Colles’ Fracture | Diagnosis & Treatment

A Colles’ fracture is a distal radius fracture named after Abraham Colles, who first described it in 1814. The mechanism of injury is a Fall On the OutStretched Hand (FOOSH injury) and it is frequently seen in the emergency department. The fractured segment is extra-articular but dorsally angulated and displaced.

Epidemiology

Colles’ fractures occur in 2 groups of people generally. In the young active or athletic population, it is often associated with high-energy trauma. The elderly population most often contracts this type of fracture by a low-energy fall from standing height, in part by having osteoporosis. The incidence of Colles’ fractures is nearly 20% in people over the age of 65 years. In the young population, fractures most often occur in children around puberty, also because in this period, their bone mineralization is relatively low. The incidence rates are low in the age group of people from 19 years to 49 years old. In men, this risk rises only slightly over the years while the incidence in women rises dramatically. Note that the picture discusses distal radius fractures in general but is not limited to Colles’ fractures alone.

Clinical Picture & Examination

Signs and Symptoms

• Wrist pain and tenderness to palpation
• Dorsiflexion deformity or antalgic position. A “dinner fork deformity” may be visible
• Bruising and swelling of the wrist and hand
• Restriction of range of motion

Examination

When you suspect a wrist fracture, the Caradeniz wrist rule can be used to determine the need for radiographs. When you have a high likelihood of a fracture being present, you should refer your patient.

The examination will reveal movement and functional limitations in the active functional assessment and passive assessment. The strength of the wrist and hand may be impaired. The integrity of the neurovascular structures should be assessed by assessing the pulse, sensation, and motor function of the hand and wrist. Here the Allan test can be of value. Associated injuries can encompass intra-articular fractures, distal radio-ulnar joint injuries, radial styloid fractures, or injuries to the soft tissues (think of the TFCC, scapholunate, and lunotriquetral ligament injuries).

Treatment

Treatment usually follows a period of immobilization in a cast or brace following open or closed reduction and possible internal fixation. After this period of immobilization, progressive range of motion exercises, mobilizations, and strengthening exercises are advocated.

The Study for Osteoporotic Fractures found that women with wrist fractures were 50% more likely to experience clinically significant functional impairment compared to those without. The decline was characterized by a decreased capacity to make meals, do heavy housework, walk stairs, shop, and exit a car. As distal radius fractures can cause severe mortality and loss of independence in the elderly, functional training and strengthening exercises are necessary to minimize the impact on ADL activities.

Since osteoporosis is a major risk factor and Colles’ fractures are often seen as a precursor fracture for later major osteoporotic fractures, treatment should also target optimal bone health and fall prevention. Frail people may benefit most from multidisciplinary treatment. The Centers for Disease Control and the National Death Index reported considerably higher mortality rates in patients with distal radius fractures compared to a matched control group in the United States. The general practitioner should screen for the presence of osteopenia or osteoporosis and treat it accordingly. Dieticians can aid when malnutrition or inadequate diets are impacting bone health. Physiotherapists can help live a healthy active life and promote strength training to increase overall bone health.

Prognosis

Generally, the prognosis of Colles’ fractures is good, especially with appropriate treatment and rehabilitation. However, complications such as stiffness, loss of motion, or chronic pain can occur, particularly in older adults or those with severe fractures. The majority of the functional improvements are seen at 6 months. Between 6 months and 4 years, only minor improvements are observed, indication the importance of early functional rehabilitation. Be sure to read our research review about it!

CRPS can complicate the recovery process and is estimated to be present in 25 to 37 percent of patients after a distal radius fracture. The presence of CRPS also requires a more multimodal treatment approach.

Do you want to learn more about conditions of the wrist & hand? Then check out our other resources:

• Wrist & Elbow Injuries in Combat Sports with Ian Gatt
• Wrist & Elbow Injuries in Sports with Ian Gatt (Webinar)
• Carpal Tunnel Syndrome Guest Blog by Sian Smale

References

Baron JA, Karagas M, Barrett J, Kniffin W, Malenka D, Mayor M, Keller RB. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996 Nov;7(6):612-8. doi: 10.1097/00001648-199611000-00008. PMID: 8899387.

Porrino JA Jr, Maloney E, Scherer K, Mulcahy H, Ha AS, Allan C. Fracture of the distal radius: epidemiology and premanagement radiographic characterization. AJR Am J Roentgenol. 2014 Sep;203(3):551-9. doi: 10.2214/AJR.13.12140. PMID: 25148157.

Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord. 2007 May 31;8:48. doi: 10.1186/1471-2474-8-48. PMID: 17540030; PMCID: PMC1904215.

Edwards BJ, Song J, Dunlop DD, Fink HA, Cauley JA. Functional decline after incident wrist fractures–Study of Osteoporotic Fractures: prospective cohort study. BMJ. 2010 Jul 8;341:c3324. doi: 10.1136/bmj.c3324. PMID: 20616099; PMCID: PMC2900548.

Rozental TD, Branas CC, Bozentka DJ, Beredjiklian PK. Survival among elderly patients after fractures of the distal radius. J Hand Surg Am. 2002 Nov;27(6):948-52. doi: 10.1053/jhsu.2002.36995. PMID: 12457343.