Colles' fracture is a break across the end of the main bone of the forearm (the radius). A Colles' fracture results in a backward and outward position of the hand in relation to the forearm.

Wrist fractures are common among children and the elderly. Children's bones are soft and tend to get buckle (torus) fractures, which are incomplete fractures on one side of the bone. Because bones become brittle with age, fractures are common among the elderly.

Wrist fractures most often occur when a person falls forward and then attempts to break the fall by throwing the hands forward. The impact of the hand on the ground and the sudden uptake of body weight by the wrist cause the ends of the radius and/or the ulna (the bones in the forearm) to buckle just above the wrist.

In older people, particularly those with osteoporosis, the radius may fracture just above the wrist, resulting in a backward angle. This is called a Colles' fracture.

The fracture may appear on an x-ray as a mild increase in density on the top side of the bone with a slight irregularity in the surface rather than a nice smooth line. Severe injuries will show evidence of a fracture through the entire bone.

Treatment may range from simple immobilization with a splint and sling to a lightweight fiberglass cast. If cast immobilization is insufficient to repair the fracture, surgery may be necessary and the break may need to be fixed with a plate and screws, pins, or an external fixation device.

Older people with Colles' fractures often fail to regain full mobility of the wrist joint. Carpal tunnel syndrome may occur as an early or late complication of the injury. Chronic pain may result from injury to the ligaments or the joint surface of the wrist. In addition, in older patients, the fracture is usually related to osteoporosis, so treatment for osteoporosis is advised.

This injury is usually the result of trauma from a fall in which the person attempts to break the fall using the hands and arms. It is frequently associated with such sports as rollerblading, skateboarding, running, or any other activity in which the hands may be called upon to prevent a foreword fall occurring at relatively high speed.

• 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)
• Unable to hold or lift object of any significant weight

• Reassure the injured person.
• A fractured or dislocated hand, finger, or wrist should be placed and splinted in a normal resting position. Rest the fingers around a padded object such as a sock, wadded cloth, or rolled elastic bandage. If the hand or wrist is injured, place the object in the victim's palm, and use a circumferential wrap to maintain the position of the object. In order for the hand to maintain circulation, keep the fingertips uncovered. If the victim has a broken wrist, place a rigid splint on the underside of the wrist, hand, and forearm to restrict any motion. Broken fingers can be splinted independently or taped together with padding in between.
• Elevate the broken wrist, hand, or finger and place it in a sling.
• Use an ice pack over the wrist to help reduce swelling.
• Transport the victim to an emergency medical facility.
• DO NOT attempt to move the wrist or hand.

The hand or the wrist should not be moved.

• Exercise to slow or prevent problems with the muscles, joints, and bones.
• Eat a well-balanced diet with adequate amounts of calcium.
• Remove any obstacles that may cause a person to trip or fall (such as loose rugs).
• Install railings or use aids such as a cane or walker to help prevent falls.

Woolfrey KGH, Eisenhauer MA. Wrist and Forearm. In: Marx J, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa: Mosby Elsevier; 2006:chap 48.