Kollis's change

Description:

Kollis change (A. Colles, Irish surgeon, 1773 — 1843; a synonym a fracture of a beam bone in the typical place) — a change of the distal end of a beam bone. Typicalness To. by the item it is connected with the injury mechanism, character of shift of fragments and the principles of their reposition. The nature of damage is not typical and differs in a big variety (out of - and an intra joint change, a change without splinters, the multisplintered shattered change). Often the change of the distal end of a beam bone is followed by a separation of an awl-shaped shoot of an ulna.

Symptoms of the Change of Kollis:

Kollis's change is observed at any age, but is the most frequent at elderly women. It arises when falling on a brush of the outstretched arm turned by a palm down. The change can be without shift, but more often distal fragment of a beam bone is displaced in the back and beam party. The closed change is usually observed, but at damage of soft tissues by the acute end of the central fragment the open change is possible. At the same time the square pronator, sinews of sgibatel, a median nerve, interosseous sensitive branches of a beam nerve, skin can be injured.
At To. items with shift are characteristic shtykoobrazny deformation of a forearm with a brush deviation in the beam party and to the back, the expressed swelling and sharp morbidity in a radiocarpal joint; the active and passive movements of fingers and a brush are limited and painful. The nature of a fracture is established at a X-ray analysis.

Reasons of the Change of Kollis:

The traumatic nature of a fracture takes place.

Treatment of the Change of Kollis:

At To. items without the shift of fragments impose a deep back plaster splint (for a period of up to 4 weeks). For control of the correct standing of fragments carry out a X-ray analysis. At changes with the shift of fragments under local or general anesthesia carry out the closed reposition and fix an extremity a plaster bandage.

    At the shattered changes of a distal epiphysis of a beam bone there is a compression of spongy substance of an epiphysis and after reposition between fragments can arise diastases.
In process of fall of hypostasis there comes the secondary shift of fragments who can be warned their transdermal transarticulary fixing by two spokes which are carried out through both bones of a forearm. Immobilization term — 6 — 7 weeks.

    In all cases of fixing of a forearm by a plaster bandage of the patient it has to be examined in 12 — 24 h. At detection of circulatory disturbances in a brush (a cold snap, numbness, hypostasis of fingers) gauze bandage is cut, edges of a splint unbend from skin and again fix bandage, extremities give sublime situation. Radiological control is exercised in 5 — 7 days. Identification of secondary shift can be the basis for repeated reposition.

    From the first days it is necessary to make the active movements by fingers, and also in elbow and humeral joints. Already in the period of an immobilization recommend to use the injured hand when performing the elementary movements necessary for self-service. After removal of gypsum appoint LFK, physical therapy, massage. Working capacity is recovered in 1 — 11/2 month.

    At children use distraktsionno-compression devices to treatment of the old shattered changes of an epiphysis of a beam bone and an epiphysiolysis. At adults they are removed in 5 — 7 weeks, at children — in 3 — 4 weeks. Further appoint LFK, physical therapy massage which allow to recover function of fingers and a brush.

    The forecast concerning function at circumarticular changes favorable.
After intra joint changes development of the deforming arthrosis of a radiocarpal joint is possible. As a result of the wrong union To. the item can arise the deformation reminding bayonet shaped. Injury of sinews breaks function of fingers, traumatic neuritis of a median nerve is followed by constant pains. Sometimes, especially after repeated reposition, Zudek's syndrome develops (see Zudek an atrophy). At children premature closing of region of growth of a beam bone can lead to talipomanus development.