A Colles fracture is a break in the radius bone of your forearm, right near the wrist. Specifically, the broken end of the bone tilts upward (toward the back of the hand), creating a visible bump that makes the wrist look like the curve of a dinner fork viewed from the side. It’s one of the most common wrist fractures, typically happening when you catch yourself during a fall with your hand outstretched and palm down.
Where Exactly 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, roughly an inch from where the radius meets the wrist joint. When the bone breaks, the fragment closest to your hand shifts and angles dorsally, meaning it tips toward the back of your hand. That dorsal displacement is what defines a Colles fracture and distinguishes it from other wrist breaks.
The closely related Smith fracture is sometimes called a “reverse Colles.” In a Smith fracture, the bone fragment angles toward the palm instead of the back of the hand, usually because the fall happened with the hand in a different position. Both fractures involve the same part of the radius, but the direction the bone shifts determines which type you have and how it’s treated.
How It Happens
The classic scenario is a fall onto an outstretched hand, sometimes abbreviated FOOSH in medical shorthand. You’re falling, you instinctively throw your hands out to catch yourself, and the impact drives through your palm with your wrist bent back. That force travels up through the wrist joint and snaps the radius. The position of your hand at the moment of impact, with the palm facing down and the wrist extended, is what drives the bone fragment upward into that characteristic dorsal tilt.
This can happen to anyone at any age. A young person might get a Colles fracture from a bike crash, a sports collision, or a skateboarding fall. In older adults, it often takes much less force. A simple slip on an icy sidewalk or a stumble off a curb can be enough, particularly when bone density has decreased.
Who Is Most at Risk
Osteoporosis is the single biggest risk factor. Nearly 75% of hip, spine, and distal forearm fractures occur in people aged 65 and older, and postmenopausal women are disproportionately affected because of the accelerated bone loss that follows menopause. But here’s something worth noting: most of these fractures actually occur in people who haven’t been formally diagnosed with osteoporosis through a bone density scan. Their bones have weakened enough to break, even though they may not meet the clinical threshold for an osteoporosis diagnosis.
For men, a wrist fracture can be an early warning sign of broader skeletal fragility. In aging men, a wrist fracture actually carries a higher absolute risk of a future hip fracture than a spinal fracture does. In other words, if you’re a man over 50 and you break your wrist in a minor fall, it may be worth having your bone density checked.
For younger people, Colles fractures tend to result from higher-energy impacts: car accidents, contact sports, or falls from height. Children and teenagers can also sustain this type of fracture, though their growing bones sometimes break in slightly different patterns.
What It Looks and Feels Like
When the fracture is displaced (meaning the bone ends have shifted out of alignment), you’ll often see a visible deformity at the wrist. The back of the wrist bulges upward while a depression forms just above it, creating that dinner fork shape when viewed from the side. Swelling sets in quickly, and the area becomes extremely tender to touch. Most people can’t move the wrist at all without significant pain, and grip strength drops to near zero.
Not every Colles fracture looks dramatic. If the displacement is minimal, the wrist may just appear swollen and feel intensely sore, without an obvious deformity. Either way, an X-ray confirms the diagnosis.
How Doctors Assess the Break
X-rays from two angles are the standard first step. Doctors measure several things on the images: the angle of the bone’s tilt, how much the radius has shortened from being compressed, and whether the fracture extends into the wrist joint surface. A normal radius has about 12 degrees of forward (volar) tilt and a radial height of about 12 millimeters. When these measurements are significantly off after the bone is set back into position, or when the joint surface has a gap or step-off greater than about 1 millimeter, the fracture is considered unstable and harder to treat with a cast alone.
CT scans are sometimes ordered if the X-ray suggests the fracture reaches into the joint, since this level of detail helps surgeons plan their approach.
Treatment Without Surgery
If the bone fragments are well aligned or can be manipulated back into a good position (a process called closed reduction), a cast or splint is usually sufficient. The wrist is immobilized for roughly six weeks while the bone heals. During the first few days, a splint rather than a full cast may be used to allow room for swelling.
The key question with non-surgical treatment is whether the bone stays in place while it heals. Follow-up X-rays in the first couple of weeks check for any slippage. Acceptable alignment after reduction generally means the bone’s forward tilt is restored to at least neutral, radial height is within 2 to 3 millimeters of normal, and any joint surface irregularity is less than 1 millimeter.
When Surgery Is Needed
Surgery becomes the better option when the fracture is unstable or involves the joint surface. According to guidelines from the American Academy of Orthopaedic Surgeons, operative treatment leads to better outcomes in patients under 65 when certain thresholds are crossed after an initial attempt at reduction: more than 3 millimeters of radial shortening, more than 10 degrees of dorsal tilt, or more than 2 millimeters of displacement at the joint surface.
The most common surgical approach uses a metal plate and screws placed along the palm side of the wrist to hold the bone fragments in position while they heal. This type of fixation tends to allow earlier recovery of function in the first three months compared to other techniques, though long-term outcomes between different surgical methods are similar. For older patients, the calculus is different. In people over 65, non-surgical treatment often produces results comparable to surgery, even when alignment isn’t perfect on X-ray.
Recovery and Rehabilitation
Whether you had surgery or a cast, recovery follows a predictable timeline with distinct phases. In the first 10 to 14 days, the focus is on managing swelling and keeping everything else mobile. You’ll be encouraged to move your fingers, thumb, elbow, and shoulder regularly. The wrist itself stays completely immobilized, and you should not bear any weight through that arm.
Around the two-week mark (or once a surgical incision has healed enough), gentle wrist and forearm motion begins. This phase lasts through about week five. Expect some discomfort as you start moving the wrist. Mild pain during these exercises is normal and doesn’t mean you’re causing damage. The wrist will feel stiff, and regaining range of motion takes patience. Weight-bearing through the arm is still off limits.
From week six through week twelve, rehabilitation ramps up. This is when you can start gently putting weight through your hand, beginning with something as simple as pressing down on a tabletop or countertop. Over the following weeks, you’ll progress to wall push-ups, hands-and-knees positions, and eventually modified push-ups as tolerated. Strengthening exercises become more aggressive during this phase.
Full recovery typically takes three to six months, though some stiffness or aching with heavy use can linger longer. Most people regain functional use of their wrist well before that endpoint. The younger and more active you are, the more likely you are to push for full range of motion and strength. Older adults may find that a slight loss of wrist motion doesn’t meaningfully affect their daily life.
Possible Complications
The most common complication is stiffness, which is why early and consistent rehabilitation matters so much. Some people develop wrist arthritis months or years later, particularly if the fracture involved the joint surface. Malunion, where the bone heals in an imperfect position, can cause chronic pain or weakness and occasionally requires a second procedure to correct.
Swelling from the fracture can compress the median nerve as it passes through the carpal tunnel at the wrist, producing numbness and tingling in the thumb, index, and middle fingers. This usually resolves as swelling goes down, but persistent symptoms may need separate treatment. Tendon irritation from hardware (the plate and screws) is another possibility after surgery, sometimes prompting hardware removal once the bone has fully healed.