Older, Stabler and Cassebaum classified Colles fractures based on the severity of the injury and the associated comminution. The authors are from Roosevelt Hospital in New York City.
Type
Classification
I
nondisplaced
II
displaced with minimal comminution
III
displaced with moderate comminution of dorsal radius
IV
displaced with severe comminution of the radial head
Parameters:
(1) angulation in dorsal and volar aspects
(2) shortening of radius (relative to distal end of the ulna)
(3) comminution of the dorsal and distal radius
Angulation
Shortening
Comminution
Type
loss of some volar angulation; up to 5° of dorsal angulation
none (>= 2 mm above distal ulna)
none
I
loss of volar angulation
usually not below distal ulna; may be up to 3 mm below
minimal
II
usually below distal ulna
of dorsal radius; distal radial fragment with large pieces
III
2-8 mm below distal ulna
marked of dorsal radius; marked of distal radius with shattering
IV
where:
• Volar refers to the flexor/palm surface of the wrist and forearm.
• Dorsal angulation increases with increasing comminution. This is best seen in the lateral X-rays of the wrist.
The outcome after healing tends to parallel the severity of the injury, with Type I injuries having excellent outcomes and Type IV injuries having some risk for poor outcome.
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