Colles Fracture: Causes, Symptoms and Treatment

What is a Colles Fracture?

A Colles fracture is a break of the distal radius -- the lower end of the radius bone in the forearm -- occurring approximately 2 to 3 centimetres above the wrist joint. The hallmark of this fracture is the dorsal (backward) displacement and angulation of the distal fragment, producing the classic dinner fork deformity visible on clinical examination and X-ray. The injury was first described in 1814 by the Irish surgeon Abraham Colles, after whom it is named. It remains one of the most frequently encountered fractures in clinical practice, particularly among older women.

Causes and Risk Factors

The most common mechanism of injury is a fall on an outstretched hand (FOOSH), in which the impact force is transmitted through the wrist to the distal radius. Several factors increase the risk of sustaining a Colles fracture:

• Osteoporosis: Reduced bone density -- especially common in postmenopausal women -- significantly lowers the force required to cause a fracture.
• Older age: Increased fall risk combined with decreased bone strength makes elderly individuals particularly vulnerable.
• High-energy trauma: In younger patients, Colles fractures may result from road traffic accidents, sports injuries, or falls from height.
• Calcium and vitamin D deficiency: Both contribute to reduced bone mineral density and a higher fracture risk.

Symptoms

Following the injury, patients typically experience:

• Immediate, severe pain around the wrist and lower forearm
• Swelling and bruising (haematoma) over the wrist
• Visible deformity of the wrist -- the classic dinner fork appearance caused by dorsal displacement
• Limited range of motion of the wrist and hand
• Tenderness on palpation over the distal radius
• Occasionally numbness or tingling in the fingers due to associated median nerve compression

Diagnosis

The diagnosis of a Colles fracture is established through a combination of clinical assessment and imaging.

Clinical Examination

The treating physician assesses the wrist for deformity, swelling, and point tenderness, and checks the neurovascular status of the hand -- specifically circulation, motor function, and sensation (CMS assessment).

Imaging

• X-ray: Standard radiographs in two planes (anteroposterior and lateral) confirm the fracture, show fragment alignment, and reveal the degree of displacement and shortening.
• Computed tomography (CT): Recommended for complex, comminuted, or intra-articular fractures to fully assess fracture geometry and aid surgical planning.

Classification

Colles fractures are most commonly classified using the AO/OTA classification system. Key factors include:

• Degree of dorsal angulation and radial shortening
• Intra-articular versus extra-articular involvement
• Number of fragments (simple vs. comminuted)
• Associated injuries (e.g., ulnar styloid fracture)

Treatment

Conservative Management

Undisplaced or minimally displaced, stable fractures are managed non-operatively:

• Closed reduction: Displaced fragments are manually realigned under local or regional anaesthesia.
• Immobilisation: The wrist is held in a below-elbow cast or splint for 4 to 6 weeks.
• Radiological follow-up: Serial X-rays are taken to monitor for loss of reduction during healing.

Surgical Management

Unstable, severely displaced, or intra-articular fractures, as well as those that cannot be maintained by closed means, require operative fixation:

• Volar locking plate (ORIF): Open reduction and internal fixation using an angle-stable volar plate is the current gold standard for surgical treatment.
• Percutaneous Kirschner wire fixation: May be used for simple displaced fractures in selected patients.
• External fixator: Applied in highly comminuted fractures or cases with significant soft tissue injury.

Rehabilitation

After immobilisation or surgical fixation, physiotherapy plays a central role in restoring full wrist function. Tailored exercises focus on regaining range of motion, grip strength, and fine motor coordination. Full recovery may take several months depending on fracture severity and patient age.

Possible Complications

• Carpal tunnel syndrome: Median nerve compression due to swelling or malreduction
• Complex regional pain syndrome (CRPS / Sudeck atrophy): A rare but debilitating chronic pain condition
• Tendon injury: The extensor pollicis longus tendon is susceptible to irritation or rupture
• Malunion: Incorrect healing due to inadequate reduction or loss of position
• Post-traumatic arthritis: Long-term complication, particularly after intra-articular fractures

References

1. Court-Brown C.M., Caesar B. - Epidemiology of adult fractures: A review. Injury, 37(8):691-697 (2006). PubMed PMID: 16814787.
2. Nellans K.W., Kowalski E., Chung K.C. - The epidemiology of distal radius fractures. Hand Clinics, 28(2):113-125 (2012). PubMed PMID: 22554654.
3. Lichtman D.M. et al. - Treatment of Distal Radius Fractures. Journal of the American Academy of Orthopaedic Surgeons, 18(3):180-189 (2010). PubMed PMID: 20190108.