Can you please explain something to me? I had a wrist fracture (the Colles type) that looked perfectly fine on the X-ray when they casted my arm. But when they took the cast off, it looks like my arm is still crooked. Why is that?
A Colles (pronounced "call-eez") fracture is a break in the last inch or inch and a half of the radius bone. The radius is one of the two bones in the forearm that meets the small bones of the wrist to form the wrist joint. Dr. Abraham Colles, an Irish surgeon, first described this type of fracture in 1814.
Colles fractures are the most common break in adults over the age of 50. The wrist is a place where bones frequently get weak from osteoporosis. The typical Colles fracture occurs when a person slips or trips and lands on an open hand with the palm down. Other causes of this fracture include car accidents and sporting activities.
This particular type of fracture actually occurs in two different age groups: the young and old but with different causes. Children and teens are more likely to be involved in high-energy, traumatic (sports) injuries. Older adults can fall from a standing position and break their wrists.
Treatment can involve closed reduction and immobilization (sounds like this is what you had done) or surgery. Closed reduction means the fracture is reset (lined up) without an incision or open surgery. Immobilization, of course refers to the cast you wore until the bone healed.
Colles fractures are notorious for loss of reduction -- meaning the bones shift apart again. This can happen no matter what type of treatment is applied. Dr. Colles explained almost 200 years ago that the deformity will not interfere with motion or function. And studies in the late 1990s and early 2000s support this statement. There just isn't a straightforward link between poor alignment with wrist deformity and function.
But in cases where the reduction is not maintained, further X-rays are usually taken to establish the underlying cause of the deformity. Then treatment options can be discussed. This can range from do nothing to a short course of rehab to surgical correction to restore shape, form, and function. Don't hesitate to check with the physician who treated you and ask this question. It is important to your peace of mind as well as direct you to further treatment is that is warranted.
Charles S. Day, MD, MBA, and Michael C. Daly, MSc. Management of Geriatric Distal Radius Fractures. In The Journal of Hand Surgery. December 2012. Vol. 37A. No. 12. Pp. 2619-2622.
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