A Colles fracture is a break in the radius bone of your forearm, right near the wrist, where the broken end shifts toward the back of your hand. It’s one of the most common fractures in adults, making up about 17.5% of all fractures seen in emergency departments. The injury almost always happens the same way: you fall and catch yourself with an outstretched hand, and the force travels through your wrist and snaps the bone.
Where Exactly the Bone Breaks
Your forearm has two bones running from your elbow to your wrist: the radius on the thumb side and the ulna on the pinky side. A Colles fracture occurs at the very end of the radius, within an inch or two of the wrist joint. What makes it a Colles fracture specifically is the direction the broken piece moves. The fragment tilts and shifts toward the back of your hand (the dorsal side). In many cases, the small bony bump at the end of the ulna fractures too.
This dorsal displacement is the key feature. A Smith fracture, sometimes called a “reverse Colles,” involves the same location but with the broken piece tilting toward the palm side instead. The distinction matters because the two injuries are treated differently.
How It Happens
The classic scenario is a fall onto an outstretched hand, sometimes abbreviated as FOOSH in medical settings. You trip, instinctively reach out to break your fall, and your palm hits the ground with your wrist bent back. That impact drives force through the wrist and into the end of the radius, snapping it and pushing the broken piece backward. The harder the impact, the more the bone fragments and displaces.
In younger adults, this usually requires significant force, like a cycling accident or a fall from a height. In older adults, especially those with weakened bones, a simple fall from standing height is enough.
Who Is Most at Risk
Osteoporosis is the biggest risk factor. Research has found osteoporosis in roughly 50% of women and 24% of men who sustain a Colles fracture. Postmenopausal women are disproportionately affected because bone density drops sharply after menopause. A Colles fracture in someone over 50 is often the first sign that their bones have weakened significantly, and it can be a warning of future fractures at the hip or spine.
Younger people get Colles fractures too, but it typically takes a much harder fall or a high-energy accident. Winter weather, icy sidewalks, and sports like skiing, skating, and skateboarding are common culprits across all age groups.
What It Looks and Feels Like
The most recognizable sign is a visible deformity at the wrist. Because the broken fragment shifts toward the back of the hand, the wrist develops a bump on top and a dip just above it, creating a profile that looks like the curve of a dinner fork viewed from the side. This is called a “dinner fork deformity,” and when it’s present, a fracture is almost certain even before an X-ray.
Not all Colles fractures look this dramatic, though. Milder breaks with less displacement may just cause intense pain, rapid swelling, and difficulty gripping or rotating the forearm. Bruising often appears within hours. You’ll typically feel sharp pain when you try to move your wrist in any direction, and the area will be very tender to the touch.
How It’s Treated
Treatment depends on how far the bone has shifted and whether the fracture extends into the wrist joint itself. For fractures that are minimally displaced or can be manually realigned, a cast or splint worn for about six weeks is the standard approach. Your doctor will take follow-up X-rays during those weeks to make sure the bone stays in position as it heals.
Fractures with significant displacement, multiple fragments, or joint involvement often need surgery. This typically involves a metal plate and screws placed along the bone to hold everything in alignment while it heals. Even after surgery, you’ll likely wear a splint for several weeks.
Regardless of treatment method, most Colles fractures take six to eight weeks for the bone to knit together enough for the cast or splint to come off. Full recovery, meaning a return to normal strength and range of motion, takes longer.
Rehabilitation After the Cast Comes Off
When your cast is removed, your wrist will be stiff, weak, and possibly still swollen. Weeks of immobilization cause the muscles to lose strength and the joint to lose flexibility, so rehabilitation is a critical part of getting back to normal. The main goals are reducing residual swelling, restoring range of motion, and rebuilding grip strength.
Exercises are typically done four to five times a day and focus on basic wrist and hand movements:
- Fist pumping: Clench and relax your fist repeatedly, ideally every hour, while raising and lowering your arm to help reduce swelling.
- Wrist bends: With your forearm resting on a table, bend your wrist up and down slowly.
- Side-to-side wrist movement: With your fingers straight, tilt your wrist toward your thumb, then toward your pinky.
- Forearm rotation: Alternate between turning your palm up and down while keeping your elbow still.
- Finger exercises: Touch each fingertip to your thumb, make fists, and hook your fingers to restore dexterity.
Everyday tasks double as therapy. Wringing out a dishcloth, unscrewing jar lids, and handwriting all challenge the wrist and hand in useful ways. Keeping your shoulder and elbow moving during recovery is also important, since stiffness can creep into those joints when you’ve been favoring the arm.
Possible Complications
Most Colles fractures heal well, but complications can occur. The median nerve, which runs through the wrist and provides sensation to the thumb and first few fingers, can be compressed by swelling or displaced bone fragments. This produces numbness, tingling, or weakness in the hand, similar to carpal tunnel syndrome. In most cases the compression resolves as swelling goes down, but persistent symptoms may need surgical release.
Tendon damage is less common but documented. The tendons that bend the thumb and index finger can rupture after a Colles fracture, sometimes weeks later during the immobilization period. Stiffness that doesn’t improve with rehabilitation, chronic pain, and early-onset arthritis in the wrist joint are other long-term concerns, particularly when the fracture extends into the joint surface.
For older adults, the fracture itself may heal fine, but the underlying bone weakness that allowed it to happen deserves attention. A bone density scan and a conversation about osteoporosis prevention can reduce the risk of more serious fractures down the road.