A very common wrist fracture. A Colles Fracture is a fracture of the radius bone of the forearm close to the wrist, resulting in an upward (posterior or dorsal) displacement of the radius and obvious deformity. Usually after a fall onto an outstretched hand. It’s not always easy to detect a fracture of the distal radius, as it can be deceivingly disguised. A clear sign of a complete colles wrist fracture is a step sign that’s as obvious as daylight on an X-ray, but may be hidden to an untrained eye. It’s a low energy impact fracture with a dorsally displaced segment, meaning backwards.

A colles fracture accompanies abnormally high pain for the seriousness of the fall. The pain perceived from a minor incident is out of proportion with the velocity and force of falling onto your hand. You might think, it’s nothing, yet, days later the pain doesn’t seem to ease up, in fact it just gets worse. Due to the nerve running very close through the wrist, angulation and displacement or shifting of the fractured pieces, stretches and pulls on the median nerve producing Carpal tunnel syndrome type symptoms, but much more intense. To distinguish between the two, pure Carpal tunnel evolves over time, and a Colles fracture starts after a specific accident or fall. A Colles fracture’s pain is constant, as the traction on the nerve is never relieved.

The biggest long term problem with treatment after a Colles fracture with or without surgery is wrist stiffness, it is the ultimate nemesis. Regaining full use of your hand is our target. The faster we intervene, the higher odds of success. We want to stop it, before it even happens.

A Broken wrist bone is usually undetected and stable, but in the long run, causes severe problems because of stiffness and the inability to bend or push on your wrist. broken wrist – especially a Colle’s fracture must heal in the correct position to prevent deformity and early aging of the joints, not to mention the complications that usually accompanies it.

The bone involved with a colles fracture is mainly the radius. The separation of the far-end part of the shaft of the radius. The radius connects to your wrist and is vital to provide a stable foundation to move your wrist and hand. There’s numerous ligaments that anchor your wrist, tendons runs across your wrist to move not only your wrist, but also your thumb and fingers. Nerves run in close proximity to the radius and relays messages to your hand. The median nerve is the dominant nerve at high risk of injury.

In all cases, bones are very resilient to forces, but they are not made to withstand angular impact. Falling onto an outstretched hand to break your fall creates the ideal circumstances for the radius to shatter. The slant of your wrist hitting the ground produces a tilt of the the radius bone, this angulation puts the bone at a disadvantage to absorb the force and snaps. In short, if the ideal force is applied to the radius at a an angle, it’s much more likely to break.

All Colles fractures are distal radius fractures, but not all distal radius fractures are Colles fractures. Only in a Colles fracture, the broken fragment moves backwards in relation to your wrist, combined with malalignment of the far-end of the radius. The classification of a Colles fracture is diverse depending on the severity and degree of separation based on the mechanism of injury, joint involvement and direction of displacement.

A Colles fracture can only be a Transverse fracture of the distal part of the radius, 2 – 2.5 cm from the proximal radiocarpal joint, with or without an Ulnar styloid process fracture, never intra-articular.

You may not always be sure if your wrist is broken. If it’s broken and you try to bend it, it will be painful, but you’ll still be able to move it. Don’t be fooled if you can still move your wrist, this does not mean the bone is not broken.

Try bending your wrist, if there is a very specific point that’s very tender or produce a sharp pain, it may be the site of a crack or break in the bone. Consider this: If you are not willing to pick up objects in anticipation of wrist pain, you may want to consider seeking medical attention, rather than hoping it’ll go away by itself.

In a non-displaced fracture, the bone cracks slightly or completely but doesn’t move. This is considered a more stable fracture and is not a true colles fracture, however all fractures must be treated with care to avoid abnormal healing. In a displaced fracture, the bone breaks into separate pieces that move and no longer line up and classifies as an unstable fracture. This means that there a high likelihood of that the bone doesn’t heal.

Sometimes multiple pieces breaks apart. Ulnar styloid fractures often accompanies a colles fracture.

Swelling is a major problem, because of the confined space, the bone is constantly dislodged. This puts excessive strain on the surrounding soft tissue including blood vessels that supply nutrients , nerves for feeling, tendons for movement, not to mention the ligament for stability. The combination of tug and crush on the median nerve is our biggest fear of nerve damage.

For every degree the radius shifts , the worse the chances are for recovery and longer recovery period. Surgery is decided by the degree of angulation and fracture size. There’s a direct connection between recovery time and how fast you receive treatment, so this is not an injury you can afford to wait. So get treatment.

We are experienced in testing the different types of problems that can cause your wrist pain, especially if you’re uncertain of your diagnosis. Rest assured, we know what to do. Our experts determines the extent of the tissue damage by categorizing the severity. Its vital we test the involvement of any nerve, ligament and muscles injury, apart from the obvious radius fracture.

When we suspect a colles fracture of the distal radius, we can refer you further investigation, the first on the list will be X-rays. The diagnosis is confirmed by x-rays, however movement test is crucial to establish stability and prognosis of recovery.

X-ray:

Its the best to show up a colles fracture. The broken pieces of your radius and degree of angulation is measured on the x-ray. No soft tissue (muscle, tendon or nerve injury) can be seen on X-rays, but is rather classified in our assessment.

MRI:

An MRI is completely unnecessary, as a colles fracture is quite obvious on x-rays. For an untrained eye, some clinicians refer for an MRI when they overly depend on scans. MRI is not recommended in a colles fracture.

Sonar (Diagnostic Ultrasound)

A sonar will be able to pickup bleeding or swelling around the bone itself and even ligament tears, but it wont show the fracture and more critical components that defines a true colles fracture. (Displacement and angulation)

A fracture of your radius normally heals in 8 weeks. If however the displaced bone is not re-aligned it can grow back in the wrong place or shape. Although the bone can grow back by itself, it is important to protect your radius using a splint or cast to ensure that it grows back in the correct position. Not getting the radius fragments aligned and reducing the angulation by using a special split hinders healing. This leads to a permanent deformity with continuous pain, discomfort and lack of movement and grip strength. Movement is much more impaired due to disruption of the bone stability that provides a stable foundation for forces to be transmitted across your wrist.

Neglecting to spot entrapment of the median nerve may causes pain to escalate and progressively reaps havoc further into your hand. Pins & Needles, numbness, weakness, burning pains are signs of this happening. Combined with constant swelling and bone oedema further slows callus formation.

Promptly getting it diagnosed and treated is the greatest impact you can make to ensure a successful recovery.

The most difficult component of recovery is regaining full and normal range of movement. This lack of mobility leads to severe stiffness in and around your wrist which alters your power transferred through your hand and forearm. It results in considerable loss of grip strength like opening a bottle, washing a glass, fastening a bra strap or even just wringing a cloth.

Chronic nerve pain can take much longer to restore, nerves tends to reap havoc long after the bone is healed. Unusual feelings like pins and needles, numbness, burning and cramps are signs to be weary of.

Waiting too long before you get treatment can limit the treatment options. The rate of recovery is directly linked to how well you are expected to recover, meaning the longer you wait – the poorer your prognosis.

We use the latest, proven research based protocols to test, diagnose and treat your wrist. Our treatment is tailored in stages and you’ll progress when you’ve achieve certain milestones. Our treatment of a Colles fracture also includes a wide range of techniques and machines that is best suited for your situation. The treatment program runs for 12 weeks, initially we’ll see you once a week for the first two months, thereafter follow up appointments are once every two weeks and a clearance examination is scheduled in the last month.

As part of your treatment you’ll receive a splint to guard the fracture from further separation. Movement based exercises progress from isometric contractions to grip strengthening, and wrist manipulations and ultimately pushing off of your wrist (pushup). We also use complimentary techniques like scar tissue mobilisation, cupping, laser and sensory reintegration training.

Surgery is a high possibility when dealing with a colles fracture. It is vital that you complete your after care program to ensure you have the best chances of recovery.

Fusion Phase: (Week 0 – 6)

• In this stage, your wrist is set in a cast, or splint, or you’ve just had surgery to fixate the bone fragments. In this phase the focus is on joining of the bones and ensure the correct position for good bone regrowth. We use a lot of different tools to control your swelling and pain while making sure your hand, fingers and thumb remains mobile and strong. You graduate from this phase when we’re able to remove the cast.

Motion Phase: (Week 4 – 10)

• We start with gentle range of motion exercises over your wrist to improve the movement while respecting your pain. Improving the strength and the function of your hand, forearm and fingers to guide you not to fear and avoid using your hand for too long – which causes its own set of problems.
• The stiffness that comes from not moving for an extended period of time limits the function of your hand. Our goal is to improve your range of motion as quickly as possible as it becomes more difficult to move the longer you wait.
• Continue to reduce swelling.
• Regain the normal movement pattern of your hand as component, and integrating it as part of your whole arm. The hand is only the last link in the entire chain of the upper limb. It is important to restore transfer of forces across your neck, shoulder, elbow and then down to the wrist and hand.
• Refine motor coordination.

Rehabilitation Phase: (Week 8 – 12)

• Regain full active and passive range of motion of all joints in your arm. You are only able to move through active range once you’ve achieved full passive range of motion.
• You must reach the normal grip power standard for your age. This confirms you’ll be able to do anything. It is also important to make sure that you have the necessary endurance in your hand to hold, carry and pull. When using our hands we need the initial power to grab an item or object but also the endurance of the muscles to be able to hold on for a while.
• Recover full fine motor coordination and control. At this time you should be back to writing, typing, using your phone and all other fine motor activities that require complex maneuvering.
• Pain free use of your hand and challenging it in more difficult tasks.

The recovery time for a Colles fracture is as short as 12 weeks or up to a year, depending upon multiple factors. The healing time greatly varies when there’s damage to the nerve, compromised blood supply, or injury to the cartilage inside the joint.

The likelihood of surgery for a Colles fracture is extremely high, because the bone fragments move. Surgery brings the two ends of the radius together to stabilise the broken area, so that it does not separate again. Surgeons use a plate and screws called an ORIF (open reduction and internal fixation). This is only the first step of the healing process. Remember that surgery is only the structural correction of the bone, all the surrounding muscles, tendons and ligaments must learn to adapt, retrained and strengthened in the after care and rehabilitation process. This is biggest and most important part of your recovery as it determines the success of your surgery.

• Distal radius fracture
• Wrist fracture
• Wrist fracture with dorsal angulation

Smith’s fracture (distal radius fracture with volar angulation)

• The broken fragments moves in a different direction.

Distal radius fracture without any angulation

• More stable fracture without separation and angulation of the bone fragments.

Ulnar fracture

• Fracture of the other forearm bone on the Pinky’s side of your wrist.

Scaphoid fracture

• There’s no visible shift or step in the wrist.

Wrist sprain

• Ligaments are injured, rather than bone breaking.