Plenty of sources disagree with you!
http://www.wheelessonline.com/orthoo/78.htm
http://www.jbjs.org/Comments/2003/cp_nov03_ladd.shtml
It is apparently reprinted in its entirety at:
Medical Classics, 1940, 4: 1038-1042 but I cannot access this.
Best wishes
Rowley.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC)
A & E - SwarkHosp-TR
Sent: 14 December 2004 09:46
To: [log in to unmask]
Subject: Re: Defining who will not survive out of hospital cardiac
arrest/ Colles fracture
Threads seem to be overlapping a bit here.
> 1. This is not a Colles' #. It may be a distal radial fracture with
> dorsal angulation, but it is not what he described. Colles (1773-1843)
> described a 'fracture of the carpal extremity of the radius' in 1814
> in female patients over 65 years old. Thus a distal radial fracture in
> a younger patient is technically not a Colles' fracture.
The source article is: Colles A. On the fracture of the carpal extremity
of the radius. Edinb Med Surg J. 1814;10:181-6. He did not state that it
was restricted to any particular age or gender as far as I can remember
(or indeed made any comments as to epidemiology), but simply described
it as a dorsally angulated distal radial fracture without crepitus
(which is
interesting: crepitus is much more commonly present in older women than
in younger men) and unstable in reduction unless a rigid splint was
applied. Women over 65 were pretty unusual in early 19th century
Ireland. There are those around who say Colles' fracture is found only
in postmenopausal women. However, that's not how he described it as far
as I'm aware, and I'm happy with calling it a Colles fracture in younger
patients.
> No A&E SHO should be even attempting to reduce this. Our rules are to
> refer all under 50s to the orthopods, 50-55 discuss and reduce over
> 55s.
I've come across this view. Equally I've seen excellent reductions from
closed manipulation under regional anaesthesia in healthy young
patients. Also the view that these fractures usually best receive
definitive treatment on a daylight hours trauma list but in younger
patients benefit from an attempt at closed reduction as early as
possible aiming to improve rather than necessarily correct the position.
I'd agree, best not done by a SHO. However, I think the case can be made
for reduction of these fractures under haematoma block or regional
technique even in the younger patient.
Matt Dunn
Warwick
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