Colles fracture

　　Colles fracture is mostly caused by indirect violence. It is mostly caused by a fall on the ground, with the palm of the hand supporting the ground and the wrist in extension and the forearm in supination, causing the violence to concentrate on the cancellous bone of the distal radius, resulting in a fracture. In this state, the distal end of the fracture must move to the dorsal and radial sides. At this time, the styloid process of the ulna may be fractured, and the triangular fibrocartilage disc may also be torn.

　　The Colles fracture can be accompanied by the following clinical symptoms:

　　1. When injured, there is often contusion of the shoulder and elbow joints along with pain at the fracture site. The activity of the affected limb is reduced, and if it persists for a long time, the shoulder and elbow joints may become rigid.

　　2. Fracture deformity can compress the carpal tunnel, causing symptoms of median nerve compression. With the correction of the fracture, it can gradually recover.

　　3. The rupture of the extensor pollicis longus tendon usually occurs 4 weeks after the injury, and sometimes occurs later. There are two possible causes of the rupture, one is due to the primary injury, and the other is that the fracture involves the Lister结节, and the tendon is worn out and ruptured on the uneven bone surface.

　　4. Failure of reduction or fixation of the fracture can lead to malunion of the fracture.

　　5. It can occur Sudeck osteopenia (reflex sympathetic osteopenia, post-traumatic osteopenia).

　　6. It can be accompanied by scaphoid bone fracture, and attention should be paid during examination to avoid missed diagnosis.

　　The patient fell while extending the wrist, with the palm of the hand hitting the ground, causing severe wrist pain. The patient is afraid to move, with swelling especially obvious locally. Sometimes, subcutaneous ecchymosis can be seen. The fingers are in a semi-flexed rest position and are afraid to clench a fist. It is necessary to support the affected hand with the healthy hand to alleviate some of the pain. If the proximal fracture end compresses the median nerve, there may be symptoms of median nerve dysfunction such as numbness in the fingers. The typical signs of Colles fracture are as follows:

　　1. Silver fork deformity

　　The distal end of the fracture, along with the hand, moves to the dorsal side, with a depression on the proximal side.

　　Second, gun-shaped deformity

　　The distal end of the fracture and the hand move medially, and the middle finger axis is not on the same plane as the radius axis.

　　Third, the ruler test

　　Normally, place a ruler on the ulnar side of the wrist, and the styloid process of the ulna is more than 1 cm from the ruler. When the distal radius is fractured, the styloid process of the ulna can touch the ruler.

　　Fourth, the linear relationship between the styloid process of the ulna and the styloid process of the radius

　　After the distal radius fracture, the styloid process of the ulna and the styloid process of the radius are almost in a straight line. Normally, the styloid process of the radius is 1～1.5 cm longer than that of the ulna.

　　There are different methods of fracture classification. Currently, the widely used one is Frykman's classification, which is based on joint surface injury, distal radioulnar joint injury, and whether there is a distal ulnar fracture, etc., and classifies distal radius fractures into the following 8 categories:

　　1. Extra-articular fracture, without distal ulnar fracture.

　　2. Extra-articular fracture, with distal ulnar fracture.

　　3. Intra-articular fracture, involving the radiocarpal joint, but without distal ulnar fracture.

　　4. Intra-articular fracture, involving the radiocarpal joint, with distal ulnar fracture.

　　5. Intra-articular fracture, involving the distal radioulnar joint, without distal ulnar fracture.

　　6. Intra-articular fracture, involving the distal radioulnar joint, with distal ulnar fracture.

　　7. Intra-articular fracture, involving the radiocarpal joint and the distal radioulnar joint, but without distal ulnar fracture.

　　8. Intra-articular fracture, involving the radiocarpal joint and the distal radioulnar joint, with distal ulnar fracture.

　　Colles fracture is caused by a fall on the ground, with the palm supporting the ground and the wrist joint in extension and forearm pronation. This leads to the concentration of violence on the cancellous bone of the distal end of the radius, resulting in a fracture. Therefore, attention should be paid to lifestyle, high-risk workers such as construction workers, miners, and mechanics are prone to injury, and protection should be paid during the work process. Stay calm when dealing with things, avoid emotional excitement and conflict, which can lead to this disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of this disease.

　　Colles fracture can be examined by X-ray photography. The radius is transversely fractured about 3.0 cm from the joint surface. On the anteroposterior film, the distal fracture segment shifts medially, and there may be impaction with the proximal segment. The distance between the ulnar and radial joints increases (dislocation). The inclination of the distal end of the radius towards the ulna decreases, normally 20°～25°, and can decrease to 5°～15° or even disappear after fracture; on the lateral view, the distal end of the radius shifts medially, and the palmar tilt angle of the joint surface decreases or disappears, normally 10°～15°.

　　The following points should be paid attention to in the diet of Colles fracture patients:

　　First, early stage (1-2 weeks):The principle of diet coordination is to keep it light, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc. Avoid eating sour and spicy, dry and hot, and greasy foods, and especially do not consume greasy and nourishing foods prematurely, such as bone soup, fatty chicken, and braised eel.

　　Second, middle stage (2-4 weeks):Diet should shift from light to moderate high-nutrition supplementation to meet the needs of callus growth. Bone soup, Panax notoginseng chicken stew, animal liver, and other foods can be added to the initial diet to provide more vitamin A, D, calcium, and protein.

　　3. Late Stage (More than 5 weeks):After 5 weeks of injury, the ecchymosis of the fracture site is basically absorbed, and bone callus has begun to grow, which is the late stage of fracture. Treatment should be supplemented, through tonifying the liver and kidney, Qi and blood, to promote the formation of a stronger bone callus, and to relax tendons and collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, restoring the past function. Diet taboos can be lifted, and the diet can be supplemented with old hen chicken soup, pork bone soup, sheep bone soup, deer tendons soup, braised water fish, etc. Those who can drink can choose Du Zhong bone碎补酒, chicken blood vine wine, tiger bone papaya wine, etc.

　　Non-displaced Colles fracture is fixed with a neutral position cast for 4 weeks. For displaced fractures, the vast majority are treated with closed reduction and external fixation. The specific methods are as follows:

　　1. Anesthesia

　　Local hematoma anesthesia is often used during reduction, which is simple and easy to perform, but attention should be paid to aseptic operation, as infection can lead to serious consequences if it reaches the fracture end. Brachial plexus anesthesia has an ideal muscle relaxation effect, and is more suitable for patients with hypertension, coronary heart disease, and for those undergoing external fixation treatment.

　　2. Reduction Method

　　The patient lies in a supine or sitting position, the elbow joint is flexed 90°, and the forearm is in a neutral position. One assistant holds the upper arm, and the operator tightly holds the injured hand with both hands, with the thumbs placed on the dorsal side of the distal fracture segment, and the other fingers holding the palmar side of the wrist and hand. The assistant and the operator perform 2-3 minutes of traction, pulling the shortened and impinged fractures apart, the operator's thumbs pressing on the dorsal side of the distal radius, quickly flexing the wrist, and at the same time ulnar deviation, the fracture can be reduced.

　　3. Fixation Method

　　Use short arm front and back plaster casts to fix, maintain wrist joint pronation, flexion and mild ulnar deviation for two weeks. After two weeks, change the cast and fix the wrist joint in a neutral position for two weeks, and then functional exercise can be performed. For unstable comminuted or open fractures, Frykman classification V, VI, VII and VIII type fractures, more than 25° angular deformation towards the back, radial shortening greater than 10mm, significantly comminuted intra-articular fractures, external fixation should be used for treatment, which can avoid recurrence of displacement and facilitate local wound treatment, which is beneficial to finger functional activity.