June 15, 2021 5 min read
Answer a fun quick question about Colles Fracture, learn more about what defines this particular fracture and find some helpful tips on the best hand therapy treatment for Colles.
Answer: a) Dorsal
A Colles' fracture is "a linear transverse fracture of the distal radius approximately 20-35 mm proximal to the articular surface with dorsal angulation of the distal fragment".
This fracture was first described in 1814 by an Irish surgeon, Abraham Colles, simply by looking at the classical deformity (this was long before X-rays were invented!)
A Colles' fracture is usually the result of a "FOOSH" (fall onto outstretched hand) and typically the distal fragment is dorsally and radially displaced and the radial-ulnar articulation disturbed. Sometimes the fracture may be comminuted or intra-articular.
The reason the radius breaks where it does, is that distal metaphysis is relatively weak. This is because the bone cortex is thinner and there is more cancellous bone at the distal metaphysis than at the bone proximal and distal to this. This is especially true for clients with decreased bone density which is why Colles' fractures are commonly seen in older women.
It is still the most common fracture across all adult age groups and demographics. Typically if you have a younger client with a Colles' fracture, their mechanism of injury may have been high impact trauma such as a motor vehicle accident, contact sports, or a serious fall (e.g. when skiing or horse riding.) 
When deciding how to manage this fracture, the medical team will consider the fracture pattern (is it comminuted? intra-articular?), degree of displacement (will it result in pain? impaction? loss of ROM?), stability of the fracture (is it likely to change position / get worse before it heals?), as well as the age and physical demands of the client. . Closed reduction may be required if there is mild angulation and displacement. However, if there is more significant angulation and deformity, or it is unstable, an ORIF (open reduction internal fixation) may be indicated.
Usually, clients heal well with no complications. Unfortunately though, sometimes there may be complications such as malunion (healed in a poor position), persistent translation of the carpus (the entire carpus is displaced radially or ulnarward on the radio-ulnar surface), shortening of radius (often resulting in DRUJ issues and / or ulnar sided pain from positive ulna variance), stiffness of the wrist / forearm, or sometimes CRPS.
My professional favourites for wrist braces are:
These are excellent options to provide light support, compression and comfort. The client feels protected and supported, while the compression helps decrease swelling. Because of this, they are more likely to use their hand functionally, resulting in faster better outcomes.
For more support, if engaging in physically demanding tasks such as housework or gardening post cast removal, or during at-risk times (eg out at a party) they may prefer something a little more supportive, such as:
If they have latex allergy, I would recommend the Latex Free wrist supports (short or long). If they have ulnar sided wrist pain as the result of malunion, you should try the ulnar-carpal wrist support
If your client is very slight, or has small wrists, they may be better suited to our paediatric wrist splint range.
This blog is a discussion format. We have listed our views above but would love to know what you think, what your comments are or how you best treat Colles Fracture in your practice. Feel free to email us at email@example.com
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