Beruflich Dokumente
Kultur Dokumente
Complications
BY
WILLIAM
P.
COONEY,
III,
M.D.t,
of Bone
Patients
ABSTRACT:
rious
complications
appreciated.
more
A study
per
cent)
neuropathies
with
of
(forty-five
(thirty-seven
the Department
with Colles
frequently
of 565
JAMES
H.
DOBYNS,
of Orthopedics,
revealed
such
complications
the median,
ulnar,
Mayo
177
(31
as persistent
or radial
nerves
cases),
radiocarpal
or radio-ulnar
cases),
and malposition-malunion
arthrosis
(thirty
cases) . Other
complications
included
tendon
ruptures
(seven)
,
unrecognized
associated
injuries
(twelve),
Volkmanns
ischemia
(four cases),
finger stiffness
(nine
cases),
many
and shoulder-hand
patients,
incomplete
or secondary
loss
of the
syndrome
restoration
reduction
(twenty
cases).
In
of radial
length
position
caused
the
complications.
Current
opinion
seems
to be that there are no important problems
relating
to the treatment
of Colles
fractures2212
, despite admonitions7#{176} that many patients
who have had such a fracture
are found to have permanent
disability
and poor function
of the hand and wrist.
In our
hospitals,
we
have
seen
a steady
flow
of patients
referred
ment,
figures
we have
on the
accumulated
incidence
fracture.
Treatment
consideration
that
cept in delineating
to us for early
of
of these
will not
a general
and
of the
These
present
bate manage-
sufficient
material
to report
complications
from
Colles
complications
is a separate
be discussed
or analyzed,
exapproach
to a specific
compli-
AND
Clinic
cation
and
Read
at the
Annual
Meeting
Material
of The
American
Academy
thopaedic
Surgeons,
New Orleans,
Louisiana,
February
2,
t Department
of Orthopedics,
Mayo
Clinic,
Rochester,
55901 . Please address
reprint
requests
to Dr. Cooney.
62-A,
NO.
4, JUNE
1980
RONALD
Foundation,
who
was
L.
LINSCHEID,
M.D.t,
respect
to the
Rochester
sent
ered to be a referral.
and follow-up
data
to us for treatment
was
mechanism
of the
fracture
into the radiocarpal
into the radiocarpab
joint
also
consid-
roentgenograms,
were assessed
injury
juries.
In evaluating
and tabulating
the
used the Frykman
classification
of the
an extra-articular
radial
fracture;
articular
radial
fracture
plus an ulnar
and
with
associated
in-
results
(Table
I), we
fracture.
Type I was
Type
II, an extrafracture;
Type III, a
a fracture
Type
V
was a fracture into the radio-ubnarjoint; Type VI, a fracture into the radio-ulnar joint plus an ubnar fracture; Type
VII, a fracture
into both joints;
and Type VIII, a fracture
into both joints plus an ulnar fracture.
When
there
were
complications,
we
especially
studied
the method
ofreduction,
the anesthesia,
immobilization,
and the post-fracture
care, and
correlate
each with the type of complication.
the type
we tried
In the
complications
eight
major
of Or-
1976.
Minnesota
total
of 565 cases,
in 128 patients,
types:
compression
there
were
as categorized
neuropathy
cases),
arthrosis
after fracture
(thirty-seven
ion after boss of reduction
(thirty
cases),
(seven
cases),
unrecognized
cases),
complications
of
manns
ischemic
contracture
the fingers
(nine
cases),
dystrophy)
Some
tients with
treatment
of the Cobles fracture,
while the others
were referred
for evaluation
and treatment
because
of complications,
either early (during
the acute treatment
of the fracture)
or late (with
specific
complications).
All patients
who were referred
had had primary
treatment
of the fracture elsewhere,
and any patient
with a recognized
compli-
VOL.
M.D.t,
(upper-limb
All patients
treated
for Cobles
fractures
at the Mayo
Clinic
from January
1968 through
December
1975 were
studied.
There
was a total of 565 patients.
Of these,
356
(63 per cent)
were
seen
primarily
at our hospitals
for
Fractures*
of
to
Observations
cation.
Clinical
Incorporated
of complications
which
has significantly
sharpened
our awareness
many
difficulties
associated
with
treatment.
difficulties
are not commonly
appreciated.
In the
study
Surgery.
MINNESOTA
fractures
have sethan is generally
fractures
Join:
of Colles
ROCHESTER,
From
and
presenting
trophy.
patients
had
shoulder-hand
associated
cases),
tendon
injuries
malunrupture
(twelve
fixation
(thirteen
cases),
Volk(four cases),
arthrofibrosis
of
and shoulder-hand
syndrome
(twenty
cases).
more than
syndrome
complications
that
tenth
complication,
(forty-one
cases),
was
to record
its occurrence
arthrosis
or malunion.
Minor complications
They included
transitory
177 serious
into these
(forty-five
one complication.
Paoften had two or more
contributed
early
boss
not included
in the analysis,
except
when it produced
a symptomatic
were
radial
not recorded
and median
in this
neuritis;
study.
flexor
and extensor
tendinitis;
cast-pressure
sores;
pin-site
irritation; and stiffness
of the wrist, elbow,
and shoulder
joints.
Conservative
treatment,
applied
early,
relieved
most of
these minor
complications.
Complications
were encountered
whatever
the
of fracture
treatment
used.
Among
the 356 patients
were primarily
treated
at our institution,
sixty-eight
form
who
pa613
614
COONEY,
P.
W.
III,
J.
H.
DOBYNS,
TABLE
COM
Frykman
No.
PLICATIONS
of
Type
Complications
OF
No.
OLLES
FRAC
TURE
Local
R.
L.
LINSCHEID
I
ACCORDING
TO
TREATMENT
Anesthesia
Block/General
of
Patients
AND
METHODS
Unknown
Immobilization
Pins
Cast
Unknown
12
II
14
10
III
IV
16
12
19
12
11
VI
VII
VIII
24
19
II
27
18
10
3
2
16
14
2
3
1
1
42
16
32
20
12
26
14
12
12
Unknown
tients
(19 per cent)
had seventy-eight
complications.
Among
the referred
patients,
sixty had ninety-nine
complications.
Ofthe
128 patients
with complications,
seventy-
patients).
eight
block
compression
at the spiral groove
of the humerus
or on the
dorsum
of the hand),
was diagnosed
in three patients.
Irri-
anesthesia
was
not
closed
reduction
and
had primary
external
had had
type of
the
recorded.
Eighty-six
patients
had
immobilization
in a cast, seventeen
pin fixation,
and twenty
had failure
This
chiab block
neuropathy,
tation
from
neuropathy
six patients
was
less
frequent
after
anesthesia
(eleven
patients).
to improper
immobilization
braRadial
(cast
external
pin fixation
caused
a severe
radial
in two patients.
Ulnar
neuropathy
occurred
in
as a result of cast compression.
All but five of
of cast immobilization
with secondary
pin fixation.
For
five patients
the types
of reduction
and immobilization
were
not specified.
The
comminuted
displaced
intraarticular
fractures
(the unstable
ones,
Frykman
Types
IV
through
VIII) were associated
with an increased
number
of
the
complications,
especially
the more comminuted
Type-Vu
and VIII fractures
(sixty-nine
of the 177 complications).
Late
forty-one
For sixteen
termined.
fractures,
The largest
additional
patients,
the median
neuropathy
with
ulnar
neuropathy.
There
were
cent)
in patients
of
neuropathies.
Thirty-one
of the forty-five
patients
required
release
of the carpal
tunnel
or Guyons
canal,
or both, and
was
the Frykman
number
of
who
had
class could
complications
had
injection
a local
anesthetic
into the fracture
site, although
that method
of
anesthesia
was used in only 56 per cent of the patints
who
had treatment
for Colles
fracture.
Complications
after the
reduction
of displaced
comminuted
fractures
were
less
likely
to occur
if either
general
anesthesia
or an axiblary
block
was
given,
followed
utes)
and
gentle
reduction.
by sustained
After
traction
primary
(ten
external
mmpin-
fixation
techniques
in seventy-five
fractures
there
were
twenty-one
complications,
while after failed closed
reduction and secondary
external
pin fixation
in forty fractures,
twenty-eight
complications
were encountered.
There were
1 28 complications
reduction
and
in patients
who
plaster-cast
fixation,
were
but
treated
by closed
that routine
was
followed
three
times
more
frequently
than
the other
methods
of treatment
combined.
The age of the patient,
sex, and mechanism
of injury
seemed
to have no relationship to the incidence
of complications.
Compressive
This
Neuropathv
was
the
most
frequent
single
complication
(7.9
per cent),
occurring
in twenty-one
patients
treated
locally
and in twenty-four
who were referred
to us for treatment.
It was observed
both acutely
and bate after the injury
had
occurred.
Median
neuropathy
developed
early
in thirtyone patients,
ture
in the
usually
emergency
associated
room
with
under
local
reduction
anesthesia
of the frac(twenty
early
complication
or general
attributable
after
neuropathies
the
required
offending
removed.
neuropathy
no treatment
compressing
agent
and
(cast
resolved
or pin)
was
mediate
carpal-tunnel
release
neuropathy
patients.
and
no permanent
of the median
All had persistent
sequelae.
nerve
occurred
in
symptoms.
In four
was combined
no late
radial
extensive
exploration
through
an appropriate
palmar
or
forearm
incision
was essential
for adequate
decompression
(Fig.
1). In six patients,
volar
fracture
fragments
were
found
were
compressing
removed.
and median
formation
nerves
(seven
and
pa-
tients),
persistent
hematoma
(six patients),
and localized
swelling
(twelve
patients),
usually
the result of the forced
volar
flex ion-ulnar
deviation
position
(Cotton-Loder),
were considered
to be responsible
for most of the other late
neuropathies.
Eleven
of the twenty-four
patients
who were
referred
to us and seven of the twenty-one
treated
primarily had one additional
complication
associated
with a compressive
neuropathy,
and one referral
patient
had three
associated
complications.
Arthrosis
after
Fracture
When
either
painful
motion
of the wrist
or forearm
was evident
or there
was a mechanical
obstruction
to
motion
after fracture,
we diagnosed
the condition
as arthrosis.
It was observed
in thirty-seven
patients
and represented
20 per
throsis
(twenty-seven
radiocarpab
VII, and
tion.
When
VIII
cent
of the
arthrosis
fractures
external
complications.
patients)
was
(ten patients).
most often
pin-fixation
THE
JOURNAL
Radio-ulnar
more
Frykman
elicited
this
techniques
OF
common
BONE
AND
arthan
Type-VI,
complica-
that
restored
JOINT
SURGERY
COMPLICATIONS
the
radial
length
was a lower
the fact that
more
were
used
incidence
pin fixation
comminuted
Of the ten
prosthetic
patients
fractures.
patients
with
fractures
two
that required
ubna (fourteen
or a Silastic
two
two
Of the
nineteen
a Darrach
patients),
replacement
nine
by dorsal ostectomy,
by arthrodesis,
and
had
motion
and required
Darrach
excision
of
the ulna.
All twenty
of the patients
who
procedure
had improvement
in motion
of
particular,
in pronation
and supination
of
the
despite
for the
arthrosis,
arthropbasty
of the wrist.
with radio-ubnar
arthrosis,
patients).
subluxation
there
patients),
treatment
radiocarpal
three
painful
radio-ulnar
joint
of the distal
end of the
procedure
(one patient),
plasty
(four
radio-ulnar
those
of arthrosis
(four
was the preferred
were treated
surgically:
proximal
row carpectomy,
total
seven
to treat
OF
by
by
twentyhad a
resection
a Mibch
arthro-
symptomatic
obstruction
to
referral
patients
and seven
of
had an additional
complica-
tion.
Ma/position-
patients
had
this
complication,
the
majority
having
been referred
for treatment.
Five patients
had fractures that were not yet fully united when they were seen for
treatment.
They required
early open reduction.
The other
twenty-five
patients
required
osteotomy.
Mabunion
was
most
which
commonly
commonly
comminuted.
rebated
occurs
This
boss of reduction
period
was a frequent
problem.
loss of reduction
was required
patients.
A corrective
early
in the
treatment
In this series,
treatment
in 27 per cent of the
reduction
was
usually
for
565
performed
by
distraction
and gentle
manipulation,
the patient
having
had
brachiab
block or general
anesthesia.
It was successful
in
most patients
(more
than 92 per cent) when accomplished
within
two weeks
of the fracture
and when the reduction
was maintained
with some form of external
pin fixation.
Our preference
third
metacarpals
was
to each
3/32
placed
A Roger
in the middle
third
of the radius.
external-fixation
apparatus
attached
to these
tamed
the reduction
and provided
stabilization.
pins or Kirschner
wires were used,
as required,
loose
were
done
other.
inch)
Two
were
Anderson
pins mainAdditional
to secure
fragments.
When the pins applied
above
and below
inadequate
to maintain
reduction
open reduction
was
(five patients),
with satisfactory
results.
After
inadequate
treatment
of the fresh fracture
was
followed
deformity,
by malunion,
and limitation
the
complaints
of motion
of significant
pain,
present
in twenty-five
patients
led to recommendations
Fourteen
patients
had that
Three
patients
accepted
the
for corrective
osteotomy.
operation
at our institution.
deformity
or preferred
not
have
the
VOL.
surgery,
62-A,
NO.
and
4, JUNE
615
FRACTURES
community.
lost
to follow-up.
fourteen
patients
the corrective
ted by bone-grafting
(Figs.
Two
were
osteotomy
2-A through
Two
referral
patients
had
two
In most
of our
was supplemen2-D).
Improveachieved
in all but
patient
required
arthis group
the twelve
had an
primary
additional
compli-
cations.
Tendon
Rupture
Rupture
five patients
of the extensor
poblicis
rupture
of the index
fundus
or flexor
each. The rupture
from
bongus
was noted
in
flexor digitorum
pro-
, and
displaced
pollicis
bongus
was primarily
fractures
that
was noted
in one patient
rebated to bone fragments
abraded
the tendon
during
the
weeks
after healing
of the fracture.
All five patients
with
boss of the extensor
polbicis
bongus
tendon
had rupture
within
two months
from the initial injury (two, two, three,
four,
and eight
weeks),
while
in the two patients
with
flexor
tendon
rupture
the rupture
occurred
after
three
months.
All patients
had either
a tendon
transfer
or a ten-
Ma/union
Thirty
COLLES
six
1980
had
operation
in
their
home
don graft.
Direct
several
centimeters
Associated
(two
fractures
patients),
and intercarpal
were recognized
because
lost.
Primari/y
scaphoid
fractures
(one patient),
tients),
which
month
usually
Unrecognized
included
head
(four
patients),
Bennetts
ligament
between
fracture
injuries
(five
two days and
of the original
injury.
by the same
mechanism
paone
These
injuries
that caused
the Cobles
fracture.
In our series,
ligament
instability
of
the
wrist
required
operative
reconstruction
of the
scaphobunate
ligament
in four patients.
Scaphoid
fractures
required
open reduction
in two patients,
and radial
head
fractures
required
excision
of the radial
head in two patients.
Comp/ications
Three
of Fixation
patients
required
operative
purulent
drainage
ation of the area
patient
sustained
with
pin fixation
had
pin breakage
that
removal
of the pins. Pin loosening
with
occurred
in eight patients,
and an ulceraround
a pin occurred
in one patient.
One
a fracture
through
the pin site in the distal
to
Injuries
These
radial
tendon
repair
was not possible
of tendon
substance
had been
5 Ischemic
Contracture
patients,
three of whom
was retained
despite
the
pain. Continued
use of
masked
the symptoms.
616
W.
P.
COONEY,
III,
J.
H.
DOBYNS,
AND
R.
L.
LINSCHEID
Shou/der-Hand
Syndrome
This
is more
appropriately
called
upper-limb
dys-
trophy
or pain-dysfunction,
and was a significant
problem
in twenty
patients,
sixteen
of whom
had been referred.
Four patients
had acute symptoms
with predominant
sympathetic
components
of change
in skin temperature,
color,
and texture;
pain and loss of motion
in the shoulder;
and
stiffness
of the hand or specific
local trigger
areas of cxquisite
pain and tenderness
(or both).
In one patient
it was
the result
of radial-nerve
irritation
from pin fixation;
in
two patients,
from excessive
wrist flexion
which produced
acute median
neuropathy;
and in one, from an unreduced,
Median
neuropathy
associated
with Colles
fracture
may involve
a
prominent
volar
callus,
which
in this patient
compressed
the median
nerve proximal
to the carpal
tunnel.
Surgical
release was extended
into
the distal
end of the forearm
to ensure
adequate
decompression.
severely
One
trophy.
They
the patients
sion,
the
lysis
of tendons
and
nerves,
release
or lengthening
FIG.
Figs.
of
limb.
displaced
Two
and
fracture
of the four
with
patients
associated
had
one
disuse
other
established
had fewer
with
the
clinical
shoulder,
2-A
FIG.
upper-limb
sympathetic
components
acute
condition,
but
complaints
stiffness
of stiffness
of the hand,
of the
complication
and
painful
dys-
than did
had longdisuse
motion,
of
carpal
2-B
of the distal
end of the radius
developed
in the wrist of a forty-five-year-old
farmer
who had been gored by a bull.
During
fracture
was overlooked.
Figs.
2-A and 2-B:
When
treatment
of the malunion
was begun
at six months,
there was marked
shortening
and radial
angulation,
median
neuropathy,
and weak grip. An open-wedge
osteotomy,
a bone graft
from
the distal end ofthe
ulna, and a small plate were employed
to regain length
and restore
alignment
of the forearm.
The carpal tunnel
was released.
2-A through
life-saving
muscle-tendon
and
The
have
2-D:
Malunion
measures
the
units,
the long-term
fourth
patient
a below-the-elbow
and
tendon
results
in three
had persistent
amputation.
transfers
when
indicated,
patients
were only fair.
pain and finally
had to
tunnel
teen
were
proved
symptoms,
patients
referred
and radiocarpal
arthrosis.
had fracture
mabunion.
with bong-established
on conservative
treatment
THE
JOURNAL
Ten ofthe
Fourteen
complaints,
extending
OF BONE
AND
six-
of them
but imfor
JOINT
from
SURGERY
six
COMPLICATIONS
weeks
to four
complication
Stiff
months.
and
four,
Six
of the
two
or more
sixteen
had
OF
one
other
complications.
COLLES
reduction
(seven
cast (four
patients),
patients),
poor
and inadequate
patients),
improper
immobilization
in the
mobilization
of the joint
efforts
at rehabilitation.
(eight
Hands
Stiff hands
from arthrofibrosis
of the fingers
were a
severe
complication
in nine patients.
It was manifested
by
pain and swelling
limited
to the hand,
with a loss of finger
motion
and occasionally
a loss of motion
of the wrist.
Swelling
synovial
lined with
findings
in
seven
patients.
Swelling
of the proximal
interphalangeal
joint was the major source
of pain and resulted
in a severe
boss of motion.
The factor most commonly
associated
with
the clinical
symptoms
and signs was improper
application
of a cast. Stiff hands
occurred
most
cast application
(seven
of nine patients
lack of early motion
of the hand was
nine
patients,
present
in
Dupuytrens
and
Mu/tiple
pre-existing
degenerative
arthritis
was
three
patients.
Three
patients
had
a mild
contracture
in the affected
hand.
Six of the
nine patients
had
improved
function
full recovery,
and
after conservative
the other
treatment.
three
had
Complications
Discussion
Severe
complications
to occur
frequently.
We
largest
was
(within
when
nosis
as repeated
FIG.
The
NO.
4.
JUNE
1980
patient
was satisfied
attempts
at
neuropathies
two
When
was
weeks)
result
later
during
the median
nerve
common.
However,
syndrome.
Median
neuropathy
series
of patients
probably
because
both
early
the period
of
was involved,
early
in some
patients,
and
and returned
because
to farming
such
as a stiff
was
identified
than in previously
there
is increased
FIG.
the final
occurred
and
preciate
or suspect
that
the
nerve
stretched,
or irritated.
This failure
was
when fixation
pins were utilized.
Delay
2-C
with
required
of complica-
condition
such
continue
more pa-
neuropathies.
the first
treatment.
recognition
with
62-A,
the
Compression
in treatment,
Colles
fracture
that there
were
nd
difficulties
from
found
tients
than we anticipated
whose
complications
extensive
treatment.
Possibly
the percentage
A study
of the patients
who had multiple
complications that usually
included
the shoulder-hand
syndrome
revealed
that the underlying
cause of the dystrophy
appeared
to be a combination
of predisposing
factors
in conjunction
VOL.
617
FRACTURES
more
patients
2-D
without
restrictions.
was
compressed,
especially
evident
in diagnosis
usuhand
or carpab
more
reported
recognition
are referred
often
tunin this
of
this
for surgi-
618
W.
P.
COONEY,
III,
J.
H.
DOBYNS,
AND
R.
L.
LINSCHEID
cab decompression.
We agree
with previous
authors10#{176}
that a significant
contributor
to the neuropathy
is the force
of fracture
reduction
and the position
of immobilization;
the higher
frequency
of this complication
after local block,
with
or without
systemically
administered
analgesics,
produce
a proximal
compressive
force
tends
fractures,
maintain
the volar
We have
to support
Post-fracture
this belief.
arthrosis
was
the second
most
common
complication
in our patients,
yet often
it went unrecognized for some time. Subtle
forms of this arthrosis
are responsible
for a barge portion
of the weakness
of grip and
limited
motion
that are commonly
seen after this fracture.
When the condition
is recognized,
the patient
often can be
improved
by conservative
measures,
such as splinting,
the
local
Present
port
do
forces,
carpab
leading
methods
not always
particularly
thrust
that results
in a dorsal
to collapse
and displacement.
of fracture
reduction
prevent
these
in comminuted
and
potentially
fractures.
cast
sup-
deforming
In unstable
of the fracture
was lost
for potentially
unstable
Types
V through
VIII),
sults3.
Operative
treatment
for radiocarpal
arthrosis
was necessary in only nine patients
in our series.
The radio-ubnar
arthrosis
that was seen
in twenty-seven
patients
mostly
Open
reduction
of Colles fracture
is rarely
advocated,
despite
the need for accurate
reduction
of the fracture8.
Because
the functional
results
so closely
parallel
the
anatomical
results,
it is our practice
that when closed
re-
stemmed
from
cal
reduction,
duction,
successful,
injection
malalignment
radius
with
dorsiflexion
inadequate
lationship
of
steroids,
and
the inability
manifested
the
use
of
salicybates.
to obtain
an adequate
in two
ways.
of the sigmoid
the ulnar head,
notch
owing
anatomiOne
was
of the
and
nificant
enough
the twenty-seven
technique
to require
patients.
of reduction
surgical
treatment
in nineteen
of
We believe
that the common
and
immobilization
in full
the distal
unsound,
fractures.
is unstable,
that exists
prona-
subby im-
mobilizing
the hand in full pronation.
The end result
be that rotation
of the forearm,
especially
supination,
comes
We
severely
agree
the best
minimizing
limited.
with Sarmiento
position
for
deforming
was
resig-
et ab.
maintaining
forces
proper
length
of the distal
maintain,
strong,
protracted
and
others36,
may
bethat
normal
alignment
supination.
When
is
and
the
tion
It usually
has
one
or
more
of
the
following
characteristics:
extensive
comminution,
marked
displacement of fragments,
or interposition
of soft tissue
and
any one of them
can lead to an incomplete
reduction.
We
amount
believe
of
that
residual
whenever
dorsal
fracture
angulation
is
after
unstable,
reduction
no
is
permissible.
Adequate
reduction
requires
that the full dorsal length
of the radius
be restored
and maintained.
This
requires
a stable volar buttress
plus dorsal tension
by tissue
or an apparatus
that prevents
dorsal
collapse.
Otherwise
the force
of active
finger
flexor
and extensor
tendons,
combined
with dorsal
translation
of the lunate,
tends
to
including
open
the use
reduction
of external
is indicated.
pin
fixation,
Definite
is not
criteria
for open
reduction
of Colles
fractures
have
not been
completely
formulated,
but for the present
the technique
should
be more strongly
considered
for use in young
adults
in whom
comminuted,
unstable
intra-articular
fractures
have
been
treated
unsuccessfully
by closed
reduction
techniques.
The incidence
of complications
from Cobbes fractures
reported
here does not differ
significantly
from the types
and frequency
of problems
reported
noted
the significant
sequebae
of
by others
radio-ubnar
Frykman
arthrosis
result.
Gartland
and
Werley
reported
an incidence
of arthrosis
of 22 per cent. In combining
both
and radio-ulnar
arthroses,
we found
symptoms
significant
enough
to require
surgical
treatment
seven
(6.5
per
cent)
Shoulder-hand
of patients
reviewed
of 526
radiocarpab
that were
in thirty-
patients.
syndrome
was present
in 1 .4 per cent
by Bacorn
and Kurtzke,
in 3.4 per
cent in Rosens
series,
and in 10 per cent
ries of 515 patients.
The latter
included
ness and S#{252}decks atrophy.
Unsatisfactory
in Lidstr#{246}ms sefinger-joint
stiffresults
were re-
ported
in 67 per cent. The incidence
in our series
was four
( 1 1 per cent) of 356 local patients
While affected
patients
are fewer in number,
this complication
is the most difficult
to treat,
and prevention
by the techniques
described
by
.
Moberg
should
be studied.
Peripheral
neuropathy
as a serious
complication
was
not noted by others
to be as frequent
as we have reported
it
to be (forty-five
patients
over-all
and twenty-one
[3.7 per
cent]
of patients
who
were
primarily
under
our care).
THE JOURNAL
OF BONE
AND
JOINT
SURGERY
COMPLICATIONS
Lidstr#{246}m believed
that
and
Schlesinger
fractures.
due
concern
sequelae.
nerve
end of the
and Kurtzke
We
in part
and
are
rare
after
radius
(slightly
more
reported
an incident
Liss
believe
to a lack
with treatment
Lynch
and
injuries
OF
noted
that
these
of recognition
of the
Lipscomb,
only
one
and
frac-
common
whenever
throsis,
Frykman
and shoulder-hand
found that of eighty
per
throsis,
five (6.3
had shoulder-hand
reports
possibly
fracture
than
Frykman,
619
FRACTURES
than 1
of 0.2
case
negative
COLLES
three
neuropathy
sympathetic
others5
have placed
proper
emphasis
on the causes
of median neuropathy
and the need for aggressive
treatment
in
certain
acute as well as late cases.
Complications
related
to more
than one factor
were
sixteen
(arthrosis
neuropathy,
syndrome
patients
with
shoulder-hand
syndrome,
sociated
complications
more
with potential
Robbins,
and
complications
ar-
were
present.
radio-ubnar
ar-
neuropathy
and five
twenty
patients
with
had one or
in ten patients,
in nine patients,
malunion
dystrophy
in five patients).
more
asmedian
in ten patients,
Evidently,
and
these
complications
and others contribute
directly
to the 24 to 27
per cent incidence
of poor functional
results
that has been
reported369
from the treatment
of Colbes
fractures.
References
1 . BACORN,
R. W.,
and KURTZKE,
Board.
J. Bone
and Joint
Surg.
2.
3.
4.
5.
6.
7.
8.
9.
10.
I 1.
12.
13.
14.
15.
16.
17.
19.
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62.A,
NO.
E.
B.:
B.,
and
Long-Term
4, JUNE
1980
LISS,
G.
H.
Follow-up
W.;
R.:
BERRY,
Fracture:
Joint Surg.,
57-A:
311-317,
April
1975.
SCHECK,
MAX: Long-Term
Follow-up
of Treatment
of Comminuted
Wires and Cast. J. Bone and Joint Surg.,
44-A:
337-351,
March
SCHLESINGER,
SMAILL,
G.
PRATT,
Colles
18.
20.
21.
AUGUSTO;
J. F.:
N.
Fundamentals,
of Colles
C.;
and
Fads
Fracture.
SINCLAIR,
and
W.
F.:
Fractures
1962.
Fallacies
J. Bone
Colles
of the Distal
in the
and Joint
Fractures.
Carpal
Surg.
Functional
End
Tunnel
47-B:
Bracing
of the Radius
Syndrome.
80-85,
Feb.
Am.
1965.
in Supination.
by Transfixation
J. Surg.,
J. Bone
with
97:
466-470,
and
Kirschner
1959.