Silver Fork Deformity

The most common fracture of the distal radius in the adult is Colles’ fracture (Figure 1). Although Abraham Colles ¹ (1773–1843) thought his 1814 report was the first to describe this injury, it had in fact been described earlier by Claude Pouteau ² (1725–1775), chief surgeon of the Hotel Dieu in Lyon. ‘In a memoir published posthumously in 1783 … [Pouteau] described the fracture of the distal end of the radius with posterior tipping or displacement of the distal fragment.’ ³ Neither of these authors used the term silver-fork deformity in their descriptions of this injury, although Colles (Steeven’s Hospital, Dublin) did accurately describe it as ‘The posterior surface of the limb presents a considerable deformity; for a depression is seen in the forearm, about an inch and a half above the end of this bone, [radius] while a considerable swelling occupies the wrist and the metacarpus. Indeed the carpus and base of metacarpus appear to be thrown backward so much, as on first view to excite a suspicion that the carpus has been dislocated forward.’ ¹ It was ‘Alfred Armand Velpeau (1795–1867) [who] termed the usual deformity seen in fractures of the distal end of the radius the talon de fourchette which, translated into English, meant the ‘silver fork deformity’.’⁵ Figure 1 Lateral radiograph showing typical Colles’ fracture with silver-fork deformity (author’s case) https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig81_1_B.jpg"/>