Who was Colles?

Abraham Colles, Irish surgeon and anatomist (1773–1843) described, amongst other things, fractures of the distal radius within 2.5 cm of the joint with dorsal displacement. He described this in the elderly, post-menopausal women and therefore distal radial fractures in other groups of patients are not, strictly speaking, Colles' fractures.

What are the five characteristic features of a Colles' fracture?

1. Dorsal displacement of the distal fragment

2. Dorsal angulation of the distal fragment

3. Radial displacement of the distal fragment

4. Shortening or impaction

5. Avulsion of the ulnar styloid process

What options of anaesthesia do you know for reduction of Colles' fractures?

• Haematoma block

• Biers block

• Axillary/brachial plexus blocks

• General anaesthesia

How do you reduce a Colles' fractures?

This aims to correct the deformities described in Question 2, after the appropriate anaesthesia is selected and informed consent is obtained.

• Disimpaction is the essential first stage. This is done by applying gentle but constant traction along the line of the forearm whilst an assistant is applying counter-traction with the elbow in 90 degrees of flexion.

• Manipulation is then undertaken by applying pressure to correct the dorsal displacement/angulation and radial deviation of the distal fragment. At times it is necessary to increase the deformity, to “unlock” the distal fragment, prior to manipulation.

• A Plaster of Paris “back slab” is then applied to maintain the reduction. This will also allow for any early swelling prior to completion of the cast. The position is in full pronation and slight ulnar deviation with the wrist in flexion.

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