A Colles' fracture is a break in the radius bone, one of the bones of the forearm near the wrist. The fracture usually occurs if you fall onto your outstretched hand. Upon landing on your hand, the end of your radius bone breaks off and gets pushed toward your inner wrist. If you fall on your hand and the wrist is in a flexed position, the radius may break and move toward the front of your wrist. This is called a Smith's fracture.
Common Signs of a Colles' Fracture
If you have suffered trauma to your wrist or have fallen onto your hand or wrist, you may have a Colles' fracture. Common signs and symptoms of a wrist fracture or Colles' fracture include:
- Swelling in the arm, wrist, or hand
- Loss of mobility in the wrist
- Visible deformity of a lump on the back side of your forearm near your wrist
Initial Treatment for a Colles' Fracture
If you have fallen and injured your wrist and hand and suspect you have suffered a Colles' fracture, you must seek medical attention right away. Immediately call your physician or report to your local emergency department. Failure to do so may result in serious complications and permanent loss of arm and hand function. Diagnosis of a wrist fracture is made be an x-ray picture.
Because of the pain and swelling that occurs with a fracture, you may wish to put ice on your wrist and hand until you get to your doctor or emergency room. The R.I.C.E. principle for acute injuries can help keep the swelling under control and the pain lessened until a medical professional can provide treatment.
The initial treatment for a Colles' fracture is to have the fracture reduced. This is where your doctor situates the broken bone or bones in the correct position so that appropriate healing can take place. This is done manually if the broken bone is not moved too far out of position. If the fracture is severe, a surgical procedure called an open reduction internal fixation (ORIF) may be necessary to reduce the fracture.
Once your wrist fracture has been reduced, it must be immobilized. This is done with a cast or a brace. You also may be required to wear your arm in a sling. You may need to visit a physical therapist to learn how to properly wear your sling. It is essential to keep the bones immobilized so that proper healing can take place. Be sure to speak with your doctor if you have any questions about your cast, sling, or brace.
Physical Therapy after a Colles' Fracture
After about four to six weeks of immobilization, your doctor may remove the cast and you may be referred to physical therapy. Some of the common impairments that your physical therapist may measure and evaluate include range of motion (ROM), strength, pain, and swelling. If you had an ORIF to reduce the fracture, your physical therapist may assess your surgical scar tissue. He or she may also analyze your hand, wrist, and arm function.
After your initial evaluation, your physical therapist will work with you to develop an appropriate plan of care to help improve the impairments and functional limitations that you may have. Be sure to ask any questions if you have any.
Range of motion. After a Colles' fracture, you may have lost a lot of mobility in the hand, wrist, and elbow. Your shoulder may also be tight, especially if you have been wearing a sling. Range of motion exercises for the hand, wrist and elbow may be prescribed, and you may have to perform ROM exercises at home.
Strength. Loss of strength is common after a Colles' fracture. Exercises that focus on hand, wrist and elbow strength may be prescribed. Again, you may be required to perform exercises at home to get the best results from physical therapy.
Pain and swelling. After a Colles' fracture, you may experience pain and swelling around your wrist and hand. Your physical therapist can provide you with various treatments and modalities to help decrease the swelling and pain.
Scar tissue. If you have had an ORIF procedure to reduce your Colles' fracture, there will likely be scar tissue that has developed around the surgical incision. Your physical therapist may perform scar tissue massage and mobilization to help improve the mobility of your scar. He or she can also teach you how to do it on yourself.
After a few weeks of physical therapy, you should notice that your mobility and strength are improving while your pain and swelling are decreasing. You may be finding it easier to use your arm and hand to perform functional activities. While the fracture should be fully healed six to eight weeks after injury, you may still be limited for up to 12 to 16 weeks. Be sure to work closely with your doctor and physical therapist to know what to expect.
A broken wrist or Colles' fracture can be a painful and scary experience. It may be difficult for you to use your hand and arm to perform basic functions like dressing, feeding yourself, or brushing your hair. You may be unable to perform your job or engage in recreational activities. Your physical therapist can help you improve your functional mobility to be sure you can quickly and safely return to normal activity.
Hertling. , & Kessler, R. (2005). Management of common musculoskeletal disorders:physical therapy perinciples and methods. (4 ed.) Lippincott Williams and Wilkins.