The radius is the larger of the two bones in the forearm and the area closest to the wrist is the distal end. The radius is the most commonly broken bone in the arm.
A distal radius break is when the bone breaks about 1 inch from the wrist on the thumb side. A Colles fracture is a type of distal radius break and occurs when the broken piece of bone points upwards.
It was first described by the Irish surgeon and anatomist Abraham Colles in 1814 and named after him.
Causes and risk factors
Colles fracture describes a broken wrist. It is characterized by the bone pointing upwards, and being around 1 inch from the thumb.
Image credit: Ashish j29, 2010 October
Colles fractures are extremely common. In the United States, a Colles fracture is the term used for all distal radius fractures. Smith fractures, Chauffer's fractures, and Barton's fractures are types of distal radial fractures also.
A Colles fracture usually happens when someone falls on to an outstretched arm. It can also occur as a result of trauma, such as occurs in a car, bike, or skiing accident.
The age of the person can affect whether or not a Colles fracture occurs.
For example, high-intensity breaks caused by trauma are more common in 18 to 25 year-olds than older adults. On the other hand, breaks caused by tripping or falling occur in older adults, as their bones can be more brittle.
These types of breaks are also common in older women who have osteoporosis. This condition weakens the bones and often occurs in later life. A person may not even know they have weak bones until the break happens.
Cases of Colles fractures in people aged over 60 tend to happen when they have fallen from a standing position.
Those at risk of breaks, such as older people with osteoporosis or those who have problems with their balance, can wear wrist guards. However, while this can limit Colles fractures, it will not prevent them all.
Common symptoms of a Colles fracture include:
- the wrist hanging in a deformed way
Symptoms of a Colles fracture may include the wrist appearing deformed, and hanging in an unnatural position.
Image credit: Sylvain Letuffe, 2011 July.
A person should consult a doctor if the pain they experience in their arm is enough to stop them from using it in a normal way.
They should go to the emergency room immediately if they experience any of the following:
- the wrist is very painful
- the wrist appears deformed
- the wrist, hand, or fingers feel numb
- the fingers change color, especially pale or white
If the wrist is not especially painful and there is no deformity, then it may be possible to wait until the next day to see a doctor.
Putting an ice pack on the wrist and keeping it elevated is recommended until a doctor can examine it. Rings should be removed from the fingers before swelling develops.
The doctor will ask about the individual's recent history to see if any of the common causes of Colles fractures have occurred. They will then check for injuries to the surrounding nerves and blood vessels.
The most common technique for diagnosing broken bones is the X-ray. As well as showing if any bones are broken, an X-ray will show if any of the bones are out of place, and how many broken pieces there are.
A doctor who specializes in bones, known as an orthopedist, will usually conduct the treatment.
Treatment for a Colles fracture will aim to get all the broken bones back in the right places and to keep them there until they have healed. There are many different ways to achieve this. Three main factors will determine which method is used:
- the nature and extent of the injury
- the person's age
- their activity levels
If the bones are in a good position and there has been no displacement, a plaster cast or a splint is likely to be applied until the bones have healed.
A splint is more commonly used in older people and those who are not very active, and when the pain is minimal.
Younger and more active individuals are likely to have a cast. The cast usually stays on for about 6 weeks, and a doctor will monitor the healing process at regular intervals. The severity of the fracture will determine the time between examinations. X-rays may be used to evaluate the healing process.
If the bone is only slightly out of position, the doctor may perform a technique called closed reduction. This is when the bone is moved back into place without having to make an incision in the skin. A cast will then be placed on the arm.
To ensure the Colles fracture heals properly, an external fixator may be used to keep the bone in place.
Image credit: Ashish j29, 2010 September
If the bones are considerably displaced, or there are more than two fragments, the doctor may decide that a cast is not enough to correct the problem. When this happens, the person will need an operation.
Once in the operating room, a surgeon may then perform closed reduction. Alternatively, the surgeon may make an incision in the skin to align the bones. This process is known as open reduction.
There are several alternative methods for holding the bone in place while it heals:
- a cast
- metal pins, usually of stainless steel or titanium
- plates and screws
- an external fixator, such as a frame on the arm
- any combination of the above
Pain management and care
How much pain is experienced with a Colles fractures varies greatly and is hard to predict.
Pain is often moderate, and the doctor may advise using ice packs, elevating the arm, and taking non-prescription painkillers.
Ibuprofen and acetaminophen may be recommended to relieve pain and inflammation. More severe pain may require prescription medication, such as opioids.
If a cast is applied, it must be kept dry at all times, and it will be necessary to put a plastic cover over it when washing.
Recovery and outlook
Most people who have a Colles fracture will recover fully. However, there can be some long-term problems.
Some general guides for a full recovery include the following:
- A cast will be taken off after about 6 weeks, although it may be changed before if it is loose or damaged.
- Physical therapy, if required, will start a few days or weeks after the cast has come off, or after surgery.
- Light activity, such as swimming, can be undertaken after 1 to 2 months.
- Vigorous activity, such as skiing, can be resumed after 3 to 6 months.
- Nearly all people with a Colles fracture will experience stiffness in the wrist afterwards.
- A full recovery from this type of break can take up to a year.
Osteoporosis is a factor in many Colles fractures, so a person may also be tested for this condition, to enable treatment to begin and prevent further fractures.