What Is a Colles Fracture? Symptoms, Causes, Diagnosis and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is a Colles fracture?
A Colles fracture is a displaced wrist fracture in which the broken radius bone tilts upward after a fall onto an outstretched hand [1] [2]. It is treated in the emergency department with realignment and a cast, or surgery if the bones are badly out of place [1] [2]. Most people return to normal activities, though complete healing may take a year [1].
Key takeaways
What it is: a broken wrist where the distal radius tilts upward (dorsal angulation) [2].
How it happens: most often a fall onto an outstretched hand [1] [2].
Who is most at risk: women over 60 with osteoporosis, plus athletes and accident victims of all ages.
Main symptoms: severe pain, swelling, bruising, an oddly angled wrist, and reduced motion [1] [2].
Treatment: emergency realignment (reduction) plus a cast, or surgery with plates, pins, screws, or an external fixator [1] [2].
Healing time: about 6 weeks in a cast; up to a year for the wrist to fully normalize [1].
What the research says
For a displaced wrist fracture that needed manipulation, a cast did as well as K-wire surgery at one year. In the DRAFFT2 trial of 500 adults with a dorsally displaced distal radius fracture (mean age 60; 83% women), people were randomized after manipulation to a moulded cast (255) or surgical fixation with K-wires plus a cast (245). At 12 months, Patient Rated Wrist Evaluation scores (0 = best, 100 = worst) were 21.2 in the cast group and 20.7 in the K-wire group (adjusted mean difference -0.34, 95% CI -4.33 to 3.66; P = 0.87). In the cast group, 33 people (13%) needed surgery in the first six weeks because the fracture lost position, compared with one revision operation in the K-wire group; 395 of 500 (79%) completed follow-up (Costa et al., BMJ, 2022 [3]).
A wrist fracture can be a warning sign for a later hip fracture in women. In a meta-analysis of 12 studies (4 in men only, 8 in women only), the relative risk of a hip fracture after a wrist fracture was 1.43 in women (95% CI 1.27-1.60). In men the increase was not statistically significant (RR 2.11, 95% CI 0.93-4.85) (Johnson et al., Injury, 2017 [4]).
Wrist protectors reduced wrist injuries in snowboarders. In a randomized trial of 5,029 snowboarders (2,515 in a braced group and 2,514 controls), 8 wrist injuries (a fracture or sprain with loss of range of motion and pain lasting at least 3 days) occurred in the braced group versus 29 in the control group, and no injuries were related to the brace. Beginners were the highest-risk group. The trial studied snowboarders only, so it does not show the same effect for other activities (Rønning et al., Am J Sports Med, 2001 [5]).
What Is a Colles Fracture?
A Colles fracture is a type of displaced broken wrist. In medical terms, it is called a distal fracture with dorsal angulation — meaning the break happens at the far end of the forearm bone, away from the center of the body, and the broken piece tilts upward [2].
It is one of the most common breaks that healthcare providers see [2]. The radius — one of the two bones in your forearm, and the one on the thumb side — is the most frequently broken bone in the arm [1].
Name breakdown: understanding the medical terms
Term | What it means |
Distal | Away from the center of the body — the end of the radius nearest the wrist |
Dorsal | Upward — the broken bone end tilts toward the back of the hand |
Displaced | The broken bone pieces have shifted out of their normal position |
Radius | The larger of the two forearm bones, running along the thumb side |
Reduction | The procedure of moving the broken bone pieces back into alignment |
The injury is named after Abraham Colles, the Irish surgeon who first described it in the early 1800s. It is a painful, serious injury that always needs professional treatment — there is no safe at-home fix.
Colles Fracture vs. Smith Fracture
These two common wrist fractures are mirror images of each other. The difference comes down to which way the broken bone tilts.
Feature | Colles fracture | Smith fracture |
Bone direction | Broken radius tilts upward (dorsal angulation) | Broken radius tilts toward the palm/front (volar angulation) |
Common nickname | Upward tilt | "Reverse Colles fracture" |
Typical cause | Fall onto an outstretched hand, palm down | Fall onto the back of the hand or wrist |
Knowing the difference matters because the realignment and casting techniques differ between the two.
Who Gets Colles Fractures?
People of all ages and genders can break a wrist this way, but one group stands out. Women over 60 with osteoporosis — a painless, often undiagnosed bone-weakening disease — are the most likely to sustain a Colles fracture. In fact, a wrist fracture can be the first obvious sign of undiagnosed osteoporosis, so anyone over 60 who breaks a wrist from a minor fall should ask their provider about bone density testing.
Beyond that, the injury is common in anyone who falls or experiences blunt-force trauma:
Risk group | Typical trigger |
Women 60+ with osteoporosis | Even a simple fall from standing height |
Skaters, skiers, snowboarders | Falling onto an outstretched hand on ice or snow |
Cyclists and horseback riders | Being thrown from a bike or animal |
Contact-sport athletes | Collisions and tumbles |
Drivers and passengers | High-force trauma from car crashes |
Wearing a wrist guard while skating or riding is a sensible precaution for anyone in the higher-risk activities.
Symptoms: How to Spot a Colles Fracture
A Colles fracture is not a subtle injury. The signs are usually obvious and immediate:
Symptom | What you will notice |
Severe pain | A great deal of pain at the wrist and lower forearm |
Odd angle | |
Swelling | Rapid swelling around the wrist [1] |
Bruising | Discoloration spreading across the wrist and forearm |
Reduced motion | Inability to rotate the wrist or move it through its normal range |
If your wrist looks bent after a fall, treat it as a fracture until a provider says otherwise.
Causes: How a Colles Fracture Happens
The classic mechanism is a fall onto an outstretched hand (sometimes called FOOSH) [1] [2]. As you fall, you instinctively reach out to catch yourself. Your body weight and momentum land on the small bones of the hand and wrist — especially the lunate and scaphoid — and that force travels up into the radius. The dorsal end of the radius snaps, typically about an inch away from the end of the bone, and the broken fragment tilts upward.
High-energy trauma such as a car accident can cause the same fracture even without a classic outstretched-hand fall [1].
A note on coping: physical trauma like a serious fracture can also trigger emotional stress. If you are struggling after an injury, it is worth seeking support.
Possible Complications
Left untreated, a Colles fracture cannot heal correctly. Even with proper treatment, several complications can occur along the way:
Complication | What it involves |
Wrist stiffness | The most common complication; usually improves within 1–2 months after cast removal |
Compartment syndrome | |
Malunion | The broken bones fail to fuse back together in proper alignment [2] |
Median nerve palsy | Hand muscles become paralyzed; you cannot flex your thumb or touch it to your fingers |
Carpal tunnel syndrome | |
Reflex sympathetic dystrophy | Burning pain that can affect the arms, legs, hands, and feet |
Secondary osteoarthritis | |
EPL tendon tear | The extensor pollicis longus tendon tears, so the thumb can no longer lift away from the palm |
Diagnosis: How Providers Confirm a Colles Fracture
A Colles fracture is treated as an emergency. You will typically be evaluated in an emergency department, where an X-ray of the wrist confirms which bones are broken and how far they have shifted [1].
Your provider will also ask focused questions to build a complete picture: Where is your pain? What does it feel like? How did you injure your wrist? What symptoms are you having? What medications do you take — and have you already taken any pain medicine?
Treatment: How a Colles Fracture Is Fixed
There is no at-home treatment for a Colles fracture. Every case requires a trip to the emergency department. The goals are always the same: move the bone back into place, then hold it still while it heals.
Treatment step | What happens |
Realignment (reduction) | |
Casting | A cast is applied starting below the elbow and extending to the middle of the fingers; it must be kept dry |
Surgery | |
Follow-up care | An orthopaedist — a specialist in bones, ligaments, joints, muscles, and tendons — monitors healing with repeat X-rays as needed |
Healing time and returning to activity
Healing varies by individual, and the wrist will not heal correctly without treatment. A broken Colles fracture left unaligned will set crookedly.
Managing pain at home
While recovering, these measures help keep pain under control. Prop your wrist on pillows so it rests above the level of your heart [1] — elevation reduces throbbing. Apply an ice pack with a cloth barrier between the ice and your skin to protect against cold injury. For medication, over-the-counter ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help, but discuss the right dosage with your provider first [1].
Rehabilitation
Physical therapy is the cornerstone of recovery after the cast comes off [1]. A therapist guides you through stretching exercises to restore range of motion and strengthening exercises to rebuild wrist power. Therapy also helps manage lingering pain and improves overall movement quality.
Outlook: What to Expect After Treatment
Most people return to their regular activities after a Colles fracture — but patience is required. Even with a smooth recovery, it can take up to a year for the wrist to feel completely normal [1]. Mild stiffness in the first two months after cast removal is common and usually fades with use and therapy.
It is also possible to break the same wrist again after another fall or trauma. Protecting the wrist in future high-risk situations is an important long-term habit.
Prevention: Reducing Your Risk of a Wrist Fracture
Falls are not always preventable, but you can meaningfully lower your risk of a Colles fracture:
Prevention step | Why it helps |
Wear a wrist guard when skating | Absorbs and spreads impact away from the radius |
Wear wrist armor when riding a motorcycle | Protects against high-force falls |
Avoid ladders and heights | Reduces exposure to falls from height |
Remove trip hazards at home | Clearing rugs and small furniture prevents the most common indoor falls |
Get tested for osteoporosis (especially women 60+) | Stronger bones resist breaking in the first place |
When to Call a Healthcare Provider
If your wrist is already in a cast, contact your provider promptly if you notice any of the following:
You cannot move your fingers
Pain becomes too severe
Your fingers or fingernails look discolored
You feel numbness or tingling in your fingers
Your finger range of motion gets worse
Also attend every scheduled follow-up for repeat X-rays — these check whether the bone is knitting back together correctly.
Questions to Ask Your Healthcare Provider
Taking a few prepared questions to your appointment helps you stay on top of your recovery:
How long do I need to wear a splint or cast?
Will I need more X-rays to monitor healing?
Do I need physical therapy?
What pain relief medications do you recommend?
When should I follow up with an orthopaedist?
Conclusion
A Colles fracture is one of the most common and most painful wrist injuries — a break near the end of the radius that tilts upward after a fall onto an outstretched hand. Women over 60 with osteoporosis are at highest risk, but the injury affects people of all ages in falls, sports, and accidents. It demands emergency care: realignment, a cast from below the elbow to the middle fingers, or surgery for badly displaced bones. With proper treatment, physical therapy, and patience, most people return to full activity, though the wrist may take up to a year to feel completely normal.
If you are working through a diagnosis or supporting someone who just broke their wrist, visual guides make recovery concepts far easier to grasp. Explore Rinnit's infographic templates to turn complex health information into clear, shareable visuals.
Frequently Asked Questions (FAQ)
What exactly is a Colles fracture?
A Colles fracture is a displaced break of the distal radius — the larger forearm bone on the thumb side — in which the broken end tilts upward (dorsal angulation). It usually occurs after a fall onto an outstretched hand.
What does a Colles fracture feel like?
It causes a great deal of pain, rapid swelling, bruising, and a wrist that may visibly hang at an odd angle. Moving or rotating the wrist is difficult and painful.
How do you know if you have a Colles fracture?
If your wrist is severely painful, swollen, bruised, and bent at an unusual angle after a fall, assume it may be a Colles fracture and go to the emergency department. An X-ray confirms the diagnosis.
Can a Colles fracture heal on its own?
No. A displaced Colles fracture needs professional realignment and immobilization. Left untreated, the bone will heal in a crooked position.
What is the difference between a Colles fracture and a Smith fracture?
A Colles fracture tilts upward (dorsal angulation), while a Smith fracture tilts toward the palm (volar angulation). A Smith fracture is sometimes called a reverse Colles fracture.
How do you get a Colles fracture?
Most often by falling and catching yourself with an outstretched hand. The force travels through the small wrist bones into the radius, snapping it about an inch from the end.
Who is most likely to get a Colles fracture?
Women over 60 with osteoporosis are the most common group, but skaters, skiers, cyclists, contact-sport athletes, and anyone in a car accident can sustain one at any age.
Is a Colles fracture an emergency?
Yes. It is a painful, serious injury that requires emergency department treatment for realignment and immobilization.
How is a Colles fracture treated?
Typically with a reduction (resetting the bone) followed by a cast from below the elbow to the middle of the fingers. If the bones are badly displaced, surgery with pins, plates, screws, or an external fixator is performed first.
Do you need surgery for a Colles fracture?
Only if the bones are too far out of place. Many Colles fractures heal well with realignment and casting alone.
How long do you wear a cast for a Colles fracture?
Typically about six weeks, though the exact duration depends on your individual healing.
How long does a Colles fracture take to heal completely?
The cast comes off around six weeks, but it may take up to a year for the wrist to feel completely back to normal.
When can you exercise after a Colles fracture?
Swimming and lower-body exercise are usually safe about one to two months after cast removal. Vigorous activities like football or skiing should wait three to six months.
Can you swim with a Colles fracture?
Not while the cast is on — casts must stay dry. Once cleared and the cast is off (usually one to two months after), swimming is typically fine.
What happens if a Colles fracture is left untreated?
The bone heals crookedly (malunion), which can cause chronic pain, deformity, reduced grip strength, and long-term complications such as secondary osteoarthritis or carpal tunnel syndrome.
What are the complications of a Colles fracture?
Wrist stiffness (most common), compartment syndrome, malunion, median nerve palsy, carpal tunnel syndrome, reflex sympathetic dystrophy, secondary osteoarthritis, and EPL tendon tears.
What is compartment syndrome after a Colles fracture?
A dangerous buildup of pressure in and around the forearm muscles after the injury or casting, causing severe pain. It requires urgent medical attention.
Why does my wrist look like a dinner fork after breaking it?
The classic "dinner fork" deformity comes from the broken radius tilting upward at the wrist — the signature shape of a Colles fracture.
What does dorsal angulation mean?
"Dorsal" means upward in this context. Dorsal angulation describes how the broken end of the radius tilts toward the back of the hand.
What does distal mean in "distal radius fracture"?
Distal means away from the center of the body — the end of the radius closest to the wrist.
Is a Colles fracture the same as a broken wrist?
It is one specific type of broken wrist — the most common distal radius fracture pattern. "Broken wrist" is the broader category.
How painful is a Colles fracture?
Very painful — providers describe a great deal of pain at the injury site, along with swelling and bruising.
Can a Colles fracture cause nerve damage?
Yes. Median nerve palsy and carpal tunnel syndrome are known complications when the shifted bone compresses nerves in the wrist.
What is median nerve palsy?
A complication where the median nerve is damaged, paralyzing hand muscles so you cannot flex your thumb or touch it to your fingers.
What is reflex sympathetic dystrophy?
A rare complication involving burning pain that can spread through the arms, legs, hands, and feet long after the injury.
Why do elderly women get more Colles fractures?
Osteoporosis weakens bones with age, especially in women after menopause. A fall from standing height — trivial for a younger person — can break an osteoporotic radius.
Should I get tested for osteoporosis after a Colles fracture?
If you are over 60, a wrist fracture can be the first sign of undiagnosed osteoporosis, so discuss bone density testing with your provider.
What are the lunate and scaphoid?
Small bones in the wrist that absorb the initial impact in a fall onto an outstretched hand, transferring force into the radius.
Can a Colles fracture happen in a car accident?
Yes. High-force trauma from car crashes can break the wrist even without a classic outstretched-hand fall.
What questions should I ask about my Colles fracture?
Ask how long you will wear a cast or splint, whether you need more X-rays, whether physical therapy is recommended, which pain medicines to take, and when to follow up with an orthopaedist.
What is an orthopaedist?
A doctor who specializes in the musculoskeletal system — bones, ligaments, joints, muscles, and tendons — and who monitors Colles fracture healing.
What is reduction in fracture treatment?
Reduction is the procedure of moving broken bone pieces back into their correct position before immobilizing them.
What is an external fixator?
A metal stabilizing frame worn outside the body that holds broken bones in alignment during healing, used in complex Colles fractures.
How long does surgery recovery take for a Colles fracture?
The timeline is similar: about six weeks of immobilization followed by months of rehabilitation, with full recovery possibly taking up to a year.
Can I drive with a cast for a Colles fracture?
Check with your provider. Driving with a dominant-hand cast is often unsafe until you can grip and react normally.
Should my Colles fracture cast stay dry?
Yes. Keeping the cast dry protects both the cast's integrity and your skin.
How do I reduce pain from a Colles fracture?
Elevate the wrist above heart level, ice with a cloth barrier over the skin, and use over-the-counter ibuprofen or acetaminophen as directed by your provider.
Why elevate a broken wrist?
Elevating the wrist above your heart reduces swelling and the throbbing pain that comes with it.
Can I ice a casted Colles fracture?
Yes — ice over the cast with a cloth barrier between the ice and your skin, and always check with your provider first.
What physical therapy is done after a Colles fracture?
Stretching exercises restore range of motion, and strengthening exercises rebuild wrist and grip strength during rehabilitation.
Is stiffness normal after a Colles fracture?
Yes — wrist stiffness is the most common complication, and it usually improves within one to two months after the cast is removed.
Can you break your wrist again after a Colles fracture?
Yes, another fall or trauma can re-break the wrist, so protective habits and osteoporosis management matter long-term.
How can I prevent a Colles fracture?
Wear wrist guards when skating, use wrist armor when riding motorcycles, avoid ladders and heights, remove trip hazards at home, and get osteoporosis screening if at risk.
Do wrist guards really help prevent Colles fractures?
They spread impact away from the radius during falls, making them a sensible precaution for skaters and riders.
What warning signs mean I should call my provider while in a cast?
Call if you cannot move your fingers, have severe pain, notice finger or nail discoloration, feel numbness or tingling, or if your finger motion worsens.
Can a Colles fracture cause arthritis?
Secondary osteoarthritis can develop in the deformed joint, causing pain and swelling long after the injury.
What is an EPL tendon tear?
The extensor pollicis longus tendon can tear after a Colles fracture, leaving the thumb unable to lift away from the palm.
Do children get Colles fractures?
Children can break their wrists in falls, though their fractures often involve the growth plate and are categorized differently.
Is a Colles fracture more common in men or women?
In the highest-risk group (over 60), it is far more common in women due to osteoporosis; among younger people, incidence is more balanced.
Can a Colles fracture affect my grip strength?
Temporarily, yes — after cast removal, grip strength is reduced until rehabilitation rebuilds it.
How many follow-up X-rays will I need?
Your orthopaedist will order repeat X-rays as necessary to monitor whether the bone is healing in the right position.
What is malunion?
Malunion means the broken bones failed to fuse together in proper alignment, potentially requiring further treatment.
Does a Colles fracture require pain medication after casting?
Over-the-counter ibuprofen or acetaminophen usually suffices, but confirm the right dosage with your provider.
When is a Colles fracture called a displaced fracture?
Whenever the broken bone pieces have shifted out of their normal anatomical position — which is the defining feature of a Colles fracture.
What is the outlook after a Colles fracture?
Most people return to regular activities, though the wrist may take up to a year to fully normalize. Stiffness in the first two months after cast removal is common and usually fades.
Related Reading
Casts for Broken Bones: Types, Care and Removal explains how casts protect healing bones and how to care for one.
Wrist X-Ray: Why It's Done, What It Shows and What to Expect explains the X-ray used first for wrist injuries and pain.
References
American Academy of Orthopaedic Surgeons. Distal Radius Fractures (Broken Wrist). OrthoInfo. Contributed and updated by Kocher S and Taylor E; peer-reviewed by Adams JE. Accessed October 15, 2026. https://www.orthoinfo.org/diseases--conditions/distal-radius-fractures-broken-wrist/
Summers K, Fowles SM. Colles' fracture. In: StatPearls. StatPearls Publishing; 2021. PMID: 31971712. https://www.ncbi.nlm.nih.gov/books/NBK553071/
Costa ML, Achten J, Ooms A, et al. Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. BMJ. 2022;376:e068041. PMID: 35045969. https://doi.org/10.1136/bmj-2021-068041
Johnson NA, Stirling ER, Divall P, et al. Risk of hip fracture following a wrist fracture: a meta-analysis. Injury. 2017;48(2):399-405. PMID: 27839795. https://doi.org/10.1016/j.injury.2016.11.002
Rønning R, Rønning I, Gerner T, et al. The efficacy of wrist protectors in preventing snowboarding injuries. Am J Sports Med. 2001;29(5):581-585. PMID: 11573916. https://doi.org/10.1177/03635465010290051001
Medical disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific condition and treatment.
Comments