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PATIENT STORY

A 65-year-old woman tripped on a rug in her home and fell on her outstretched hand with her wrist dorsiflexed (extended). She felt immediate pain in her wrist and has difficulty in moving her wrist or hand. She has been postmenopausal for 15 years and has never taken hormone replacement therapy or bisphosphonates. She presented with pain and swelling in her wrist. Her arm had a "dinner-fork" deformity. Radiographs showed a distal radius fracture with dorsal angulation on the lateral view (Figure 105-1).

FIGURE 105-1

Colles fracture. This occurred after a fall on an extended wrist. A. Lateral view shows a distal radius fracture with dorsal angulation. B. Anterior–posterior view demonstrating a transverse distal radius fracture. (Reproduced with permission from Rebecca Loredo-Hernandez, MD.)

INTRODUCTION

Distal radius fractures are common, especially in postmenopausal women. Patients present with wrist pain and a "dinner-fork" deformity. Diagnosis is confirmed by radiographs. Treatment is either operative or nonoperative, based on the degree of displacement and the age of the patient.

SYNONYMS

Colles fracture is the most common type. Other types of distal radius fractures include Smith fracture, Barton fracture, and Hutchinson fracture.

EPIDEMIOLOGY

  • Bimodal distribution: more common under the age of 17, lowest between ages 18 and 39, then increasing with age.1

  • More common in women compared to men at ages 40–64 (35 vs. 16 per 10,000), ages 65–79 (77 vs. 19 per 10,000), and over age 80 (110 vs. 31 per 10,000); less common in girls compared to boys under the age of 17 (42 vs. 64 per 10,000).1 These differences are likely due to higher rates of osteoporosis in older women than age-matched men and higher risk-taking physical activities in boys than age-matched girls under the age of 17.

ETIOLOGY AND PATHOPHYSIOLOGY

  • Classic history is a fall on an outstretched hand.

  • 65% of patients older than 65 years of age who were seen with a distal radial fracture in an emergency room had osteoporosis.2

  • Men and women over the age of 60 with distal radius fractures are more than five times as likely (85 vs. 15 per 10,000) to have a hip fracture within 1 year as age-/gender-matched controls. Most of these hip fractures occur within the first month after the radius fracture.3 This is likely due to increased risk of falls and decreased bone density in the patients who have already suffered a distal radius fracture.

RISK FACTORS

  • Osteoporosis.4

  • Engaging in activities that increase the risk of falls on the wrist, such as skating, gymnastics, snowboarding, and skiing. (Many coaches and ...

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