KOLLIS CHANGE

From Big Medical Encyclopedia

KOLLIS CHANGE (A. Colles, Irish surgeon, 1773 — 1843; synonym fracture of a beam bone in the typical place) — change of the distal end of a beam bone.

To. the item — the most frequent change at the person, it is for the first time described by Kollis in 1814.

Typicalness To. the item can be carried to the mechanism of an injury, character of shift of fragments and the principles of their reposition. The nature of damage of the distal end of a beam bone is not typical and differs in a big variety (out of - and an intra joint change, a change without splinters, the multisplintered shattered change).

Very often the change of the distal end of a beam bone is followed by a separation of an awl-shaped shoot of an ulna.

Fig. 1. Schemes of roentgenograms of a radiocarpal joint at Kollis's change (at the left — side, on the right — a direct projection); shift of fragments, and also a separation of an awl-shaped shoot of an ulna is visible.

To. the item is observed at any age, but is the most frequent at elderly women that is connected with the general involute processes in bones, an atrophy of cortical substance and thinning of a beam bone in the place of transition of a diaphysis to an epiphysis. It arises during the 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 (fig. 1). Usually there are closed changes, however at injury of skin by the acute end of the central fragment the open change is possible. At the same time, except skin, other fabrics — the square pronator, sinews of sgibatel, a median nerve, interosseous sensitive branches of a beam nerve can be damaged.

For clinical picture To. the item shtykoobrazny deformation of a forearm with a deviation of a brush in the beam party and to the back is characteristic, the swelling and sharp morbidity of area of a radiocarpal joint is expressed, 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.

At To. items without the shift of fragments impose a deep back plaster splint (for a period of up to 4 weeks) with the subsequent X-ray analysis for the purpose of control of the correct standing of fragments.

At changes with the shift of fragments under local anesthesia or an anesthesia apply the closed reposition with fixing of an extremity a plaster bandage. For this purpose the forearm is bent in an elbow joint at an angle 90 ° and stacked a palmar surface on a little table, the brush hangs down for the table edge. Carry out a reverse thrust for a shoulder. At the same time the assistant one hand behind I, and other hands for the II—IV fingers within 3 min. stretches fragments. After that the surgeon at the proceeding draft a hand presses on distal fragment from the back, then bends a brush of the patient and rejects it in the elbow party. At the same time there is reposition of fragments. Continuing draft, impose a deep back splint from an elbow joint to the basis of heads of metacarpal bones, to-ruyu well model and fix gauze bandage. The brush remains in the bent situation at an angle 30 — 40 °. Draft is stopped after hardening of gypsum and make control roentgenograms. Gypsum is removed in 4 — 6 weeks.

At failure of manual reposition apply reposition of a change by means of Sokolovsky's devices, Ivanov, etc.

Fig. 2. Schemes of roentgenograms of a radiocarpal joint with the shattered distal epiphysis of a beam bone (at the left — side, on the right — direct projections): 1 — before treatment; 2 — after reposition and fixing of fragments spokes; solid lines designated projections of spokes.

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 a plaster bandage in process of fall of hypostasis thereof there comes secondary shift, it is possible to warn a cut transdermal transarticulary fixing of fragments two crosswisely carried out spokes through both bones of a forearm (fig. 2). An immobilization during 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 hours. 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. Rentgenol, control is exercised in 5 — 7 days. Identification of secondary shift can be the basis for repeated repositions (see).

From the first days it is necessary to make the active movements by fingers, and also in elbow and humeral joints. After removal of gypsum appoint LFK, physical therapy, massage. Working capacity is recovered in 1 — 1,5 month.

At children use distraktsionno-compression devices to treatment of the old shattered changes of an epiphysis of a beam bone and an epiphysiolysis. For this purpose one spoke is carried out through a diaphysis of a beam bone, the second — through the II—IV metacarpal bones. On spokes strengthen the device, and single-step or gradual distraction possible to achieve reposition of fragments and their fixing (see. Distraktsionno-kompressionnye devices ). The device is removed at adults in 5 — 7 weeks, at children in 3 — 4 weeks. The subsequent LFK, physical therapy, massage allow to recover function of fingers and a brush.

Forecast at circumarticular changes favorable. After intra joint changes development of the deforming arthrosis of a radiocarpal joint is possible. Injury of sinews breaks function of fingers, traumatic neuritis of a median nerve leads to constant pains. At children premature closing of region of growth of a beam bone can lead to development of talipomanus.

See also Forearm .



Bibliography: Kaplan A. V. The closed injuries of bones and joints, page 235, M., 1967, bibliogr.; Lyuboshits N. A., and N z at r S. of the Lake and 3 and and to and Yu. V. Kompressionno-'s N distraktsionny an osteosynthesis of fractures of bones of a forearm at children, in book: Aktualn, vopr, travmat, and the orthoitem, under the editorship of M. V. Volkov, page 11, M., 1974; The Multivolume guide to orthopedics and traumatology, under the editorship of N. P. Novachen-co, t. 3, page 483, M., 1968; P e r N and in-sky V. A. and Adbul hub and M. A ditch. Treatment of fractures of beam bone in distal Epi metaphysis, Ortop, and travmat., No. 4, page 40, 1971; With about 1 1 e s A. On the fracture of the carpal extremity of the radius, Edinb. med. surg. J., v. 10, p. 182, 1814.


H. A. Lyuboshits.

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