A Colles fracture is a break in the radius bone of the forearm, right near the wrist, where the broken end of the bone tilts upward toward the back of the hand. It’s one of the most common types of wrist fracture, and the classic sign is a visible deformity that makes the wrist look like the curve of a dinner fork when viewed from the side. The injury happens most often from falling onto an outstretched hand and is strongly linked to osteoporosis, especially in postmenopausal women.
Where the Break Happens
The radius is the larger of the two forearm bones, running from your elbow to the thumb side of your wrist. A Colles fracture occurs at the distal end, the part closest to your hand. What distinguishes it from other wrist fractures is the direction of displacement: the broken fragment angles upward (toward the back of the hand), a pattern doctors call dorsal angulation. Most Colles fractures don’t extend into the wrist joint itself, meaning the break stays in the shaft of bone just above the joint surface.
Normally, the end of the radius has a slight forward tilt of about 11 degrees. In a Colles fracture, that tilt reverses, pushing the broken piece backward. The bone’s normal sideways angle (about 23 degrees) can also flatten. These changes in alignment are what create the visible deformity and determine how the fracture needs to be treated.
Who Gets Colles Fractures
Two distinct groups are most affected. The first is older adults, particularly postmenopausal women with lower bone density. Epidemiological research shows a growing incidence of Colles fractures in elderly populations, driven by aging demographics and rising rates of osteoporosis. Studies of postmenopausal women who sustained Colles fractures found that those 65 and younger already had lower-than-expected bone density at the hip, suggesting a Colles fracture can be an early warning sign of systemic bone loss.
The second group is younger, active people who experience high-energy falls or impacts, such as from sports, cycling, or motor vehicle accidents. Risk factors beyond age include sex (women are affected more often), population density, climate (icy conditions increase falls), lower socioeconomic status, and poor bone healing capacity.
Symptoms and What It Looks Like
The pain is immediate and intense. Your wrist will swell quickly, and bruising often appears within hours. In a displaced fracture, the wrist takes on a stepped or angular appearance because the broken bone fragment has shifted out of its normal position. This “dinner fork” shape is sometimes obvious just by looking at the wrist from the side, though milder fractures may only show swelling without visible deformity.
You’ll have significant difficulty gripping or rotating your forearm. Numbness or tingling in your fingers, particularly the index and middle fingers, can signal pressure on the median nerve, the same nerve involved in carpal tunnel syndrome. If the tip of your second finger goes numb or you have trouble touching your thumb to your pinky finger, that nerve is likely involved.
How the Fracture Is Diagnosed
Standard X-rays from the front and side of the wrist are usually all that’s needed. Doctors look at three key measurements: the direction the bone fragment is tilting, how much the bone has shortened, and whether the fracture line extends into the joint surface. Specific features that signal an unstable fracture include backward tilting greater than 20 degrees, bone shortening greater than 5 millimeters, severe fragmentation at the break site, and involvement of the joint surface. A fracture of the ulna (the smaller forearm bone) alongside the radius also raises concern.
Treatment Without Surgery
Fractures that are minimally displaced and stable are treated with immobilization. Your wrist is placed in a splint (a partial cast that allows for swelling) in a neutral position. About one week later, once the initial swelling has gone down, the splint is typically replaced with a full circumferential cast. This staged approach prevents the cast from becoming too loose as swelling subsides or too tight if swelling increases in the first few days.
For fractures that are displaced but can be manually realigned, a procedure called closed reduction is performed, often with local anesthesia. The doctor manipulates the bone fragments back into position, then applies a splint or cast to hold them in place. Follow-up X-rays over the next few weeks confirm the bone stays aligned as it heals.
When Surgery Is Needed
The decision depends heavily on your age. For patients under 65, moderate evidence supports surgery when the bone has shortened more than 3 millimeters after realignment, when backward tilt exceeds 10 degrees, or when the joint surface is disrupted by more than 2 millimeters. These thresholds matter because younger patients need precise alignment for decades of use.
For patients 65 and older, the picture is different. Strong evidence shows that surgery does not lead to better long-term outcomes compared to non-surgical treatment in this age group. Older adults often do just as well with a cast, even if the bone heals in a slightly imperfect position. This doesn’t mean surgery is never appropriate for older patients, but the bar is higher.
When surgery is performed, several techniques exist, and research shows no significant difference in long-term results between them. However, one approach using a plate attached to the palm side of the wrist does lead to faster return of function in the first three months, which may matter for people who need to get back to work or daily activities quickly.
Recovery and Rehabilitation
After the cast comes off, your wrist will be stiff, weak, and possibly still swollen. New bone forms at the fracture site over 12 to 18 months, and you may notice a firm bump on the back or side of your wrist during this time. That’s normal remodeling.
Rehabilitation starts with gentle range-of-motion exercises performed four to five times a day. Early exercises focus on the fingers and hand: making a fist, hooking the fingers, and touching each fingertip to the thumb, all in sets of 10. Wrist exercises come next, including bending the wrist up and down with the forearm supported on a table, tilting the wrist side to side, and rotating the forearm to turn the palm up and down.
Strengthening follows once motion improves. This includes clasping the hands together and moving the wrists through their range, pressing the palms together and holding for five seconds, and gradually returning to gripping tasks. Mild discomfort during exercises is expected and acceptable as long as it settles down through the day. Heavy lifting, including pots, pans, and kettles, should be avoided early on because grip strength isn’t reliable enough and you risk dropping things.
Possible Complications
Most Colles fractures heal without major problems, but several complications are worth knowing about. Stiffness is the most common, particularly in the fingers if they weren’t kept moving during immobilization. Persistent pain, permanent mild deformity, and arthritis in the wrist joint can develop, especially when the fracture extended into the joint surface.
One well-known late complication is rupture of a thumb tendon called the extensor pollicis longus, which straightens the tip of the thumb. Counterintuitively, this happens more often after minimally displaced fractures than severely displaced ones. In one study, 5% of patients with nondisplaced fractures experienced this rupture, occurring on average about 6 to 7 weeks after the injury. The cause is likely a combination of the tendon rubbing against rough bone edges and disruption of its blood supply. If you suddenly can’t lift the tip of your thumb weeks after a wrist fracture, that tendon may have given way.
Complex regional pain syndrome, a condition involving persistent burning pain, swelling, and skin changes in the hand, is a rarer but more disabling possibility. Median nerve compression causing numbness and weakness in the hand can also persist if swelling or bone displacement isn’t adequately addressed.