Colles fracture

Alternative names

Wrist fracture, buckle fracture

Definition

A Colles fracture is a wrist fracture involving a break across the end of the radius bone. Colles fracture usually occurs when people try to break their fall using their hand. It can take an unusually long time to heal and is common in older people and children. 

Cause

This injury is usually the result of a person attempting to break their fall using the hands and arms. The impact of the hand on the ground together with the sudden weight of the body on the wrist causes the end of the radius and ulna (the two forearm bones) to buckle just above the wrist.

It is frequently associated with sports such as rollerblading, skateboarding, running or any activity in which the hands may be called upon to prevent a forward fall occurring at a relatively high speed.

Colles fractures may also occur in a motor accident or any other incident where there is a sufficiently strong force on the hand.

Who gets it and who is at risk?

The Colles fracture is a common fracture in children and the elderly. Anybody who often engages in sports where a fall may occur is at risk of enduring a Colles fracture.

Symptoms and signs

• History of a typical fall resulting in wrist injury
• Wrist pain
• Swelling just above the wrist
• Deformity of the arm just above the wrist (increased angulation)
• Inability to hold or lift object of any significant weight

Diagnosis

A medical history of a fall will ascertain whether there is a chance of a Colles fracture having occurred. X-rays are usually needed to show exactly what the problem is.

The fracture may appear on an X-ray as a mild increase in density on the topside of bone with a slight irregularity in the surface. Severe injuries will show evidence of a fracture through the entire bone, with deformity and displacement.

Prevention

Colles fractures can be prevented by:

• Careful supervision of child’s play when climbing, skating or biking.
• Using wrist guards when involved in skating or biking.
• Teaching children how to roll when falling.

Treatment

Treatment may range from simple immobilisation of the wrist with a splint and sling or a lightweight fibreglass cast to surgery.

If displacement of the fracture is significant, reduction may be necessary. The surgeon will pull the bone fragments into place using local or general anaesthesia. The arm will then be immobilised in a plaster cast.

If that is insufficient to repair the fracture, surgical intervention with internal fixation may be necessary. This may involve pins, screws and wires to hold the pieces in place in order to set the break. There are many different types of surgery. Treatment must be tailored to fit the break.

A physiotherapist may also be useful in supervising special exercises to improve the movement and strength of the wrist.

First aid when someone has just sustained a Colles fracture:

• Reassure the injured person
• Stabilise the fractured wrist by placing the arm close to the body. Secure the arm against the abdomen or chest. The arm can be secured with a shirt or jacket or by using towels or sheets to prevent movement of the bones.
• Use an ice pack over the wrist to help reduce swelling
• Transport to an emergency medical facility
• Do not attempt to move the wrist or hand
• A rolled up newspaper can serve as a temporary splint by strapping it to the forearm.

Outcome of a Colles fracture

Regardless of treatment, recovery takes a surprisingly long time (six to twelve months is typical). Wrist and finger stiffness is very common after this injury. On average, 75% of people have a satisfactory result following a Colles fracture.

Wrist arthritis may occur following a wrist fracture in some people. This can be the result of cartilage injury at the time of the break, or wear and tear from changes in the joint alignment after the bone is healed.

Carpal tunnel syndrome, causing numbness and tingling in the fingertips, may also develop when a wrist fracture narrows the path for the nerve and tendons in front of the bone.

A common development after a Colles fracture is a change in the contour of the back of the wrist due to the bone healing in a tipped-back position. This is referred to as a “dinner fork deformity”. This often looks worse than it feels. Older people with Colles fracture often fail to regain full mobility of the wrist joint.

When to call the doctor

Immediately after a fall where you think a fracture may have occurred.

Reviewed by Dr Sirk Loots, orthopaedic surgeon