Definition/Description

A Colles Fracture is a complete fracture of the radius bone of the forearm close to the wrist
resulting in an upward (posterior) displacement of the radius and obvious deformity. It is
commonly called a “broken wrist” in spite of the fact that the distal radius is the location of the
fracture, not the carpal bones of the wrist.[1]

The Colles fracture is named after Abraham Colles, an Irish surgeon, who first described it in
1814 by simply looking at the classical deformity before the advent of X-rays

The fracture originates from a fall on the outstretched hand and is usually associated with dorsal
and radial displacement of the distal fragment, and disturbance of the radial-ulnar articulation.
Possibly the ulnar styloid may be fractured. Communication of the distal fragment and fractures
into the joint surface is present in some of these fractures. The colles fracture is one of the most
common and challenging of the outpatient fractures[2]. Colles' fracture is defined as a linear
transverse fracture of the distal radius approximately 20-35 mm proximal to the articular surface
with dorsal angulation of the distal fragment[3]. The below brief video gives a summary of Colles
Fractures.

Colles Fracture
also raikar's fracture, is a fracture of the distal radius in the forearm with dorsal (posterior) and
radial displacement of the wrist and hand. This occurs as a result of a fall onto the outstretched
hand.
The fracture is sometimes referred to as a dinner fork or bayonet deformity due to the shape of
the
resultant forearm. Colles fractures are often seen in people with osteoporosis.

Dinner Fork Deformity

lateral view of wrist is similar to a fork, tines down
Minimally Displaced and Angulated
defined as less than 5 mm and less than 10°, respectively
Closed Reduction
is a procedure to set (reduce) a broken bone without surgery. This allows the bone to grow
back together. It works best when it is done as soon as possible after the bone breaks.

Characteristics/Clinical Presentation
The clinical presentation of Colles fracture is commonly described as a dinner fork deformity. A
distal fracture of the radius causes posterior displacement of the distal fragment, causing the
forearm to be angled posteriorly just proximal to the wrist. With the hand displaying its normal
forward arch, the patient’s forearm and hand resemble the curvature of a dinner fork.

 "Dinner Fork" Deformity

 History of fall on an outstretched hand
 Dorsal wrist pain
 Swelling of the wrist
 Increased angulation of the distal radius
 Inability to grasp object

Signs and Symptoms- Pain, numbness, tenderness, bruising, deformity of wrist.

Frykman Classification
Gosta Frykman identified many different forms of Colles fracture and classified it
into eight different types based on the extra- or intra-articular nature of fractures involving the
distal ends of the radius and ulna.

 Type I: transverse metaphyseal fracture

o includes both Colles and Smith fractures as angulation is not a feature
 Type II: type I + ulnar styloid fracture
 Type III: fracture involves the radiocarpal joint
o includes both Barton and reverse Barton fractures
o includes Chauffeur fractures
 Type IV: type III + ulnar styloid fracture
 Type V: transverse fracture involves distal radioulnar joint
 Type VI: type V + ulnar styloid fracture
 Type VII: comminuted fracture with the involvement of both the radiocarpal and
radioulnar joints
 Type VIII: type VII + ulnar styloid fracture

Although it appears complicated, there is only a four-type classification (odd-numbered types)

with each type having a subtype which includes ulnar styloid fracture (the even-numbered types)

Patients frequently heal well with no complications. If the displacement of the Colles fracture is
seen a few weeks after reduction, it's important to take and check radiographs a week-10 days
after injury. Possible complications may include:

 Malunion
 Persistent translation of the carpus
 Shortening of radius
 Stiffness of the wrist and the forearm

Few very rare complications are carpal tunnel syndrome, Sudeck's atrophy and ulnar and radial
compression neuropathy.

Differential Diagnosis/ Associated Injuries

 Scapholunate ligament tear
 Median nerve injury
 TFCC (triangular fibrocartilage complex) injury, up to 50% when ulnar styloid fx also
present
 Carpal ligament injury: Scapholunate Instability(most common), lunotriquetral ligament
 Tendon injury, attritional EPL rupture, usually treated with EIP tendon transfer
 Compartment syndrome
 Ulnar styloid fracture
 DRUJ (Distal Radial Ulnar Joint) Instability
 Galeazzi Fracture: highly associated with distal 1/3 radial shaft fractures
Suggested Guidelines for the Conservative and Non-
Conservative Management of a Colles Fracture
In a paper by Pho et al they suggested definitive guidelines for the management of conservative
and non-conservative treatment of a Colles fracture[40].

In the conservative management of Colles fractures they recommend dividing rehabilitation into
three stages, acute, sub-acute and settled. The acute stage (0-8 weeks) focuses on protection with
a short-arm cast, controlling pain and oedema and maintaining the range of the digits, elbow and
shoulder. Once the cast is removed, the sub-acute stage, the aim is to control pain and oedema
(TENS, ice), increase range of movement and increase activities of daily living (ADLs). In the
final, settled, stage the goal of rehabilitation is to regain full ROM, incorporate strengthening and
return to normal activity.[40]

Where conservative management is not an option they again suggest the same three stages as for
conservative management but the timescales differ. The acute stage begins in week 1 and ends at
week 6. During this stage, the aim of any intervention focuses on controlling pain and oedema
(TENS, ice), protection of the surgical site and maintaining ROM of the digits, elbow, shoulder.
The next, sub-acute, stage (7-10 weeks) emphasis is on protecting the fracture site, controlling
pain and oedema (TENS, ice) and the ROM of both the involved and uninvolved joints. [40] In the
final, settled, stage the goals are the same as conservative management, regain full ROM, begin
strengthening and increase tolerance of ADLs with the aim of returning to normal activity