Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an out stretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without involvement of the articular surface.
Although Colles fractures are seen in all age groups and demographics, they particularly common in osteoporotic individuals and as such are most frequently seen in elderly women. The relationship of Colles fractures to osteoporosis is strong enough that if an older male presents with this fracture, he should be investigated for osteoporosis, as he is at elevated risk of hip fractures 1.
Younger patients who sustain Colles fractures are usually involved in high impact / fall activity, e.g. contact sports, skiing, horse riding 1.
Most Colles fractures are secondary to a fall on an outstretched hand (FOOSH) with a pronated forearm in dorsiflexion (the position one adopts when trying to break a forward fall). It is the most common of the distal radial fracture.
The proximal row of the carpus (particularly the lunate and scaphoid) transfer energy to the distal radius, both in dorsal direction and along the long axis of the radius; thus the resultant fracture is dorsally angulated and impacted.
A number of classification systems exist for distal forearm fractures. One of the more popular is the Frykman classification system, although it fails to distinguish between Smith and Colles fractures as it is based on AP radiographs 2-3. As such in clinical practice use of the term Colles fracture with appropriate description of associated injuries is probably sufficient in most instances.
Plain films usually suffice, although if there is concern of intra-articular extension then CT may be beneficial.
AP and lateral wrist x-rays usually suffice. The fracture appears extra articular, and usually proximal to the radioulnar joint. Dorsal angulation of the distal fracture fragment is present to a variable degree (as opposed to volar angulation of a Smith fracture) as is impaction with resultant shortening of the radius. An associated ulnar styloid fracture is present in ~50% of cases.
In addition to noting the presence of a fracture a number of features should be sought and commented upon:
- degree of dorsal angulation
- degree of impaction
- degree and direction of displacement
- location of the medial fracture line: does it involve the radioulnar joint
- presence for intra-articular fractures
- other fractures
- ulnar styloid
- carpal bones
Treatment and prognosis
The vast majority of Colles fractures can be treated with closed reduction and cast immobilisation. The cast extends from below the elbow to the metacarpal heads and holds the wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australian rules football, this position is reminiscent of the the position adopted when holding a ball in preparation for a kick. This cast is known as a Colles cast 4.
Open reduction and internal fixation should be considered when the fracture is unstable, and/or un-satisfactory closed reduction is achieved (e.g. >10 degrees dorsal angulation; >5mm shortening; significant comminution) 1.
Complications include 1-3:
- mal-union resulting in dinner fork deformity
- median nerve palsy and post traumatic carpal tunnel syndrome
- reflex sympathetic dystrophy
- secondary osteoarthritis, more frequently seen in patients with intra-articular involvement
- EPL tendon tear
Originally named by Abraham Colles (1773 - 1843) Irish surgeon, Dublin.
Wrist and hand fractures
wrist and hand fractures
- distal radial fractures
- distal ulna fractures
fracture dislocations of the radius and ulna
- carpal fractures
- metacarpal & phalangeal fractures
- 1. Munk PL, Munk P, Ryan A. Teaching Atlas of Musculoskeletal Imaging. Thieme Medical Pub. (2007) ISBN:1588903729. Read it at Google Books - Find it at Amazon
- 2. Bohndorf K, Imhof H, Pope TL. Musculoskeletal Imaging, A Concise Multimodality Approach. George Thieme Verlag. (2001) ISBN:1588900606. Read it at Google Books - Find it at Amazon
- 3. Reiser M, Baur-Melnyk A. Musculoskeletal Imaging. TIS. (2008) ISBN:3131493410. Read it at Google Books - Find it at Amazon
- 4. Maheshwari J. Essential Orthopaedics. Jaypee Brothers Medical Pub. (2012) ISBN:8184655428. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
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