprofen. Avoid trying to straighten your wrist and keep it in a fixed position. Make an appointment with your doctor at Medical City Kids Ortho right away, or seek treatment at an urgent care facility. If your wrist is completely numb or the pain is extreme, get straight to the emergency department.

Non-Surgical Treatment

For the first few days, elevate your wrist by resting it on a pillow or the back of a chair above the level of your heart. This will reduce swelling and discomfort. For two to three days, place ice on the wrist to reduce swelling.  Do this for 15 to 20 minutes every two to three hours. While icing, take care to keep the cast or splint dry.

There is a comprehensive and detailed list of specific strengthening exercises tailored for post-operative rehabilitation of a Colles’ fracture. Here are some of the methods:

Detailed Exercise Instructions:

  • The following outlines a variety of strengthening exercises, including specific movements such as “Full fist,” “Hook,” “Table Top,” and “Pincer”. When recommended, each exercise is described with clear instructions on how to perform them, ensuring the reader understands the correct technique.

Progressive Exercise Regimen:

  • We recommend a phased approach to rehabilitation, suggesting progressions from basic exercises to more advanced ones like theraband exercises and dynamic strengthening with a weighted ball. This progression is crucial for effective rehabilitation.

Variety and Specificity:

  • Our physical therapy personnel offer a diverse range of exercises targeting different aspects of wrist rehabilitation, such as radial and ulnar deviation, dart-throwing motion, and proprioception training with tools like a tennis racquet and body blade. This variety ensures comprehensive recovery.

Use of Tools and Equipment:

  • There’s an emphasis on using specific rehabilitation tools like therapy, therabands, and hammers, which are often used in clinical settings to enhance recovery.

Frequency and Repetition Guidance:

  • Our physical therapy personnel provide recommendations on repetitions and frequency (e.g., “Aim for 2 x 12 repetitions 2 x per day”), offering a structured routine that patients can follow.

Inclusion of Proprioception Exercises:

  • Exercises such as using a soft pipe or tennis racquet for proprioception highlight the focus on regaining wrist stability and coordination, which is essential in post-operative rehabilitation.

Ask your physician about NSAIDs.

NSAIDs can aid in reducing pain and swelling. The negative effects of these medications include a higher risk of bleeding and ulceration. Unless your doctor advises differently, they should only be taken seldom as doing so might cause recovery to be delayed.

Practice stretching and strengthening exercises.

If your doctor advises it, perform stretches and shoulder, elbow, and finger strengthening exercises. These therapies will usually help your child. However, surgery is occasionally required for persons with fractured wrists. If the bone is not likely to mend well in a cast, your doctor could advise this. Sometimes holding the bone in place as it heals requires the use of pins, plates, screws, or other tools.

Surgical Treatment

Your doctor will advise surgery to treat a wrist fracture if it is serious. Pins, a plate, screws, or an external device that keeps the pins in place to straighten your child’s bones and hold them together. Doctors will conduct surgery if the bone is so misaligned that it cannot mend properly even with a cast. The most popular technique is referred to as reduction. An incision is created during the treatment to provide access to your child’s shattered bones. Following that, your surgeon straightens your child’s bones and closes the incision. For retaining the bone in the appropriate position as it heals, many solutions are depending on the fracture:

  • Metal pins
  • Plate and screws.
  • External fixator
  • Any combination of these methods.

What are the Goals of a Post-Operative Rehabilitation Protocol for Colles’ Fractures?

When addressing the healing process of Colles’ fractures, a structured rehabilitation protocol is crucial. Here’s what a comprehensive plan aims to achieve:

  • Alleviate Pain: Managing and reducing discomfort is a top priority to ensure a smoother recovery and improve patient compliance.
  • Enhance Joint Mobility: Gradually increasing the range of motion in the wrist, fingers, and elbow is vital. Initially, progress tends to be rapid, particularly over the first six months, helping the injured side regain comparable mobility to the uninjured side within about a year.
  • Safeguard the Recovery Area: Protecting the fracture site is essential to avoid reinjury and facilitate undisturbed healing.
  • Minimize Swelling: Controlling swelling helps in reducing pain and improving joint mobility, thereby accelerating rehabilitation.
  • Set Practical Goals: Establishing realistic expectations ensures that patients are motivated and not discouraged by the natural limitations of healing, especially since full grip strength may not be restored even when mobility is achieved.

By following this plan, patients can work towards regaining a functional level of activity, closely mirroring their pre-injury status.

Stages of Initial Rehabilitation for a Colles Fracture

Rehabilitating a Colles fracture involves several critical stages, each targeting specific recovery goals to enhance wrist function and mobility. Here’s a breakdown of these key stages:

1. Restoring Range of Motion (ROM)

Initially, the primary objective is to regain the normal range of motion. The process begins with passive ROM exercises—where the therapist gently moves the wrist for you—to minimize discomfort. As healing progresses, active ROM exercises become a focus, encouraging you to move your wrist independently within a pain-free range. These exercises are crucial for preventing the formation of scar tissue and adhesions that can restrict movement.

2. Pain and Swelling Management

Controlling pain and reducing edema (swelling) in the wrist and hand area are essential components of early rehabilitation. This might involve techniques such as ice therapy, compression, and elevation, alongside prescribed medication, to ease discomfort and minimize swelling.

3. Joint Mobilization

In addition to focusing on the wrist, it’s important to maintain movement in the adjacent joints. Exercises for the shoulder, elbow, and fingers are integral throughout all phases of rehab, ensuring no joint becomes stiff due to inactivity. This holistic approach ensures better overall arm function and supports the recovery of the wrist.

Additional Tips

  • Consistent Monitoring: Regular check-ups with your healthcare provider ensure exercises are being performed correctly and modifications are made as healing progresses.
  • Patience and Persistence: Recovery is a gradual process, and maintaining a balance between activity and rest is key to effective rehabilitation.

By following these stages, the path to recovery becomes structured, ensuring each phase builds upon the last, leading to a successful return of wrist function.

Recovery

The entire recovery from a Colles wrist fracture might take a year or longer. Usually, 3 to 6 months following surgery, your child can resume more strenuous activities. After the cast is removed, your child’s wrist will likely feel stiff for a month or two. For around two years, your child can continue to have dull pain or stiffness. Some children who have Colles wrist fractures go on to develop carpal tunnel syndrome. Following are some general pointers for a complete recovery:

  • Following the removal of the cast or following surgery, physical rehabilitation will begin.
  • Almost everyone who has a Colles wrist fracture will develop wrist stiffness.
  • It may take up to a year to fully recover from a Colles wrist fracture.

The following provides a comprehensive and detailed outline of the initial treatment protocol following Colles’ fracture surgery. It meticulously covers each step of the rehabilitation process, beginning with immediate post-operative care:

Communication with Surgeons:

  • It emphasizes the importance of close communication with the orthopedic surgeon to ensure proper treatment.

Rehabilitation Frequency:

  • The rehabilitation treatments occur 1-2 times per week, providing a structured timeline.

Day 1 Post-Op Care:

  • It includes specific actions such as removing the post-operative plaster, redressing the wound, fabricating a volar distal orthosis, and providing compression to control swelling.

Precautions and Exercises:

  • Detailed instructions are given on precautions (e.g., no weight-bearing for 6 weeks) and active range of motion exercises. It lists specific exercises, such as thumb opposition and wrist flexion/extension, with clear guidelines on frequency (10 times every 2-3 hours).

Progression Over Weeks:

  • The patient is provided an outline for the week-by-week progression of care, including when to start passive range of motion exercises, scar management, and the eventual reduction of splint use.

When rehabilitating the wrist, especially if there are concerns like ligament issues, focusing on proprioception and stability is vital. Here are some exercises that can significantly aid in these areas:

Types of Exercises in a Supervised Active Rehabilitation Program for Wrist Injuries

Recovering from a wrist injury requires a thoughtful and well-structured rehabilitation plan. Here’s an outline of exercises typically included in a supervised program:

1. Isometric Exercises

  • Focus: Wrist muscles
  • Activities: Engage in isometric exercises targeting the wrist flexors and extensors to build strength without joint movement.

2. Active Range of Motion Exercises

  • Focus: Forearm and wrist flexibility
  • Activities:
  • Perform assisted stretches targeting the forearm flexors and extensors.
  • Engage in radial and ulnar deviation exercises.
  • Practice weight-bearing wrist extensions by leaning forward on the hands.
  • Stretch the shoulder girdle and rotator cuff muscles.
  • Stretch the elbow flexor and extensor muscles actively.

3. Intrinsic Hand Muscle Exercises

  • Prioritize: Hand muscles
  • Exercises:
  • Practice thumb and finger opposition drills.
  • Squeeze therapy putty repeatedly to strengthen the hand muscles.
  • Perform repetitive towel-wring exercises to enhance grip strength.

4. Strengthening Routine

  • Focus: Arm and wrist strength
  • Activities:
  • Conduct bicep curls using light weights, typically 1.5-2 pounds.
  • Engage in shoulder exercises, including abduction, flexion, and extension, with 2-pound weights.
  • Repeatedly squeeze a rubber ball with the affected hand.
  • Perform wrist flexion and extension using 1.5-pound weights, increasing resistance as tolerated.

5. Functional Activities

  • Focus: Daily task reintegration
  • Activities: Gradually resume daily activities that involve the injured wrist, such as writing, typing, and cooking, to promote functional recovery.

These exercises are customized to each individual’s needs and abilities, providing a comprehensive approach to restoring wrist function and minimizing recovery time. Always consult a healthcare professional before starting any rehabilitation program.

Key Exercises for Wrist Rehabilitation

Supination and Pronation Twists

  • Supination: With your arm at your side, palm facing up, gently twist your wrist.
  • Pronation: Start with your palm facing down and rotate your wrist outward.

These simple movements enhance wrist flexibility and control.

Wrist Flexion and Extension

  • Flexion involves bending the wrist forward, while extension moves it backward. This exercise is crucial for improving wrist mobility and strength.

Resistance Band Workouts

  • Use a resistance band to add gentle tension while performing wrist curls and extensions. This not only builds strength but also enhances proprioceptive feedback.

Stability Ball Exercises

  • Placing your hand on a small stability ball and performing circular motions can challenge your wrist stability and coordination.

Grip Strengthening

  • Using a stress ball or grip-enhancing tools can boost the overall strength of the wrist’s supporting muscles.

By incorporating these exercises consistently, individuals can improve the proprioceptive abilities and stability of their wrists, easing the journey through rehabilitation.

What is Involved in the Sub-Acute Phase of Rehabilitation for a Colles’ Fracture?

In the sub-acute phase of rehabilitating a Colles’ fracture, the focus shifts to enhancing wrist range of motion (ROM) and initiating strengthening exercises. This phase typically begins around 6 to 8 weeks following surgery, if the fracture requires surgical intervention.

ROM Exercises:

  • Wrist Flexion and Extension: Gently move the wrist up and down.
  • Radial and Ulnar Deviation: Shifting the wrist side to side.
  • Pronation and Supination: Rotating the forearm to turn the palm up and down.
  • Grip Exercises: Making a fist and then opening the hand wide.

Transition to Strengthening:

As ROM improves, exercises incorporate resistance. This might involve:

  • Adding Weights: Holding a light weight while performing the previously mentioned movements.
  • Grip Squeeze: Using items like a foam ball or towel roll to increase grip strength.

Addressing Muscle Groups:

Focus is placed on not only the forearm muscles but also the muscles within the hand. It’s crucial to build resistance gradually, ensuring that both extrinsic (those originating outside the hand) and intrinsic (those within the hand) muscles are strengthened adequately.

Stretching Protocol:

Stretching becomes a vital component to further expand ROM. Suggested techniques involve:

  • Long Holds: Stretches held for 30-60 seconds with 3 repetitions to improve flexibility.
  • Alternate Method: If prolonged stretching causes discomfort, shorter stretches (10 seconds each) can be performed for 10 repetitions.

This balanced approach ensures that as strength increases, flexibility and range of motion continue to progress, ultimately aiding in a more complete recovery.

Measuring Outcomes

When assessing Colles fractures, medical professionals commonly rely on a variety of outcome measures to evaluate patient progress and recovery. Here’s a breakdown of some key tools used in these evaluations:

  • Disabilities of the Arm, Shoulder, and Hand (DASH) Score
    This tool measures the overall disability and symptoms of the upper extremities. It provides insight into how well a patient can perform daily activities involving the arm, shoulder, and hand.
  • Patient-Rated Wrist Evaluation (PRWE)
    The PRWE is a specific measure that focuses on wrist pain and functional impairment. It allows patients to rate their wrist condition, offering a subjective view of the impact on their day-to-day life.
  • Green and O’Brien Score
    These scores are utilized to evaluate the functional status of the wrist post-injury. They consider factors like pain, movement, and the ability to perform routine activities to deliver a comprehensive overview of wrist functionality.

Employing these outcome measures provides a well-rounded assessment of recovery, helping tailor treatment plans to the individual needs of patients.

Pain Management and Care

Colles fractures cause a wide range of discomfort that is difficult to predict. The discomfort is frequently mild, so the doctor may suggest using cold packs, elevating the arm, and taking over-the-counter pain relievers. To treat pain and inflammation, ibuprofen and acetaminophen may be suggested. The doctor will prescribe opioid drugs for more severe pain. If a cast is used, parents should try and keep it dry.

Complications

For a Colles’ fracture, problems are often avoidable with quick treatment and attentive aftercare. Nerve or blood vessel injuries are examples of complications that might occur without prompt medical attention or with major wounds. Additionally, some persons have compartment syndrome, a disorder that occurs when the pressure inside the muscles becomes dangerously high. These issues typically arise quickly following the fracture. Osteoarthritis and carpal tunnel syndrome are complications that may develop later. Tendon damage and chronic discomfort might result when a fracture doesn’t always heal properly. Colles’ more severe fractures may result in the following:

  • The wrist joint is affected by the break.
  • A shattered bone fragment pierces the skin.
  • The bone has many fractures.
  • Bone fragments shift about.
  • Bone fragments harm a nerve or blood artery.
  • Ligaments might tear.

The above complications depict instances where wrist fractures can heal slower than normal.

Key Warning Signs to Watch for During Rehabilitation of Distal Radius Fractures

When guiding someone through the rehabilitation of a distal radius fracture, it’s essential to be vigilant for certain warning signs that may indicate the need to stop or modify their exercise regimen.

Sharp or Intense Pain

  • If the person experiences sharp or severe pain during exercises, it’s critical to halt the activity immediately and assess the situation.

Painful Clicking or Snapping

  • This may suggest complications, warranting a reassessment of their physical activity.

Persistent Pain

  • Pay attention if there’s severe pain post-exercise lasting over 48 hours. This often signifies that the rehabilitation intensity is too high, and a break is necessary for recovery before proceeding with a more cautious approach.

Excessive Swelling

  • Noticeable swelling, particularly the day after exercising, needs to be addressed. It’s important to re-evaluate their rehabilitation protocol and monitor future progress more attentively.

Monitoring these signs ensures safe and effective rehabilitation while minimizing the risk of exacerbating the injury.

Choose the Very Best Doctors for your Child

The Medical City Children’s Orthopedics and Spine Specialists have been providing excellent broken bone fracture care for many years. We focus on improving the long-term health of your child’s bones. If your child is in pain as a result of a broken wrist or arm, call one of our compassionate experts at 214-556–0590 to schedule an appointment with us. Finally, we offer personalized treatment and urgent pediatric care services at all of our four locations — ArlingtonDallas, Flower Mound, Frisco, and McKinney, TX. If you notice any symptoms of a broken arm in your child, don’t hesitate to contact us to avoid complications.

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Footnote:

Medline Plus: Colles Risk Fracture

 

Call 214-556-0590 to make an appointment.

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