Rediscovering Colles’ fracture

Colles’ fracture, spelled with or without an apostrophe, is one of the more widely known and resilient eponymous conditions. This may be because the condition it describes, a fracture of the distal radius with dorsal displacement of the distal end and carpus, is cumbersome to describe otherwise and it is clinically necessary to distinguish it from other, also eponymous, fractures of the distal radius such as Smith’s and Barton’s. It was Robert William Smith who first described the fracture as Colles’, or more precisely Colles’s, in book ‘A Treatise on Fractures in the Vicinity of Joints and on certain forms of Accidents and Congenital Dislocations’. This was published in 1847, the same year he was appointed Professor of Anatomy and Surgery in Trinity College Dublin. He coined the term to distinguish the fracture from distal radial fracture with ventral displacement of the distal fragment which was also first described in his book and named eponymously for him. The fracture was named for Abraham Colles, another Irish surgeon who first described the fracture in a brief paper to the ‘Edinburgh Medical and Surgical Journal’ in 1814. Colles was Professor of Surgery in the Royal College of Surgeons in Ireland and was better known during his career for his work on syphillis and the anatomy of the pelvis. Colles’ fascia is still named for him and the inguinal ligament was for a time called Colles’ ligament. His 1814 description is remarkably perceptive for a Surgeon working more than 80 years before the first clinical X-ray. He recognized the fracture as usually occurring from a fall on an outstretched hand. Unlike previous authors he realized the deformity that resulted was because of a fracture of the radius rather than a dislocation of the wrist. As the fracture rarely killed anyone, confirmation of the cause by early dissection was not an option. Colles argued that the deformity could be reduced using appropriate traction, however, it rarely stayed well aligned, a state far more likely due to a fracture than a dislocation. He attributed the lack of crepitus at the fracture site to the associated swelling of the surrounding tissues. Robert William Smith was well acquainted with Colles through the Royal College of Surgeons and Richmond Hospital in Dublin. He had a distinguished career both as a Surgeon and a teacher and in addition to his works on fractures he also described Neurofibromatosis some 30 years before Von Recklinghausen. As professor, he amassed a large teaching collection of paintings and book plates, many from his own works and on his death in 1872 these were purchased by his successor as Professor of Surgery and Anatomy, Edward Hallarhan Bennett. These illustrations continued to be used for teaching and either Smith or Bennett had many of the pathological and anatomical paintings cut out and mounted on board before display, but as the 19th century progressed, illustrated textbooks became more available and long term preservation of specimens became more practical the collection was fortuitously placed in storage within the TCD Anatomy Department rather than being discarded. It was subsequently transferred to the Library for storage and eventual cataloguing. In 2012, the TCD Anatomy department moved from its 19th century buildings on campus to a modern structure nearby which precipitated an audit of its historical collection. As a consequence the School of Medicine recognized what a rich collection of historical, documents, artifacts, illustrations and specimens it held and has begun to make plans for the development of an anatomical and medical museum on site. As part of this project Department staff with the assistance of the librarians, undertook a project to examine a sample of the record boxes transferred to the library to gain some appreciation of their contents and permit development of a cataloguing and preservation plan. Within these boxes the investigators found a rich collection of illustrations including early X-rays or Skiagrams from the 1890s, 19th century medical photographs, book plates and paintings. Of particular note the collection clearly included examples of plates from Smith’s books ‘Treatise on Fractures’ and his 1849 work ‘A Treatise on the Pathology, Diagnosis and Treatment of Neuroma’. We identified a large number of book plates, often multiple copies of same likely used for teaching but with some of the original paintings on which the illustrations were based (Figure 1). This lead us to conclude that the boxes may potentially also contain the original illustrations of Colles’ Fracture and Smith’s Fractures. After an examination of several more boxes paintings of what were clearly Colles’s fractures were located and a copy of Smith’s book was examined to check if we could find plates matching the images found (Figure 2). We were not able to locate an image that corresponded to the picture of his eponymous fracture from the book. The paintings appear to have been performed in water color and had been cut out and mounted on artists’ board. Neither the plates nor the original painting have an obvious artist’s attribution or signature and we are continuing to research these. Illustration of a foot fracture (?Charcot’s foot) from R.W. Smith’s collection (left) with associated book plate. Courtesy Library of Trinity College Dublin. Original illustrations of Colles’ fracture (left) from Smith’s collection with associated book plates. Courtesy Library of Trinity College Dublin. The University, library and School of Medicine are continuing to work to record catalogue restore and protect all the artefacts found and will continue to work to make them available to researchers in the future. Plans are being developed for a museum associated with the collection on the site of the old Anatomy building on the Trinity campus. Conflict of interest: None declared.

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