A study of clinical profile of patients with fracture of distal end radius at tertiary health care centre

 

Sawant Angraj¹, Sanjay More^2*

 

¹Assistant Professor, ²Associate Professor, Department of Orthopedics, RCSM Government Medical College, Kolhapur, Maharashtra, INDIA.

Email: sanjaysmore@yahoo.com

 

Abstract               Background: Sir Abraham Colles, an Ireland surgeon, classically described the fracture in the Edinburgh Medical Surgical journal in 1814. Aims and Objectives: To study clinical profile of Patients with Fracture of distal end radius at tertiary health care. Methodology: This was a cross-sectional study in the patients of Fracture of distal end radius at the D Y Patil Medical College, Kolhapur from March 2013 to December 2014 were collected for the O.P.D hours and some as an emergency in casualty. In the study duration total 103 patients were included into study. General condition of the patient was assessed and associated injuries were excluded. Detailed history of the patient was taken with emphasis on the time since injury, history or massage etc. x-rays of the injured wrist were taken. The clinical examination of the injured wrist was done. Result: The most common age group was 40-50-37.86% followed by 50-60 were 30.10%. The majority of the patients were Female i.e. 59.23% followed by Male i.e. 40.77%. The most common side of involvement was Left i.e. 70.87% followed by Right 29.12 %. Fall on Outstretched Hand was most common mode i.e. 63.11% followed by Road Traffic Accident in 36.89%. Conclusion: it can be concluded from our study that the most common age group was 40-50The majority of the patients were Female, the most common side of involvement was Left. Fall on Outstretched Hand was most common mode of injury.

Key Words: Fracture of distal end radius, Colle’s Fracture, Osteoporosis.

 

 

INTRODUCTION

Sir Abraham Colles¹, an Ireland surgeon, classically described the fracture in the Edinburgh Medical Surgical journal in 1814. He classically described the ‘dinner fork deformity’ and the six displacements: dorsal displacement, dorsal angulation, lateral displacement, lateral angulation, impaction and supination. He also described the management of the fracture by closed reduction and cast application. The first description of this fracture has been attributed to Pouteau², the French surgeon. He described the fracture in 1783. In some parts of the world the fracture of the distal radius is called Pouteau’s fracture. Sir Astley Cooper produced the first book to describe wrist injuries.’ Dislocations And Fractures Of Joints’ in 1822. Barton³ in 1838 described a fracture dislocation or subluxation in which the rim of the distal radius is displaced dorsally or volarly along with the hand and carpus. Smith⁴ in 1854 described a volar angulated fracture of the distal radius with a ‘Garden Spade’ deformity. In the reverse Colle’s fracture the hand and wrist are displaced volarly with respect to forearm. This fracture pattern included both extra articular as well as intra articular involvement and also formed part of the fracture dislocation of the wrist. J.H. Myer described experimental studies on Colle’s fracture and published in British Journal of Surgery. Sir reginal watson-jones described the fracture in his book “Fractures And Joint Injuries” in 1941. In 1951 Gartland And Werley⁵ published their system of evaluation of Colle’s fracture in the functional demerit system in JBJS 1951. This system allows for comparison of results among several studies and different methods of fracture management.

MATERIAL AND METHODS

This was a cross-sectional study in the patients of Fracture of distal end radius at the D Y Patil Medical College, Kolhapur from March 2013 to December 2014 were collected for the O.P.D hours and some as an emergency in casualty. In the study duration total 103 patients were included into study. General condition of the patient was assessed and associated injuries were excluded. Detailed history of the patient was taken with emphasis on the time since injury, history or massage etc. x-rays of the injured wrist were taken. The clinical examination of the injured wrist was done.

 

RESULT

Table 1: Age wise distribution of the patients

The most common age group was 40-50-37.86% followed by 50-60 were 30.10%.

 

Table 2: Distribution of the patients as per the sex

The majority of the patients were Female i.e. 59.23% followed by Male i.e. 40.77%

 

Table 3: Side of Involvement

The most common side of involvement was Left i.e. 70.87% followed by Right 29.12%.

 

Table 4: Distribution of the patients as per the Mode of Injury

Fall on Outstretched Hand was most common mode i.e. 63.11% followed by Road Traffic Accident in 36.89 %.

DISCUSSION

Claude pouteau was probably first surgeon who described colles’ fracture in 1783. He differentiated it from the wrist dislocation. However in 1814, a young Irish surgeon Abraham Colles ¹³ of Dublin published an article” on the fracture of the carpal extremity of the radius” in the Edinburgh medical and surgical journal. He reduced the fracture by traction and maintained the position with the help of malleable tin splints and narrow wooden splint. Bohler¹² in 1929, was using traction followed by manual pressure on the distal fragment to obtain the reduction. Chinese finger traps were used to give traction and reduction was maintained in the plaster by incorporating kirchner wires or pins. Green and Gay¹⁴ in 1956, advocated treatment of the colles’ fracture with the help of sugar tong splint which restricted supination and pronation strain at the fracture site while elbow enjoying some degree of movements. In 1964, Hudson and rusnack recommended primary resection of the lower end of ulna to achieve perfect reduction. Distal end radius fractures constitutes 10% of all human skeletal fractures ⁹. Such fractures mainly affect the elderly population and they involve low energy trauma¹⁰. However, in young adults, high energy trauma such as that resulting from vehicular traffic accidents accounts for a substantial number of cases, the majority of which are unstable. Restoration of volar angulation, radial length, and radial inclination are essential for good functional outcomes at the wrist joint. Maintenance of articular congruity and stable fixation reduce the incidence of osteoarthritis and also help with earlier rehabilitation¹¹. In our study we have found The most common age group was 40-50-37.86% followed by 50-60 were 30.10% this is comparable to the studies of Ayhankilic et al (2009)⁶, Kevin C. Chung et al., (2006)⁷ and R.E. Anakwe at (2010)⁸ who had an average age of 45 years and 48 years respectively. In this study significant male dominance, 11 out of 20 (55%) was seen and the same pattern was also reported by Ayhankilic et al (2009)⁶ (55%).The majority of the patients were Female i.e. 59.23% followed by Male i.e. 40.77%.The majority of the females in our study can be explained due to presence underlying osteoporosis in females. The most common side of involvement was Left i.e. 70.87% followed by Right 29.12 %. Fall on Outstretched Hand was most common mode i.e. 63.11% followed by Road Traffic Accident in 36.89 %. Regarding the side of fracture right side (60%) is predominant as compared to left (40%) and same is reported in the series of Ayhankilic et al., (2009)⁶ (52%) Kevin C. Chung et al., (2006)⁷ (57%) R.E. Anakwe et al., (2010)⁸ (71%) 14 out of 20 (70%) cases are due to RTA in this study and the same outcome is shown by Ayhan Kilic et al (2009) (60%), R.E. Anakwe et al., (2010) (67%). Out of 9 patients in famales 6 (66%), sustained fractures because of domestic fall showing the fact that osteoporosis is most common cause in the elderly females. 19 patients (95%) out of 20 have closed type of injury.

 

 

CONCLUSION

It can be concluded from our study that the most common age group was 40-50 The majority of the patients were Female, the most common side of involvement was Left. Fall on Outstretched Hand was most common mode of injury.

 

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