Overview

Colles fracture is a common type of wrist fracture that occurs when the distal radius, the larger of the two forearm bones, breaks near the wrist joint. It is characterized by a break with the distal fragment of the bone being displaced upwards and backwards, often resulting in a distinctive “dinner fork” or “bayonet” deformity of the wrist. This injury is most frequently seen in older adults, especially postmenopausal women with osteoporosis, and typically results from a fall onto an outstretched hand. Prompt diagnosis and treatment are essential for proper healing and restoration of wrist function.

Causes

The primary cause of a Colles fracture is trauma that impacts the wrist in a specific way:

• Falls: Falling onto an outstretched hand (FOOSH injury) is the most common cause, especially in the elderly.
• Sports injuries: High-impact sports or activities that involve frequent falls, such as skiing, skating, or cycling, can result in this fracture.
• Motor vehicle accidents: Trauma from car or motorcycle accidents can lead to wrist fractures.
• Osteoporosis: Reduced bone density increases susceptibility to fractures even from minor falls or impacts.

Symptoms

Patients with a Colles fracture usually present with distinct symptoms that include:

• Immediate pain: Severe pain in the wrist following the injury.
• Swelling: Noticeable swelling around the wrist and forearm.
• Deformity: A visible deformity of the wrist, commonly described as resembling a “dinner fork.”
• Bruising: Discoloration and bruising around the injured area.
• Restricted movement: Difficulty moving the wrist, hand, and fingers due to pain and mechanical blockage.
• Tenderness: Pain on palpation of the wrist and distal forearm.

Diagnosis

Diagnosing a Colles fracture typically involves a combination of clinical evaluation and imaging tests:

• Physical examination: The doctor assesses visible deformity, swelling, tenderness, and range of motion.
• X-rays: Standard wrist X-rays are used to confirm the diagnosis, determine the type of fracture, and assess displacement and angulation.
• CT scan: In complex or intra-articular fractures, a CT scan may be ordered to provide detailed images of the bone structure.
• Bone density test: In older adults, especially women, bone density testing may be suggested to evaluate for underlying osteoporosis.

Treatment

Treatment of a Colles fracture depends on the severity, displacement, and patient factors such as age and activity level:

• Non-surgical treatment:
• Closed reduction: Manipulating the broken bone back into place without surgery.
• Casting or splinting: Immobilizing the wrist with a cast or splint for 4-6 weeks to allow the bone to heal.
• Surgical treatment:
• Open reduction and internal fixation (ORIF): Surgery to realign the bone and secure it with plates, screws, or pins.
• External fixation: In some cases, an external frame is used to stabilize the fracture from the outside of the body.
• Pain management: Use of analgesics and anti-inflammatory medications to control pain and swelling.
• Physical therapy: Rehabilitation exercises after immobilization or surgery to restore range of motion, strength, and function.

Prognosis

The prognosis for Colles fracture is generally good, especially with prompt treatment and proper rehabilitation:

• Excellent outcomes with treatment: Most individuals regain full or near-full function of the wrist.
• Recovery period: Bone healing typically occurs within 6 to 8 weeks, but full recovery, including strength and mobility, may take several months.
• Potential complications: Some cases may develop stiffness, decreased range of motion, chronic pain, or post-traumatic arthritis, especially in older adults.
• Risk of re-fracture: Individuals with osteoporosis have a higher risk of future fractures.
• Importance of rehabilitation: Adherence to physiotherapy greatly improves functional recovery and reduces long-term complications.

Overall, with timely and appropriate treatment, most individuals with a Colles fracture can expect a favorable outcome and return to normal activities.