Colles Fracture: Symptoms, Types, Causes and Treatment

A Colles fracture is one of the most common injuries affecting the wrist, especially in adults and the elderly. Named after the Irish surgeon Abraham Colles, who first described it in 1814, this fracture involves the distal radius—one of the two major bones of the forearm—just above the wrist. While it’s often thought of as a straightforward injury, Colles fractures can result in a surprising range of symptoms, complications, and outcomes. Understanding the symptoms, different types, causes, and evidence-based treatment options is crucial for patients and clinicians alike.

Symptoms of Colles Fracture

Recognizing the symptoms of a Colles fracture is key to prompt diagnosis and effective management. Symptoms can vary in intensity and duration, and may persist long after the initial injury. While the classic features are well known, complications and long-term effects are often overlooked.

Symptom	Description	Frequency/Impact	Source(s)
Pain	Acute, localized pain at wrist	Nearly universal, can persist	1 2 7
Swelling	Swelling around wrist/hand	Common, varies by severity	1 2
Deformity	"Dinner fork" appearance	Typical in displaced fractures	2
Stiffness	Limited wrist/finger movement	Can be persistent	1 2 7
Weakness	Reduced grip strength, wrist power	Frequently reported, long-term	1 9
Nerve Symptoms	Numbness, tingling (esp. median nerve)	Carpal tunnel syndrome, 12–17%	7 10
Functional Loss	Difficulty with daily/leisure activities	Up to 50% report impairment	1 7

Table 1: Key Symptoms

Pain and Swelling

Pain is the most immediate and prominent symptom after a Colles fracture. It is typically sharp and localized to the wrist, often accompanied by swelling that may extend to the hand and forearm. While acute pain usually diminishes as the fracture heals, some patients experience chronic discomfort or aching, especially with movement or cold weather 1 2.

Deformity and Loss of Function

A hallmark of Colles fracture is the characteristic wrist deformity, often described as a “dinner fork” or “bayonet” appearance. This is due to the dorsal (backward) angulation of the distal fracture fragment. Many patients also report difficulty using their hand for everyday tasks, such as turning door handles, carrying objects, or even returning to work or leisure activities. Studies show that up to half of patients experience some functional impairment, and about 8% must give up certain activities or make accommodations 1.

Stiffness and Weakness

Stiffness, especially in the wrist and fingers, is a common sequela. In some cases, stiffness persists for months or even years, limiting the range of motion. Grip strength may also be reduced, particularly if the fracture heals with residual deformity or malunion 1 2 9.

Nerve and Soft Tissue Complications

Colles fractures can lead to nerve-related symptoms, most frequently carpal tunnel syndrome due to compression of the median nerve. This complication affects 12–17% of patients at three to six months post-injury, particularly in older adults and those with greater residual dorsal angulation 7 10. Other possible complications include tendon ruptures, finger stiffness, and shoulder-hand syndrome 7.

Types of Colles Fracture

Not all Colles fractures are the same. Understanding the various types is important because the characteristics of the fracture influence treatment decisions and prognosis.

Type	Defining Feature	Clinical Relevance	Source(s)
Extra-articular	Does not involve wrist joint surface	Most common, better prognosis	2 3 15
Intra-articular	Extends into wrist joint surface	Higher risk of arthritis/malunion	2 3 4
Comminuted	Bone broken into multiple fragments	More difficult to treat, worse outcome	2 4 13
Displaced	Fracture fragments shifted from normal position	Classic "dinner fork" deformity	2 3 4
Stable	Fragments remain aligned after reduction	Less likely to redisplace	4
Unstable	Tendency to lose position after reduction	Needs closer monitoring or surgery	4 13

Table 2: Types of Colles Fracture

Extra-articular vs Intra-articular

Colles fractures are classified based on whether the break extends into the wrist (radiocarpal) joint. Extra-articular fractures do not involve the joint surface, while intra-articular fractures do. Intra-articular fractures are associated with a higher risk of complications such as post-traumatic arthritis and chronic pain 2 3 4.

Comminuted vs Simple

A simple Colles fracture features a clean break, whereas a comminuted fracture means the bone is shattered into several pieces. Comminuted fractures are more challenging to treat and have a greater risk of long-term disability or arthritis 2 13.

Displaced vs Non-displaced

Displaced fractures occur when the broken bone fragments have moved from their normal alignment, producing the classic deformity. Non-displaced fractures maintain normal alignment and generally heal with fewer complications 2 3.

Stability

The stability of a Colles fracture refers to the likelihood that the bone fragments will remain in place after being set. Some fractures are inherently unstable and prone to re-displacement, especially if there is significant comminution or initial deformity 4 13. Stable fractures are less likely to require surgical intervention.

Causes of Colles Fracture

Colles fractures are most often the result of a specific type of trauma, but several factors can increase the risk or severity of these injuries.

Cause	Description	At-risk Groups	Source(s)
Fall on outstretched hand	Most frequent scenario	Elderly, active adults	8
Osteoporosis	Weakened bones, increased risk	Postmenopausal women, elderly	8
High-energy trauma	Road accidents, sports injuries	Younger adults	8
Occupational hazard	Manual labor, repetitive use	Workers, athletes	8

Table 3: Common Causes

Typical Mechanism: Fall on Outstretched Hand

The classic scenario for a Colles fracture is a person falling onto an outstretched hand, with the wrist extended. The force drives the distal radius backward and upward, resulting in the typical deformity 8.

Role of Bone Health

Osteoporosis, a condition where bones become brittle and prone to fracture, significantly increases the risk of Colles fractures. This is especially true for postmenopausal women and elderly individuals, for whom even a minor fall can cause a break 8.

Other Causes

While falls are by far the most common cause, Colles fractures can also result from higher-energy trauma, such as car accidents or sporting injuries, particularly in younger individuals. Occupational hazards—such as repetitive manual labor or heavy lifting—can also contribute to risk over time 8.

Treatment of Colles Fracture

The management of Colles fractures has evolved with a better understanding of fracture mechanics, bone healing, and rehabilitation. Treatment aims to restore function, minimize pain and deformity, and prevent complications.

Treatment	Approach/Method	Suitability/Outcome	Source(s)
Closed reduction & casting	Manual realignment + plaster cast	Most extra-articular, stable cases	2 5 14 15
Functional bracing	Removable brace, allows early motion	Comparable outcomes, better grip	3 12 16
Surgical fixation	Pins, plates, or external fixation	Comminuted, unstable, intra-articular	13
Immobilization duration	3 vs 5 weeks (older, less severe fractures)	3 weeks sufficient for many cases	5
Immobilization position	Dorsiflexion, supination, pronation	Dorsiflexion: less redisplacement	3 12 14 15
Rehab/physio	Early mobilization, exercises	Reduces stiffness, speeds recovery	1 16
Correction of malunion	Osteotomy, nerve decompression	For severe, disabling deformity	6 9

Table 4: Treatment Options

Non-Surgical Management

Closed Reduction and Casting

For most extra-articular and stable Colles fractures, the standard treatment is closed reduction (manipulating the bone fragments back into alignment) followed by immobilization in a plaster cast. Recent studies suggest that three weeks of immobilization is often sufficient for less severe fractures in older patients, with no disadvantage compared to five weeks 5. The position of immobilization is important: casting the wrist in slight dorsiflexion (extension) reduces the risk of redisplacement and results in better early function compared to palmar flexion 14. Forearm rotation during immobilization is debated—some studies favor pronation to reduce redislocation, while others find that supination may yield better anatomic results for certain fracture types 3 12 15.

Functional Bracing

Removable functional braces are increasingly used. They allow early wrist motion and may improve grip strength in the early stages, with outcomes at least comparable to traditional casting 3 12 16.

Surgical Treatment

Severely displaced, comminuted, intra-articular, or unstable fractures often require surgical fixation. Techniques include percutaneous pinning, plate fixation, and external fixation. Skillful application of these methods, especially for comminuted fractures, can yield excellent anatomical and functional results, but the best outcomes are associated with precise reduction and stabilization 13.

Managing Complications and Malunion

Malunion—when the bone heals in a misaligned position—can cause chronic pain, weakness, and deformity. In severe cases, surgical correction (osteotomy) may be necessary, sometimes combined with procedures to decompress the median nerve or resect the ulnar head 6 9. Post-traumatic complications such as carpal tunnel syndrome, tendon injuries, and arthritis require specific management strategies 7 10.

Rehabilitation

Early mobilization and physiotherapy are critical to minimize stiffness, restore motion, and improve function. Functional bracing and allowing some wrist movement during immobilization can help reduce swelling and prevent joint stiffness 1 16.

Conclusion

Colles fractures, while common, have a wide range of symptoms, presentations, and outcomes. Key points include:

• Symptoms often go beyond pain and deformity, including long-term stiffness, weakness, and nerve complications.
• Types vary by involvement of the joint, displacement, comminution, and stability, and these factors strongly influence prognosis.
• Causes are most frequently falls on an outstretched hand, with osteoporosis being a major risk factor, particularly in the elderly.
• Treatment must be individualized: non-surgical options (casting, bracing) work for many, but unstable or complex fractures often need surgical intervention. Early mobilization and careful attention to reduction and immobilization position are critical for the best outcomes.

In summary:

• Pain, swelling, deformity, and functional loss are key symptoms, with persistent issues common 1 2 7.
• Extra-articular, intra-articular, comminuted, and unstable types affect management and prognosis 2 3 4 13.
• Falls and osteoporosis are leading causes 8.
• Proper reduction, immobilization (dorsiflexed position preferred), and early rehabilitation are essential. Surgery is reserved for difficult or unstable cases 3 5 13 14 16.

Understanding these aspects empowers patients and clinicians to make informed decisions for optimal recovery.