A 68-year-old woman presents to the emergency department after a fall on her outstretched hand while walking in her garden. She reports immediate wrist pain and swelling. On examination, the wrist shows a characteristic 'dinner fork' deformity with dorsal angulation. Radiographs confirm a distal radius fracture with dorsal displacement and angulation. Which of the following is the most likely diagnosis?

## Diagnosis: Colles Fracture **Key Point:** A Colles fracture is a transverse fracture of the distal radius with dorsal displacement and dorsal angulation, classically described as producing a 'dinner fork' deformity on lateral radiographs. ### Clinical Presentation - **Mechanism:** Fall on outstretched hand (FOOSH) with wrist in extension — the most common mechanism in elderly patients - **Deformity:** Dorsal prominence (dinner fork appearance), swelling, pain - **Age group:** Elderly patients with osteoporosis; also seen in younger patients from high-energy trauma ### Radiographic Features | Feature | Colles | Smith | Barton | |---------|--------|-------|--------| | **Displacement** | Dorsal | Volar | Volar | | **Angulation** | Dorsal | Volar | Volar | | **Deformity** | Dinner fork | Reverse dinner fork | Intra-articular | | **Mechanism** | FOOSH (extension) | FOOSH (flexion) | High-energy | | **Intra-articular** | May involve | May involve | Always | **High-Yield:** The 'dinner fork' deformity is pathognomonic for Colles fracture — this is the single most tested radiographic sign in NEET PG. ### Complications - Malunion with loss of radial height, radial inclination, and volar tilt - Post-traumatic arthritis - Median nerve compression (acute) - Posterior interosseous nerve (PIN) injury - Extensor pollicis longus (EPL) rupture (late) **Clinical Pearl:** EPL rupture typically occurs 6–12 weeks post-injury due to ischemic necrosis from friction against the fracture callus; loss of thumb IP joint extension is the presenting sign. ### Management 1. **Closed reduction** under appropriate anesthesia (hematoma block, procedural sedation, or regional block) 2. **Immobilization** in a dorsal slab or cast for 4–6 weeks 3. **Radiographic follow-up** at 1–2 weeks to assess loss of reduction 4. **Operative fixation** (percutaneous pinning, plate osteosynthesis) if: - Unstable fracture pattern - Loss of reduction on follow-up - Intra-articular extension - Bilateral fractures **Mnemonic:** **COLLES** = **C**ommon, **O**lder patients, **L**ateral (dorsal) displacement, **L**arge deformity, **E**xtension mechanism, **S**welling [cite:Rockwood & Green's Fractures in Adults 9e Ch 18] [cite:Rockwood & Green's Fractures in Adults 9e Ch 18]