"The least little turn of the wrist will do the job."
Jean Anouilh (1910-1987), French playwright.
-- Antigone (1944)
In 1814, 81 years before the discovery of X-rays, Abraham Colles, a surgeon from Dublin, accurately described a fracture of the wrist that now bears his name. Colles' fracture refers to a break in the radius, one of the forearm bones. The radius is just above the wrist on the side of the thumb.
Who often gets it and why. Colles' fracture is osteoporosis-related. The risk factors in osteoporosis, and by extension, in osteoporotic fractures are:
* Female gender
* White or Asian ancestry
* Sedentary lifestyle
* Life-long low calcium intake
* Excessive use of alcohol
* Postmenopausal status
We ought to add to these failing vision and poor balance, a terrible combination as we grapple for reasons why Lolo or Lola slipped and fell. As it is often the case, a bad fall is instinctively braced with an outstretched hand. With tremendous force, bones of the wrist are rammed into the flared weak end of the adjacent bone, the radius. With tremendous force, the radius breaks.
The dinner fork deformity. Traditionally, the doctor thinks of Colles' fracture upon seeing the wrist pushed back on the broken radius. If the tines of the fork are the fingers, the wrist and broken radius together is the slope of the fork. One look and anyone, not even a doctor, will know it isn't right. Besides, the victim will be in exquisite pain.
What should be done emergently? Before taking the victim to the emergency room, the forearm must be immobilized in a sturdy split from the hand to just above the elbow. Elevate the forearm, apply ice after wrapping the arm in a compressive dressing such as elastic bandage.
At the emergency room. A good emergency room physician will take a complete history and perform a thorough physical examination. As much as 10% of other injuries are missed the first time around. For the fracture itself, confirmation is sufficient with front and side-view X-rays of the forearm that include the wrist and the elbow.
Treatment. Now, depending on the severity of the fracture fragments - whether the bone has been pulverized to several bits or miraculously just an indistinct line, the orthopedic surgeon will suggest several treatment options. Usually, undisplaced and incomplete fractures are cast in plaster of paris or fiber glass. The more severe fracture types have to be reduced or put back in anatomic alignment by a variety of techniques. While fractures of the distal radius (end of the bone nearest the wrist) remain problematic, doctors are slightly more optimistic now than in Colles' time. He said that the "deformity will remain undiminished through life."
Prevention. Fracture prevention begins by recognizing that the elderly have poorer balance and bad eyesight. Sometimes, the reason they are not as sure-footed is that they are on maintenance drugs that cause them to be sleepy. Maybe it's too late to teach Lola judo rolls for sudden slips. It may be easier not to keep the kids' toys scattered on the floor and to clean up immediately after food spills.
Let's hope to see less dinner forks on wrists this time.