Fractures of the distal radius

Fractures of the distal radius are associated with many eponyms. These are based mainly on the direction of displacement and on involvement of the articular surface. The following description highlights only the salient features of certain injuries and a detailed discussion of distal radius fractures follows later.

Colles' fracture

Originally described by Abraham Colles from Dublin in 1814, this fracture is the commonest injury of the distal radius (Fig. 20(a)). It is usually seen following a fall on the outstretched hand with wrist in radial deviation and the forearm in pronation. The fracture line lies within 2 cm of the articular surface of the distal radius and may extend into the joint. Various components of the classical ‘dinner fork deformity’ are dorsal angulation, dorsal displacement, radial angulation and radial shortening. Associated injuries of the ulnar styloid process, ulnar collateral ligament and the triangular fibro-cartilage complex are not uncommon. Most fractures unite following closed reduction and immobilization in a below elbow cast. However, some injuries may require operative intervention due to significant displacement, comminution or intra-articular involvement.

Smith's fracture (reverse Colles' fracture)

This injury occurs following a fall on the dorsum of the hand such that the forearm is in supination. Unlike Colles' fracture, the distal fragment in this injury displaces and angulates, volarly (Fig. 20(b)). Smith's fracture is inherently unstable and often requires open reduction and internal fixation.