All fractures › Elbow, forearm & wrist

Distal radius fracture

AO/OTA 2R3A2

Extra-articular, dorsally tilted (Colles)

See it in 3D on the real bones, displace and reduce it, with simulated X-ray and CT — free, in your browser.

The most common fracture in adults. In a Colles fracture the distal fragment tilts and shifts dorsally and the radius shortens, giving the "dinner fork" deformity. Normal values: radial inclination about 22°, volar tilt about 11°, radial height about 11 mm, ulnar variance neutral.

Colles fracture, PA and lateral. Arrows: extra-articular distal radius fracture with dorsal displacement on the lateral view. — Lucien Monfils, CC BY-SA 3.0, via Wikimedia Commons.

Mechanism

Fall on the outstretched hand with the wrist extended (Colles, dorsal). Fall on the flexed wrist gives a Smith fracture (volar displacement).

Clinical findings

Dinner-fork deformity, swelling; check the median nerve (acute carpal tunnel syndrome) and the skin.
Look for associated scaphoid fracture and ulnar styloid fracture.

Imaging

PA and lateral of the wrist.
Measure radial inclination (~22°), radial height (~11 mm), volar tilt (~11°) and ulnar variance.
CT for intra-articular fractures (die-punch, volar rim) before surgery. Check the median nerve.

PA and lateral views; measure radial inclination, height, volar tilt, articular step and ulnar variance. CT for complex articular fractures.

Classification

2R3A: Extra-articular (A2 simple, A3 wedge/multifragmentary).
2R3B: Partial articular: radial styloid (chauffeur), volar Barton (B3), dorsal Barton (B2).
2R3C: Complete articular.
Eponyms: Colles (dorsal displacement), Smith (volar), Barton (rim fracture with carpal subluxation), chauffeur (radial styloid).

Types shown in 3D

Colles (2R3A2): Extra-articular, dorsal tilt and dorsal shift with radial shortening: "dinner fork".
Smith (2R3A2): Extra-articular with volar tilt and volar displacement ("reverse Colles"): unstable in a cast, usually plated.
Chauffeur (2R3B1): Radial styloid: partial articular; often part of a perilunate injury, so check the carpus. Screws or K-wires.
Dorsal Barton (2R3B2): Dorsal rim fracture with the carpus subluxed dorsally.
Volar Barton (2R3B3): Volar rim shear fracture with the carpus subluxed volarly: unstable, needs a volar buttress plate.
2R3C1: Complete articular, simple: the radial styloid and the lunate facet are split from each other and from the shaft. CT and anatomical reduction of the joint.

Treatment

Non-operative: Closed reduction under haematoma block and a well-moulded dorsal or sugar-tong splint, then cast for about 5–6 weeks. Acceptable after reduction (adults): dorsal tilt < 10°, radial shortening < 3 mm, articular step < 2 mm; more tolerance in elderly low-demand patients.
Operative: Unstable or unacceptable reduction, articular displacement, volar shear (Smith/Barton), open fractures: volar locking plate through the FCR (modified Henry) approach is the workhorse; K-wires, external fixation or dorsal / fragment-specific plates in selected cases.

Aftercare

Early finger motion; wrist motion after 1–2 weeks with stable plating.

Complications

Malunion (loss of tilt and height)
Median nerve compression, CRPS
EPL tendon rupture (also after undisplaced fractures)
Flexor tendon irritation by a plate placed beyond the watershed line