A 68-year-old woman from Delhi falls on her outstretched hand while climbing stairs. She presents to the emergency department with severe pain and swelling in the wrist. On examination, the wrist shows a characteristic 'dinner fork' deformity with dorsal angulation. X-ray confirms a distal radius fracture with dorsal displacement and angulation. The distal fragment is dorsally displaced relative to the proximal fragment. What is the most likely diagnosis?

Explanation

## Diagnosis: Colles Fracture **Key Point:** Colles fracture is a fracture of the distal radius with DORSAL displacement and dorsal angulation of the distal fragment, classically producing a 'dinner fork' deformity on lateral X-ray. ### Clinical Presentation - **Mechanism:** Fall on outstretched hand (FOOSH) with wrist in extension - **Age group:** Most common in elderly women (osteoporosis) and young males (high-energy trauma) - **Deformity:** Dorsal angulation and dorsal displacement of the distal fragment - **Associated injuries:** Ulnar styloid fracture (50–60% of cases), anterior displacement of the carpus ### Radiological Features | Feature | Colles | Smith | |---------|--------|-------| | **Displacement** | Dorsal | Volar | | **Angulation** | Dorsal | Volar | | **Deformity** | Dinner fork | Reverse dinner fork | | **Mechanism** | FOOSH in extension | FOOSH in flexion or direct blow | | **Radial height loss** | Yes | Yes | **High-Yield:** The 'dinner fork' deformity is pathognomonic for Colles fracture and is visible on the lateral view of the wrist. ### Colles Fracture Criteria (Frykman Classification) Colles fractures are classified based on: 1. Presence or absence of ulnar styloid fracture 2. Involvement of radiocarpal joint (intra-articular vs. extra-articular) ### Management Principles 1. **Closed reduction** under anesthesia (hematoma block or procedural sedation) 2. **Immobilization:** Above-elbow plaster cast for 4–6 weeks 3. **Elevation and ice** to reduce swelling 4. **Regular X-ray monitoring** to assess for loss of reduction 5. **Physiotherapy** after union to restore wrist function **Clinical Pearl:** Loss of radial height, radial inclination, and volar tilt are common complications leading to poor functional outcomes. Modern management increasingly favors percutaneous pinning or volar plate fixation for unstable fractures. **Warning:** Posterior interosseous nerve (PIN) injury can occur with dorsal displacement; assess for wrist and finger extension weakness. [cite:Rockwood and Green's Fractures in Adults Ch 8]