In the Beginning

Distal radius fractures were historically thought of as dislocations of the wrist, from Hippocrates’ time until the 18th century, when Petit first posed the possibility that they may be fractures.² The memoir of Pouteau, chief surgeon of L’Hotel Dieu in Lyon, published in 1783, described distal radius fractures as such, and recognized that there were several types.³ This memoir predates Colles’ article by 30 years, and in France, distal radius fractures are still often referred to as Pouteau-Colles fractures.⁴

Abraham Colles (Fig. 1-1) was born in 1773, near Kilkerny, Ireland; he presumably became interested in medicine after receiving an anatomy book in gratitude from the town surgeon after a flood swept away all of the surgeon’s possessions. Colles trained in Dublin and Edinburgh, obtained his medical degree in 1797, and was elected president of the Royal College of Surgeons of Ireland in 1802 at age 29. His landmark work on distal radius fractures was published in 1814,¹ preceded by an article on surgical anatomy in 1811, and followed by an article on clubfoot (1818) and a text on venereal disease and the use of mercury (1837). His contribution to orthopaedics does not include an illustration or any description of the dissection of the injury, which is surprising given his reputation as an anatomist. His work is an explanation for his logic as to why the injury is likely a fracture rather than a dislocation. Colles made this assumption based on the presence of crepitus typical to well-described fractures at the time. He discussed the tendency of the wrist to revert to its deformity at the time of injury in the absence of appropriate immobilization, and the importance of guarding “against the carpal end of the radius being drawn backwards,” recognizing the deleterious effect of loss of palmar tilt.

FIGURE 1-1 Abraham Colles.

(Reprinted with permission from the Colles-Graves foundation, New York.)

Colles concluded his work with the following remarks:

This statement suggests that fractures of the distal radius were likely just as common in 1814 as they are today.

Colles’ article was published in a narrowly distributed medical journal, the Edinburgh Medical Surgical Journal, and received little attention until Dupuytren brought the distal radius fracture to the attention of his students and to the surgical world at large via published lectures:

Goyrand in the 1830s noted that most cases of distal radius fractures had dorsal displacement, but also described occasional cases of palmar displacement and illustrated both.^6,7 Nelaton contributed to the anatomical study of these injuries and to the study of the mechanism of injury using cadavers with his paper in 1844.⁸ In 1838, Barton of the United States described a fracture-dislocation of the radiocarpal joint, saying, as many authors (including Colles) prior had, that these injuries are often mistaken for sprains or dislocations of the wrist. Barton distinguished the injury under discussion, however, by describing a subluxation of the wrist resulting from a fracture through the distal radial articular surface, not to be mistaken for fractures “of the radius, or of the radius and ulna, just above, and not involving the joint.”⁹ Smith published a chapter, “Fractures of the Bones of the Forearm, in the Vicinity of the Wrist-Joint,” in 1847 describing the anatomy of Colles’ fracture and a palmarly displaced distal radius fracture, although he did not have the benefit of an anatomical specimen as Goyrand did a decade earlier.¹⁰

And Then There Was Röntgen

The discovery and development of roentgenography in late 1895 was a significant advance in the nature of fracture evaluation and treatment. Wilhelm Conrad Röntgen (Fig. 1-2) was born in Prussia and emigrated to Holland with his family as political refugees. He became Professor of Physics at Wurzburg in 1888 and developed a practical use for roentgenography in the early winter of 1895. He submitted his first paper on the topic to the local scientific community on December 28, 1895. The idea took hold quickly, and within months larger hospitals obtained and used the technology. His wife recalled:

FIGURE 1-2 Wilhelm Conrad Röntgen.

(Reprinted with permission from Bill DeHope.)

Röntgen received the Nobel Prize in 1901 for his work.

Beck and Cotton were two of the first to use roentgenograms for further investigation of distal radius fractures, publishing their findings independently from 1898 through 1900.^11–14 Cotton focused not only on the radiographic characteristics of this injury, but also on the experimental and anatomical correlations with roentgenograms on 140 patients with distal radius fractures. Several other authors studied the radiographic characteristics of these fractures, including Morton,¹⁵ Pilcher,¹⁶ and Destot.¹⁷