Colles' Fracture
Upper LimbOverview
Colles' fracture is a distal radius fracture with dorsal angulation and displacement, typically occurring within 2-3 cm of the wrist joint. It is the most common type of wrist fracture, accounting for approximately 90% of distal radius fractures. The injury typically results from a fall onto an outstretched hand (FOOSH) with the wrist in extension.
Pathophysiology
A fall onto an extended wrist creates a compressive and shear force through the distal radius, causing a transverse fracture line typically 2-3 cm proximal to the articular surface. The dorsal angulation occurs because the distal fragment is displaced and angulated dorsally. Associated injuries may include ulnar styloid fractures (50-60% of cases), anterior interosseous nerve injury, or compartment syndrome in severe cases. Healing typically occurs over 6-12 weeks depending on fracture complexity and patient factors.
Patient Education
Most Colles' fractures heal well with appropriate immobilization and rehabilitation; early mobilization of non-immobilized joints and progressive wrist exercises after cast removal are essential to restore function and prevent stiffness.
Typical Presentation
Site
Distal forearm, dorsal wrist, and radial-sided wrist; swelling extends from hand to mid-forearm
Quality
Sharp, throbbing pain with immediate onset; associated with 'dinner fork' deformity if severely displaced
Intensity
Severe (8-10/10) immediately post-injury; moderate (4-6/10) during healing phase
Aggravating
Any wrist movement, gripping, weight-bearing through the arm, direct pressure over fracture site
Relieving
Immobilization in cast or splint, elevation of arm, ice application, analgesic medication
Associated
Swelling and bruising, visible deformity ('dinner fork'), loss of wrist extension range, finger swelling, potential sensory changes in radial nerve distribution
Orthopaedic Tests
Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.
Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).
Clinical Inspection and Palpation
Procedure
Look at the wrist from the side for the 'dinner fork' deformity, swelling and bruising. Palpate gently along the distal radius and ulnar styloid, and check circulation (capillary refill, radial pulse) and sensation in the median nerve distribution.
Positive Finding
Dorsal angulation of the wrist (dinner fork deformity), swelling and localised bony tenderness over the distal radius.
Interpretation
Suggests a distal radius fracture and needs an X-ray. Numbness in the median nerve distribution or poor circulation needs urgent medical review. Do not carry out provocative tests on a visibly deformed wrist.
Axial Loading Test (Compression Test)
Procedure
Only if there is no visible deformity and imaging is not yet available: with the wrist supported in neutral, apply gentle pressure along the long axis of the forearm through the hand.
Positive Finding
Localised pain over the distal radius.
Interpretation
Localised pain on gentle axial loading raises suspicion of a fracture and means X-ray before any further testing. Do not perform it on a deformed wrist; it adds pain and risk without adding information.
Pronation–Supination Range of Motion Assessment
Procedure
Once a fracture has been treated, or during rehabilitation: with the elbow at 90° and tucked against the side, measure active forearm pronation and supination on both sides.
Positive Finding
Reduced rotation, especially supination, or pain at end of range.
Interpretation
Forearm rotation is commonly limited after distal radius fractures and is a key rehabilitation target. Persistent painful loss of rotation, or pain over the distal radioulnar joint, suggests DRUJ involvement and may need review.
Scaphoid Compression Test
Procedure
Palpate the anatomical snuffbox and the scaphoid tubercle for tenderness, then gently push along the long axis of the thumb.
Positive Finding
Localised tenderness in the snuffbox or over the scaphoid tubercle, or pain on axial thumb compression.
Interpretation
A scaphoid fracture can occur alongside a distal radius fracture and is easy to miss. Radial-sided wrist pain after a fall means check the X-rays for the scaphoid specifically, and consider further imaging if it hurts but the X-ray looks clear.
Two-Point Discrimination and Median Nerve Sensory Testing
Procedure
Test light touch and two-point discrimination on the palmar thumb, index and middle fingertips, comparing with the ulnar-supplied little finger and with the other hand.
Positive Finding
Reduced sensation, numbness or tingling in the median nerve distribution.
Interpretation
Median nerve symptoms after a distal radius fracture can come from acute compression in the carpal tunnel. Worsening numbness is an emergency and needs same-day medical review.
Distal Radioulnar Joint (DRUJ) Stability Test
Procedure
Only once fracture healing allows: stabilise the distal radius, grasp the ulnar head and move it palmar and dorsal in neutral, full pronation and full supination. Compare with the other wrist.
Positive Finding
More translation than on the other side, loss of a firm end-point, or pain.
Interpretation
Suggests distal radioulnar joint instability, which can follow a distal radius fracture with an ulnar styloid or TFCC injury. Instability should be referred to a hand surgeon.
⚠ Red Flags
- •Immediate post-injury with severe deformity requiring emergency reduction
- •Signs of neurovascular compromise: absent radial pulse, cold fingers, sensory loss in radial nerve distribution, severe pain out of proportion
- •Signs of compartment syndrome: severe pain, paresthesias, pallor, paralysis, pulselessness
- •Open fracture with skin breach or wound contamination
- •Multiple trauma or polytrauma
- •Severely comminuted fractures with intra-articular involvement requiring surgical intervention
⚡ Yellow Flags
- •Anxiety about loss of hand function affecting compliance with rehabilitation
- •Fear-avoidance behavior limiting active participation in recovery
- •Depression or mood disturbance affecting motivation for rehabilitation
- •Poor understanding of fracture healing timeline leading to unrealistic expectations
- •Social or occupational factors that may compromise immobilization compliance
- •History of osteoporosis or metabolic bone disease affecting healing capacity
Osteopathic Techniques
Refer first
A suspected distal radius (Colles) fracture needs X-ray and orthopaedic management. Stable extra-articular fractures with acceptable alignment are reduced under anaesthesia and immobilised in a splint or cast; others need surgery. Refer before using manual techniques on the wrist.
- Reference bookSummers et al. · StatPearls 2023
Rehabilitation Exercises
Finger and Thumb Flexion-Extension (in cast)
Elbow Flexion-Extension (pendulum swings)
Shoulder Circumduction (active-assisted)
Wrist Flexion-Extension (post-cast removal)
Wrist Radial-Ulnar Deviation (post-cast removal)
Forearm Pronation-Supination (active-assisted)
Wrist Flexor Stretch (doorway lean)
Wrist Extensor Stretch (over-table hang)
Grip Strength Training (squeezing therapy putty)
Wrist Flexion Against Resistance (light dumbbells)
Wrist Extension Against Resistance (light dumbbells)
Shoulder Blade Stability (prone Y-T-W positions)
Referral Criteria
- •Immediately post-injury: refer to emergency department or orthopaedic urgent care for imaging, reduction, and immobilization
- •Any neurovascular compromise requiring emergency vascular or surgical assessment
- •Signs of compartment syndrome requiring emergency fasciotomy
- •Open fractures requiring wound management and surgical intervention
- •Fractures with significant intra-articular involvement or severe comminution requiring surgical consultation
- •Failed conservative management or loss of reduction during healing phase
- •Post-immobilization: refer to physiotherapy for structured rehabilitation program if significant functional loss
- •Persistent pain, stiffness, or swelling beyond expected healing timeline suggesting complex regional pain syndrome
- •Associated injuries requiring specialist assessment (nerve injury, vascular injury, other fractures)