Colles Fracture

A broken wrist is a common injury. In fact, wrist fractures are the most common extremity fracture, accounting for more than 10% of all fractures of the arms or legs. About 3/4 of all forearm fractures occur on the end of the radius bone – this part of the bone is called the distal radius. One of the most common types of distal radius fractures is called a Colles fracture.

Illustration of an X-ray of a wrist fracture with an inset view of the fracture side-by-side / Getty Images

Colles Fracture Meaning 

The Colles fracture is a specific type of distal radius fracture. The reason it is called a Colles fracture is the surgeon who first described this injury pattern in the early 1800s. Dr. Abraham Colles was an Irish surgeon who described this injury and his name is still used today by many clinicians describing this injury pattern.

When a patient sustains a Colles' fracture, their wrist joint is pushed back behind the forearm bone (the radius). A Colles' fracture most commonly occurs after falling on to an outstretched hand. A true Colles fracture is known as an extra-articular fracture, meaning the break does not enter the cartilage portion of the wrist joint. Instead, the break is just above the level of the joint.

While the original description of a Colles fracture was a dorsally displaced, extra-articular distal radius fracture, often the name of a Colles fracture is loosely applied to just about any wrist fracture. You may have been told you have a Colles fracture when in actuality you have a slightly different fracture pattern than what Colles described 200 years ago. The good news is, whether or not you have a true Colles fracture or another type of wrist fracture, the general treatment principles are similar.

Not Every Distal Radius Fracture Is Colles

I often see patients and physicians alike referring to any distal radius fracture as a Colles fracture. This is not an accurate statement, as there are many variations to distal radius fractures (specific location, direction of displacement) and a Colles fracture is merely one of those.

In my experience, a true Colles fracture is actually a relatively unusual injury. Much more often I see fractures that are a result of poor bone density, and in these situations, the fracture often extends into the wrist joint cartilage, a problem called an intra-articular fracture. While the location of this fracture is near to a true Colles fracture, it is clearly not the injury that Colles described. So be forewarned, when you leave the hospital emergency department, and they tell you that it's a Colles fracture, it is possible the injury may be slightly different.

Treatment Options

Determining the proper treatment of a Colles fracture depends on a number of factors. Specifically, your surgeon will look for the alignment and the stability of the fracture. Bones that are poorly aligned or unstable are more likely to require surgical stabilization.

Often a Colles fracture can be reset without performing surgery; this is a procedure called a fracture reduction. During this procedure, either a local or general anesthesia is administered to the patient, and a clinician will re-position the bones and then apply a splint to hold the bones in proper position.

Depending on the degree of displacement of the forearm bone (radius) and the abnormality of the wrist angulation, a Colles' fracture may need surgery for treatment. When the injury is more significant it will likely require surgical treatment. During a surgical procedure, your surgeon may use pins, plates, and/or screws to secure the bones in a better position. While surgery does not make the break heal faster, it does hold the bones in proper position while they heal. Furthermore, because the bones are held securely with the metal implants, often patients don't require cast immobilization.

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.