Colle’s fracture

60 year old patient come to ED after hitting his arm on the side of the door. X-ray was done and it shows colle’s fracture with minimal displacement. You have already applied below elbow cast (POP). The patient is about to be discharged. Your task is to provide the care of the cast and explain the follow up plan.

• Start by explaining fracture
  • This is called a colle’s fracture. We have two bones in our forearm and the thicker one is called radius. When there is fracture of this bone with upward tilt we call it a colle’s fracture.
  • This can happen due to trauma but sometimes can happen with minimal trauma when our bone is weak. In your case, it looks like you have had the fracture due to minimal trauma and I will consider this in your management.
  • For now, we have applied a cast to immobilise the broken bone and facilitate the healing. Generally, we keep this cast for 6 weeks.
  • We will do another x-ray after 24 hours to check if the swelling is causing any tightness of the cast that can prevent blood flow to your fingers. If that is the case, we will have to open it, assess you again and reapply the cast.
• Care of the cast
  • I will provide you with the painkillers
  • There can be mild swelling, but you can minimise that by elevating your hand by using a sling or keeping your hand above the level of the heart using a pillow
  • You can also use a pack of ice wrapped in a thin towel to reduce the swelling
  • It’s important to keep the cast dry So when you are bathing wrap it with a plastic bag and tape the bag to your skin
  • if the cast gets wet, you can use a hair dryer blowing cool air
  • Do not use any lotion or powder near the cast and do not use any sticks or any other items to scratch inside the cast as it can injure the skin
  • Remember to regularly move the finger to keep the blood flow and avoid stiffness
• Redflags (VINCoR) 
  • Vascular
    • blue or pale discoloration of finger
  • Infection
    • If you get fever, any blisters on the skin around the cast (the inside of the cast if you can see it) or any foul smell
  • Neurological
    • cannot move your finger
    • numbness or tingling of your fingers
  • Compartment syndrome
    • pain not responding to pain killers
    • exaggerated pain while moving your fingers
  • Review
    • review in 24 hours
    • review in the [[fracture clinic]]
      • In one or two weeks
    • remove the cast in 6 weeks and follow up in physiotherapy for active exercise program
    • If you experience any problem doing your everyday activities, we can do occupational therapy assessment.
    • If you need to go back to your work, I can organise work assessment and rehabilitation.
• Management of minimal trauma fracture (MTF)
  • As this fracture happened with a minimal trauma, we will measure the level of certain substances such as calcium in your blood and will also measure the density of your bone to find out if you have thinning of your bone called osteoporosis. For this, I will arrange a referral to Fracture Liasion Service. Our further management will depend on our finding of the investigation, but we will explain everything to you as more information becomes available.